Q & A: Are Atypical Antipsychotics Helpful for Anorexia Nervosa?

Q: Some staff members in my facility are using low-dose atypical antipsychotics (Risperdal, Seroquel) to help manage the “delusional” thought processes that occur with anorexia nervosa. I am not particularly impressed with the results obtained from using these medications in this population of patients. Would you be so kind as to give me your opinion of this trend?

(J. Sommers, MD, Tulsa, OK)

A: Dear Dr. Sommers,

On the whole, there’s little indication for using atypical neuroleptics in the usual, run-of-the mill patient with anorexia nervosa. However, recently clinicians at the University of Pittsburgh published two cases of treatment-resistant patients with anorexia nervosa treated with atypical antipsychotics (Int J Eat Disord 2000;27:363). The clinicians were targeting impulsivity, lability, and paranoia, but not specifically the “delusional” ideas to which you refer. These patients benefited, and gained weight. Their weight gain was sustained, at least in the short term, while they stayed on the medication. The impact may be due to the known weight-gain side of olanzapine rather than to any specific effects on anorexia nervosa per se. These side effects were also noted years ago when patients with anorexia nervosa were treated with typical neuroleptics such as chlorpromazine (Thorazine). There, too, patients maintained their weight gain only as long as they remained on the medication. Of note, olanzapine (Zypyrexa) may be more prone to produce weight gain than either Risperdal or Seroquel. The authors suggest that more research on the utility of olanzapine is indicated.

— J.Y.