Q & A: New Antipsychotics for Anorexia Nervosa?

Q: I know that there’s been controversy about the use of atypical antipsychotic medications such as olanzapine in the treatment of anorexia nervosa (AN). Is there anything new for clinicians to use?

A: Unfortunately, the number of well-conducted studies on atypical antipsychotic medications for AN remains quite small. As reported in another article in this issue of EDR, in one open trial aripiprazole has shown some promise. When it comes to randomized controlled trials, few have been conducted. One recently published small, randomized controlled trial compared outcomes in 23 AN patients randomized to olanzapine (starting at 2.5 mg/day and increasing to 10 mg/day if tolerated) or placebo over 8 weeks. Psychological symptoms improved in both groups, but there were no differences between those receiving active medications vs. placebo. However, over the course of the study those receiving olanzapine gained modestly more weight than those receiving placebo (roughly 1.1 kg vs. 0.2 kg). All those receiving olanzapine reported feeling moderately or severely sedated for at least one week at some point (compared to 58% on placebo who reported sedation). In this 8-week period, none of the patients developed hyperglycemia, hyperlipidemia, or hepatic enzyme changes (Psychol Med 2011; Mar 22:1-6, published online prior to print DOI: 10.1017/S0033291711000390). Whether the advantages ultimately outweigh the disadvantages remains to be seen. At this point the best we can say is that clinicians should advise patient about these options, and then help them weigh the potential costs and potential benefits.

— J.Y.