Night eating syndrome

Night eating syndrome or nocturnal eating syndrome, is a proposed eating disorder that is characterized by extremely elevated appetite (hyperphagia) in the evening and/or night eating and associated with insomnia and morning anorexia ¹, and awakening from sleep to eat ². Sufferers can be of normal weight or overweight. There is a high co-morbidity of depression with night eating syndrome ³. Night eating syndrome affects between 1 and 2% of the general population in the United States, which is similar to binge-eating disorder and higher than more traditionally recognized eating disorders, such as bulimia nervosa and anorexia nervosa ⁴. But research at the University of Pennsylvania School of Medicine suggests that about six percent of people who seek treatment for obesity have night eating syndrome ⁵.

Although not all persons with night eating syndrome are overweight or obese, the syndrome is more frequently found in obese populations ⁶. Another study suggests that more than a quarter (27%) of people who are overweight by at least 100 pounds have the problem. In a population-based twin study in Sweden, night eating syndrome was 2.5 times more prevalent in males with obesity and 2.8 times more prevalent in females with obesity as compared to non-obese men and women ⁷. In a 2003 review conducted by de Zwaan, Burgard, Schenck, and Mitchell ⁸, night eating syndrome prevalence was found to be between 6–64% among obese persons seeking weight loss surgery. Other studies have found up to 55% of individuals who seek bariatric surgery report some symptoms of night eating syndrome ⁹.

Night eating syndrome typically begins during early adulthood (late teens to late twenties) and appears to be long lasting with periods of remission and relapse, often tied to life stressors ¹⁰. In one age and gender population survey, similar proportions of males and females reported waking at night to eat ¹¹. However, in an interview-based study of night eating syndrome among Swedish Twin Registry participants, fewer men than women met full criteria for night eating syndrome, possibly due to low levels of distress associated with their night eating syndrome symptoms ¹². This may suggest that both men and women experience night eating syndrome symptoms equally, but women are more negatively affected. The prevalence of night eating syndrome and associated features in various racial groups is not well characterized, although a wide number of studies have included Caucasian, Hispanic, African-American and Pima Indian ethic and racial group ¹³.

Night eating syndrome is more common among people with insomnia, eating disorders, and other psychiatric disorders ¹³. Individuals diagnosed with night eating syndrome are more likely than those in the general population to have another eating disorder with prevalence estimates ranging from 5–44% ¹³. Approximately 15–20% of patients with night eating syndrome also have BED. Although there are some overlapping symptoms between Night eating syndrome and binge-eating disorder, it has been suggested that the disorders can be differentiated by the amount of food eaten per episode, as well as the motivation to eat (i.e., in night eating syndrome, the motive is to achieve sleep) and level of concern regarding shape and weight ¹⁴.

Night eating syndrome prevalence also increases with body mass index (BMI) in psychiatric populations. In a study conducted by Lundgren and colleagues ¹⁵, participants were recruited from psychiatric outpatient clinics. The night eating questionnaire ¹⁶ was used to screen broadly for morning anorexia, food cravings in the evening, number of awakenings, and nocturnal ingestions, followed by a clinical interview. The Night Eating Syndrome History and Inventory was subsequently used to diagnose night eating syndrome. The researchers found that 12.3% of the study population met criteria for night eating syndrome. In addition, those with night eating syndrome were more likely to have obesity.

Night eating syndrome can cause sleep disturbances, but sleep disturbances and insomnia may also precede night eating syndrome. Studies have found that patients with night eating syndrome have difficulties initiating and maintaining sleep ⁶. Agents of sleep disturbances in individuals with night eating syndrome may include nocturnal ingestions and insomnia. Although night eating syndrome is largely characterized by nocturnal ingestions, these episodes also occur in sleep related eating disorder. Sleep related eating disorder is characterized by recurrent episodes of involuntary eating and drinking during sleep. It is considered a parasomnia rather than an eating disorder ⁶. Night eating syndrome and sleep related eating disorder can be differentiated by a lower level of consciousness while eating, as well as the consumption of unusual subtances with sleep related eating disorder ¹⁷.

Night eating syndrome was first described in 1955 by Stunkard, Grace, and Wolff ¹⁸ among a group of individuals with obesity seeking weight loss treatment. They reported that those with the syndrome consumed a large majority of their caloric intake (25% or more) at a time when individuals without obesity would not be eating. In addition, the patients experienced insomnia and morning anorexia. Most of the patients with night-eating syndrome reported that they experienced symptoms during times of weight gain and life stress ¹⁸. Since this time, the definition of night eating syndrome has varied. For example, in later years, Stunkard’s definition was expanded to include nocturnal ingestions ¹⁹.

Night eating syndrome prevalence is similar for women and men and is more common in patients with insomnia, obesity, and other psychiatric disorders although most reports are not based on population-based prevalence data ²⁰. Proposed diagnostic criteria have been developed which require the presence of several of the features outlined below ¹. The core night eating syndrome criteria include having at least 25% of daily food consumption after the evening meal (evening hyperphagia) and/or the presence of waking in the night to eat (nocturnal eating) ¹. At least 3 of the 5 following criteria should also be present: lack of desire to eat breakfast (morning anorexia), depressed or worse mood in the evening, strong urge to eat between dinner and sleep onset (or during the night), a belief that one must eat in order to fall asleep, and/or sleep onset/maintenance insomnia (sleep problems) ¹. Finally, these symptoms should occur in the absence of the unconscious sleep-related eating disorder, i.e. awareness of eating behavior is present, and in the presence of personal distress and/or impairment associated with the night eating ¹.

Night eating syndrome is also characterized by at least three of the following symptoms ¹⁴:

1. Morning anorexia, the presence of a strong urge to eat between dinner and sleep and/or during the night,
2. Sleep onset and/or maintenance insomnia, frequently depressed mood or mood worsening in the evening, and
3. A belief that one cannot get back to sleep without eating.

Night-eating syndrome has not yet been formally defined as an eating disorder. Underlying causes are being identified, and treatment plans are still being developed. It seems likely that a combination of biological, genetic, and emotional factors contribute to night eating disorder. Stress appears to be a cause or trigger of night eating syndrome, and stress-reduction programs, including mental health therapy, seem to help.

Researchers are especially interested in the foods chosen by night eaters. The heavy preference for carbohydrates, which trigger the brain to produce so-called “feel-good” neurochemicals, suggests that night eating may be an unconscious attempt to self-medicate mood problems.

Treatments are available, including cognitive behavior therapy (CBT), progressive muscle relaxation, bright light, and pharmacotherapies (mainly SSRIs). Cognitive behavior therapy has shown efficacy in reducing night eating symptoms ²¹. At this time night eating syndrome appears to respond to treatment with the SSRI sertraline (a prescription medication). However, further research is needed to understand the cause of night eating syndrome and to test these treatments more rigorously and in larger samples.

If you are seeking help for night-eating syndrome, you would be wise to schedule a complete physical exam with your physician and also an evaluation with a counselor trained in the field of eating disorders. In addition, a dietitian can help develop meal plans that distribute intake more evenly throughout the day so that you are not so vulnerable to caloric loading in the evening.

Summary

Night eating syndrome is a disorder of a delayed pattern of eating that is associated with increased weight and metabolic dysfunction. Night eating syndrome is often associated with other forms of psychopathology, including mood, anxiety and insomnia.

Night eating syndrome cause

The cause of night eating syndrome is unknown, but research suggests links to genetics and neurobiological and psychological processes ²². In a study conducted by Lamerz and colleagues ²³, German children were more likely to report night eating if their mothers exhibited night eating behavior, as compared to children of mothers who did not engage in this behavior. Also, in a study comparing night eating in families with night eating syndrome to those without, the probability of an individual with night eating syndrome having a first degree relative with the disorder was greater than those in the control group, suggesting heritability ²⁴. In fact, among participants in the Swedish Twin Registry, found moderate heritability for night eating for both males and females ²⁵.

The literature suggests that night eating syndrome is exacerbated during times of major life stress. This finding has led researchers to examine the role of cortisol and other stress hormones in night eating. Cortisol is a hormone released by the adrenal cortex in response to stress that has been associated with overeating and weight gain ²⁶. In a study conducted by Birketvedt and colleagues ²⁷, 12 participants with night eating syndrome and 21 control participants were fed fixed meals at regular intervals over a 24 hour period with no food after 8:00 PM. Blood drawn every 2 hour over 24 hours showed that cortisol levels were highest from 8:00 AM until 2:00 AM in night eaters, as compared to individuals in the control group. This finding led researchers to hypothesize that night eating syndrome may be associated with a dysregulation of the hypothalamic–pituitary–adrenal axis, which controls the cortisol stress response ²⁸.

In 1955, Stunkard and colleagues ¹⁸ suggested that major life stress worsened symptoms of night eating and removing that person from a stressful environment would alleviate symptoms. More recent studies have found that stress, as well as psychiatric disorders, such as depression, are often associated with the initial onset of night eating and maintenance of the night eating disorder ²⁹. Additionally, researchers are now suggesting that emotions and cognitions may play a major role in the onset and maintenance of night eating syndrome. Nocturnal episodes may be maintained by possessing the belief that one cannot sleep without eating, as well as the desire to control the anxiety associated with that belief ³⁰.

Night eating syndrome symptoms

Night Eating syndrome is a unique disorder characterized by a delayed pattern of food intake in which recurrent episodes of of night-eating and/or excessive food consumption occur after the evening meal (evening hyperphagia) or eating after awakening from sleep (i.e., nocturnal ingestions) ³¹.

Night eating syndrome is also characterized by at least three of the following symptoms ¹⁴:

1. Morning anorexia, the presence of a strong urge to eat between dinner and sleep and/or during the night,
2. Sleep onset and/or maintenance insomnia, frequently depressed mood or mood worsening in the evening, and
3. A belief that one cannot get back to sleep without eating.

People who suffer from night eating syndrome generally:

• Has little or no appetite for breakfast. Delays first meal for several hours after waking up. Person feels tense, anxious, upset, or guilty while eating.
• Consume at least half their calories after dinner. Many sources would list this as after 9 or 10 pm; dessert is generally not included, if one is eaten. Late night binges almost always consist of carbohydrates: sugary and starch. However, this eating is typically spread over several hours, which is not consistent with a typical eating binge as seen in other eating disorders. Night-eating syndrome involves continual eating throughout evening hours.
• This eating produces guilt and shame, not enjoyment.
• This pattern has persisted for at least two months.
• Night eating syndrome is thought to be stress related and is often accompanied by depression. Especially at night the person may be moody, tense, anxious, nervous, agitated, etc.
• Has trouble falling asleep or staying asleep. Wakes frequently and then often eats.

To be considered a bona fide night eating disorder, this pattern should continue for two months or more.

Night eating syndrome appears to be associated with obesity. As mentioned earlier, previous studies suggest that night eating syndrome is more common among weight loss treatment seeking individuals ¹³. Night eating syndrome may also be associated with weight gain. Marshall and colleagues compared the characteristics of people with obesity and night eating syndrome and those of individuals without obesity or the disorder. Twenty-one patients with obesity were included in the study which included a clinical interview, while 80 patients completed the Night Eating Questionnaire (NEQ) on the Internet ³². The participants were separated into three groups: 40 participants with a BMI less than 25 kg/m² completing the Night Eating Questionnaire (NEQ) on the internet, 40 participants with a BMI greater than 30 kg/m² completing the Night Eating Questionnaire (NEQ) on the internet, and 21 participants with a BMI greater than 30 kg/m² who completed a clinical interview. The study found that there were remarkable similarities between the internet-based participants without obesity and those with obesity on their total and individual item Night Eating Questionnaire (NEQ) scores. The most important difference between the two groups was that the non-obese individuals with night eating syndrome were 8.9 years younger than the obese group, suggesting that night eating syndrome may contribute to the development of obesity ¹⁰. These results are also in line with the finding that night eating severity is correlated with a higher BMI in middle-aged, but not young adults ³³.

Other studies suggest that obesity and weight gain are not necessarily associated with night eating syndrome. In a cross-sectional observational study examining 266 participants with class II-III obesity either with or without night eating syndrome, the researchers found that night eating syndrome was non-significantly associated with higher BMI. There were also no differences in metabolic complications or psychological features, with the exception of depression ³⁴. However, given that all patients were obese, there could be a ceiling effect. In a nationally representative population study in Denmark, night eating syndrome, as indicated by endorsement of “getting up at night to eat”, was not associated with weight gain during the previous or following 5 years. However, women with obesity and night eating syndrome gained more weight than women with obesity but without the disorder, suggesting that getting up at night to eat may contribute to additional weight gain in individuals with obesity ¹¹.

Delays in usual daytime eating patterns increase the risk of metabolic syndrome ³⁵. Research suggests that night eating syndrome has a prevalence of 9.7% in those with diabetes, and those with symptoms of night eating have substandard metabolic control (elevated A1C) and two or more diabetes related complications ³⁶. In another study conducted by Hood and colleagues ³⁷, 194 participants with type 2 diabetes showed that 7% of the sample met criteria for night eating syndrome. Night eating was also correlated with poorer glycemic control, which could be a result of the food choices made by individuals with night eating, including high carbohydrate and high fat foods ³⁷.

Night eating syndrome diagnosis

In order to be diagnosed with night eating syndrome, individuals must be aware of and be able to recall the eating episodes. These symptoms must also cause significant distress and/or impairment in functioning and not be better explained by external factors or another disorder, such as a sleeping disorder or other disordered eating pattern ³⁸. Night eating syndrome is classified in the DSM 5 as an “other specified feeding or eating disorder” ³⁸.

Night eating syndrome treatment

Several treatment approaches have been tested for night eating syndrome. Psychotherapy has shown efficacy in reducing night eating symptoms. Allison and colleagues ²¹ developed a cognitive behavior therapy (CBT) approach that was administered in a pilot study to 25 patients over 12 weeks. The intervention included building rapport, providing education about CBT, self-monitoring of sleep and eating disturbances and negative thoughts, regulation of eating and sleep patterns, development of coping skills, and, for those with overweight or obesity, behavioral weight management. At the conclusion of the study, the participants showed significant reductions in caloric intake in the evening (after dinner), nocturnal ingestions and awakenings at night and improvements in mood and quality of life. They also lost a modest but statistically significant amount of weight (3.1 kg) ²¹.

Pharmacological treatments have also been examined, as night eating syndrome research has suggested that the serotonin system plays a role in regulating eating, sleep, and mood, all components of night eating syndrome. The hypothesized decrease in serotonin availability in night eating syndrome would lead to disturbances in circadian rhythms and a decrease in satiety, thereby increasing risk of evening hyperphagia and nocturnal ingestions ³⁹. Therefore, increasing postsynaptic serotonergic activity by blocking the serotonin reuptake transporter by use of SSRIs may be effective in treatment night eating syndrome. The first clinical trial examining the efficacy of pharmacotherapy was a 12-week, open label study of 17 participants treated with the SSRI sertraline ⁴⁰. Two additional trials with sertraline followed, including an randomized control trial. The three studies showed significant reductions in awakenings, nocturnal ingestions, and caloric intake after the evening meal ⁴¹, including a response rate of 67% and a remission rate of 29% with sertraline ⁴⁰. Those who achieved remission also lost a significant amount of weight (−4.8 kg). In the randomized control trial, those with overweight and obesity lost an average of −2.9 kg compared to those receiving the placebo ³⁷. The researchers noted that the effects on night eating syndrome were independent of its antidepressant effects, with no significant correlation found between night eating syndrome symptoms and mood changes  ⁴⁰. Escitalopram has also been tested with reductions in the core night eating syndrome symptoms, number of nocturnal ingestions and percent of energy intake consumed after dinner, in an open label trial ⁴². However, no significant differences in symptom reduction were found when escitalopram was compared to a placebo in an randomized control trial⁴³.

Progressive muscle relaxation has also been studied in an effort to find alternative treatments for night eating syndrome. Progressive muscle relaxation has been shown to reduce stress, which is often associated with night eating syndrome. In a recent study, Vander Wal and colleagues ⁴⁴ randomized 44 men and women to one of three groups: education, education plus progressive muscle relaxation, or progressive muscle relaxation plus exercise. The three groups reported reduction in night eating syndrome symptoms, as well as symptoms of depression, anxiety, and perceived stress. The only significant difference between groups was the percentage of food eaten after the evening meal, with the progressive muscle relaxation group showing the greatest reduction, followed by the progressive muscle relaxation plus exercise group and the educational group, respectively ⁴⁴.

Phototherapy or bright light therapy, another alternative treatment for night eating syndrome, has been studied to examine its possible efficacy in treatment of symptoms. Phototherapy has been shown to increase the availability of postsynaptic serotonin ⁴⁵. In two case studies, bright light therapy was used to treat both seasonal depression and symptoms of night eating syndrome. In a study conducted by Friedman and colleagues ⁴⁶, a 51-year-old woman diagnosed with night eating syndrome and comorbid depression was treated with paroxetine; light therapy was added. After 14 daily sessions of white light for 30 min, the patient no longer met the DSM-IV criteria for depression or the core symptoms of night eating syndrome. However, once the light treatment was discontinued, her symptoms of night eating syndrome returned, although her depression remained in remission. After being treated for another 12 days with light therapy, her night eating symptoms remitted once more ⁴⁶. Additionally, in a pilot study conducted on the effects of bright light therapy among 15 individuals with night eating syndrome, significant reductions were found in night eating syndrome symptoms and mood and sleep disturbances post treatment ⁴⁷.

References

1. Allison KC, Lundgren JD, O’Reardon JP, Geliebter A, Gluck ME, Vinai P, et al. Proposed diagnostic criteria for night eating syndrome. Int J Eat Disord. 2010;43:241–7. https://doi.org/10.1002/eat.20693
2. Birketvedt GS, Florholmen J, Sundsfjord J, Dinges D, Bilker W, Stunkard A. Behavioral and neuroendocrine characteristics of the night-eating syndrome. JAMA. 1999;282:657–63. https://doi.org/10.1001/jama.282.7.657
3. Night Eating Syndrome (NES). http://glossary.feast-ed.org/types-of-eating-disorders-and-disordered-eating/night-eating-syndrome-nes
4. de Zwaan M, Muller A, Allison KC, et al. Prevalence and correlates of night eating in the German general population. PLoS ONE. 2014;9:e97667
5. Night Eating Syndrome. https://www.anred.com/nes.html
6. Kucukgoncu S, Midura M, Tek C. Optimal management of night eating syndrome: challenges and solutions. Neuropsychiatric Dis Treat. 2015;11:751–760.
7. Tholin S, Lindroos A, Tynelius P, et al. Prevalence of night eating in obese and nonobese twins. Obesity. 2009;17:1050–1055.
8. de Zwaan M, Burgard MA, Schenck CH, et al. Nighttime eating: a review of the literature. Eur Eat Disord Rev. 2003;11:7–24.
9. Gallant AR, Lundgren J, Drapeau V. The night-eating syndrome and obesity. Obes Rev. 2012;13:528–536.
10. Marshall HM, Allison KC, O’Reardon JP, et al. Night eating syndrome among nonobese persons. Int J Eat Disord. 2004;35:217–222.
11. Anderson GS, Stunkard AJ, Sorensen TIA, et al. Night eating and weight change in middle-aged men and women. Int J Obes. 2004;28:1338–1343.
12. Allison KC, Lundgren JD, Stunkard AJ, et al. Validation of screening questions and symptom coherence of night eating in the Swedish Twin Registry. Compr Psychiatry. 2014;55:579–587.
13. Vander Wal JS. Night eating syndrome: A critical review of the literature. Clin Psychol Rev. 2012;32:49–59.
14. de Zwaan M, Marschollek M, Allison KC. The night eating syndrome (NES) in bariatric surgery patients. Eur Eat Disord Rev. 2015;23:426–434.
15. Lundgren JD, Allison KC, Crow S, et al. Prevalence of the night eating syndrome in a psychiatric population. Am J Psychiatry. 2006;163:156–158.
16. Allison KC, Lundgren JD, O’Reardon JP, et al. The Night Eating Questionnaire (NEQ): psychometric properties of a measure of severity of the night eating syndrome. Eat Behav. 2008;9:62–72.
17. Howell MJ, Schenck CH, Crow SJ. A review of nighttime eating disorders. Sleep Med Rev. 2009;13:23–24.
18. Stunkard AJ, Grace WJ, Wolff HG. The night-eating syndrome: a pattern of food intake among certain obese patients. Am J Med. 1955;19:78–86.
19. Allison KC, Lundgren JD, O’reardon JP, et al. Proposed diagnostic criteria for night eating syndrome. Int J Eat Disord. 2010;43:241–247.
20. Vander Wal JS. Night eating syndrome: a critical review of the literature. Clin Psychol Rev. 2012;32:49–59. https://doi.org/10.1016/j.cpr.2011.11.001
21. Allison KC, Lundgren JD, Moore RH, et al. Cognitive behavior therapy for night eating syndrome: a pilot study. Am J Psychother. 2010;64:91–106.
22. McCuen-Wurst C, Ruggieri M, Allison KC. Disordered eating and obesity: associations between binge-eating disorder, night-eating syndrome, and weight-related comorbidities. Ann N Y Acad Sci. 2018;1411(1):96–105. doi:10.1111/nyas.13467 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5788730
23. Lamerz A, Kuepper‐Nybelen J, Bruning N, et al. Prevalence of obesity, binge eating, and night eating in a cross‐sectional field survey of 6‐year‐old children and their parents in a German urban population. J Child Psychol Psychiatry. 2005;46:385–393.
24. Lundgren JD, Allison KC, Stunkard AJ. Familial aggregation in the night eating syndrome. Int J Eat Disord. 2006;39:516–518.
25. Root TL, Thornton LM, Lindroos AK, et al. Shared and unique genetic and environmental influences on binge eating and night eating: a Swedish twin study. Eat Behav. 2010;11(2):92–98. doi:10.1016/j.eatbeh.2009.10.004 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2830904
26. Epel E, Lapidus R, McEwen B, et al. Stress may add bite to appetite in women: A laboratory study of stress-induced cortisol and eating behavior. Psychoneuroendocrin. 2001;26:37–49.
27. Birketvedt GS, Florholmen J, Sundsfjord J, et al. Behavioral and neuroendocrine characteristics of the night-eating syndrome. JAMA. 1999;282:657–663.
28. Ungredda T, Gluck ME, Geliebter A. Pathophysiological and neuroendocrine aspects of night eating syndrome. In: Lundgren JD, Allison KC, Stunkard AJ, editors. Night Eating Syndrome: Research, Assessment, and Treatment. New York: Guilford; 2012. pp. 197–217.
29. Marchesini G, Calugi S, Marzocchi R, et al. Night eating syndrome in obesity. In: Preedy VR, Patel VB, Le L-A, editors. Handbook of Nutrition, Diet and Sleep. The Netherlands: Wageningen Academic Publishers; 2013. pp. 104–120.
30. Sassaroli S, Ruggiero GM, Vinai P, et al. Daily and nightly anxiety among patients affected by night eating syndrome and binge eating disorder. Eat Disord. 2009;17:140–145.
31. Kucukgoncu S, Midura M, Tek C. Optimal management of night eating syndrome: challenges and solutions. Neuropsychiatr Dis Treat. 2015;11:751–760. Published 2015 Mar 19. doi:10.2147/NDT.S70312 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4371896
32. Napolitano MA, Head S, Babyak MA, et al. Binge eating disorder and night eating syndrome: psychological and behavioral characteristics. Int J Eat Disord. 2001;30:193–203.
33. Meule A, Allison KC, Brahler E, et al. The association between night eating and body mass depends on age. Eat Behav. 2014;15:683–685.
34. Calugi S, Dalle Grave R, Marchesini G. Night eating syndrome in class II-III obesity: metabolic and psychopathological features. Int J Obes. 2009;33:899–904.
35. Canuto R, Garcez AS, Olinto MT. Metabolic syndrome and shift work: a systematic review. Sleep Med Rev. 2013;17:425–431.
36. Morse SA, Ciechanowski PS, Katon WJ, et al. Isn’t this just bedtime snacking? The potential adverse effects of night-eating symptoms on treatment adherence and outcomes in patients with diabetes. Diab Care. 2006;29:1800–1804.
37. Hood MM, Reutrakul S, Crowley SJ. Night eating in patients with type 2 diabetes. Associations with glycemic control, eating patterns, sleep, and mood. Appetite. 2014;79:91–96.
38. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th. Washington, DC: 2013. DSM-5.
39. Stunkard AJ, Allison KC, Lundgren JD, et al. A biobehavioural model of the night eating syndrome. Obes Rev. 2009;10(Suppl. 2):69–77.
40. O’Reardon JP, Stunkard AJ, Allison KC. Clinical trial of sertraline in the treatment of night eating syndrome. Int J Eat Disord. 2004;35:16–26.
41. Stunkard AJ, Allison KC, Lundgren JD, et al. A paradigm for facilitating pharmacotherapy at a distance: sertraline treatment of the night eating syndrome. J Clin Psychiatry. 2006;67:1568–1572.
42. Allison KC, Studt SK, Berkowitz RI, et al. An open-label efficacy trial of escitalopram for night eating syndrome. Eat Behav. 2013;14:199–203.
43. Vander Wal JS, Gang CH, Griffing GT, et al. Escitalopram for treatment of night eating syndrome: a 12-week, randomized, placebo-controlled trial. J Clin Psychopharm. 2012;32:341–345.
44. Vander Wal JS, Maraldo TM, Vercellone AC, et al. Education, progressive muscle relaxation therapy, and exercise for the treatment of night eating syndrome. a pilot study. Appetite. 2015;89:136–144.
45. Krysta K, Krzystanek M, Janas-Kozik M, et al. Bright light therapy in the treatment of childhood and adolescence depression, antepartum depression, and eating disorders. J Neur Transm. 2012;119:1167–1172.
46. Friedman S, Even C, Dardennes R, et al. Light therapy, obesity, and night-eating syndrome. Am J Psychiatry. 2002;159:875–876.
47. McCune AM, Lundgren JD. Bright light therapy for the treatment of night eating syndrome: A pilot study. Psychiatry Res. 2015;229:577–579.