That's rough for your friend. Agree with the take that some people just don't respond to these meds, I've read figures putting it as high as one in ten who just don't respond. Sounds like she's already run through a bunch of combos though. Has she specifically tried semaglutide? It's known for having the strongest appetite suppression of the main three. Had someone in my circle dealing with binge eating disorder, never got close enough to know the full outcome, but she got referred to a bariatric specialist for medication management of it. Can't say more since I don't actually know more, but might be worth her looking into that route. Really hope she finds something that works, and credit to her for getting this far without any medication help at all.