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Psychopharmacological options for adult patients with anorexia nervosa

  • Mario Miniati (a1), Mauro Mauri (a1), Agnese Ciberti (a1), Michela Giorgi Mariani (a1), Donatella Marazziti (a1) and Liliana Dell’Osso (a1)...


The aim of this review was to summarize evidence from research on psychopharmacological options for adult patients with anorexia nervosa (AN). Database searches of MEDLINE and PsycINFO (from January 1966 to January 2014) were performed, and original articles published as full papers, brief reports, case reports, or case series were included. Forty-one papers were screened in detail, and salient characteristics of pharmacological options for AN were summarized for drug classes. The body of evidence for the efficacy of pharmacotherapy in AN was unsatisfactory, the quality of observations was questionable (eg, the majority were not blinded), and sample size was often small. More trials are needed, while considering that nonresponse and nonremission are typical of patients with AN.


Corresponding author

*Address for correspondence: Mario Miniati, MD, Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, University of Pisa, 57 Via Roma, Pisa, Italy. (Email:


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1.Simon, J, Schmidt, U, Pilling, S. The health service use and cost of eating disorders. Psychol Med. 2005; 35(11): 15431551.
2.Hudson, JI, Pope, HG Jr. Genetic epidemiology of eating disorders and co-occurring conditions: the role of endophenotypes. Int J Eat Disord. 2007; 40(Suppl): 7678.
3.Hoek, HW, Van Hoeken, D. Review of the prevalence and incidence of eating disorders. Int J Eat Disord. 2003; 34(4): 383396.
4.Hoek, HW. Incidence, prevalence and mortality of anorexia nervosa and other eating disorders. Curr Opin Psychiatry. 2006; 19(4): 389394.
5.Grucza, RA, Przybeck, TR, Cloninger, CR. Prevalence and correlates of binge eating disorder in a community sample. Compr Psychiatry. 2007; 48(2): 124131.
6.Mitchinson, D, Hay, PJ. The epidemiology of eating disorders: genetic, environmental, and social factors. Clin Epidemiol. 2014; 17(6): 8997.
7.Machado, PP, Machado, BC, Gonçalves, S, Hoek, HW. The prevalence of eating disorders not otherwise specified. Int J Eat Disord. 2007; 40(3): 212217.
8.Castellini, G, Lo Sauro, C, Mannucci, E, et al. Diagnostic crossover and outcome predictors in eating disorders according to DSM-IV and DSM-V proposed criteria: a 6-year follow-up study. Psychosom Med. 2011; 73(3): 270279.
9.Bulik, CM, Sullivan, PF, Fear, J, Pickering, A. Predictors of the development of bulimia nervosa in women with anorexia nervosa. J Nerv Ment Dis. 1997; 185(11): 704707.
10.Eckert, ED, Halmi, KA, Marchi, P, Grove, W, Crosby, R. Ten-year follow-up of anorexia nervosa: clinical course and outcome. Psychol Med. 1995; 25(1): 143156.
11.Strober, M, Freeman, R, Morrell, W. The long-term course of severe anorexia nervosa in adolescents: survival analysis of recovery, relapse, and outcome predictors over 10–15 years in a prospective study. Int J Eat Disord. 1997; 22(4): 339360.
12.Eddy, KT, Dorer, DJ, Franko, DL, Tahilani, K, Thompson-Brenner, H, Herzog, DB. Diagnostic crossover in anorexia nervosa and bulimia nervosa: implications for DSM-V. Am J Psychiatry. 2008; 165(2): 245250.
13.Hoek, HW, van Hoeken, D. Review of the prevalence and incidence of eating disorders. Int J Eat Disord. 2003; 34(4): 383396.
14.Eating disorders. Core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders. National Clinical Practice Guideline Number CG9 developed by National Collaborating Centre for Mental Health commissioned by the National Institute for Clinical Excellence. London: The British Psychological Society & The Royal College of Psychiatrists; 2004.
15.Brambilla, F, Tortorella, A. Disturbi del comportamento alimentare. In: Marazziti D, ed. Psicofarmacoterapia Clinica. 5th ed.Rome: Giovanni Fioriti Editore; 2013: 183191.
16.American Psychiatric Association. Practice Guideline for the Treatment of Patients with Eating Disorders. 3rd ed. Washington, DC: American Psychiatric Association; 2006.
17.Steinhausen, HC. Treatment and outcome of adolescent anorexia nervosa. Horm Res. 1995; 43(4): 168170.
18.Smink, FR, van Hoeken, D, Hoeck, HW. Epidemiology of Eating Disorders: Incidence, Prevalence and Mortality Rates. Curr Psychiatry Rep. 2012; 14: 406414.
19.Biederman, J, Herzog, DB, Rivinus, TM, et al. Amitriptyline in the treatment of anorexia nervosa: a double-blind, placebo-controlled study. J Clin Psychopharmacol. 1985; 5(1): 1016.
20.Halmi, KA, Eckert, E, LaDu, TJ, Cohen, J. Anorexia nervosa: treatment efficacy of cyproheptadine and amitriptyline. Arch Gen Psychiatry. 1986; 43(2): 177181.
21.Lacey, JH, Crisp, AH. Hunger, food intake and weight: the impact of clomipramine on a refeeding anorexia nervosa population. Postgrad Med J. 1980; 56(1): 7985.
22.Crisp, AH, Lacey, JH, Crutchfield, M. Clomipramine and ‘drive’ in people with anorexia nervosa: an in-patient study. Br J Psychiatry. 1987; 150(3): 355358.
23.Hollander, E, Kim, S, Braun, A, Simeon, D, Zohar, J. Cross-cutting issues and future directions for the OCD spectrum. Psychiatry Res. 2009; 170(1): 36.
24.Phillips, KA, Friedman, MJ, Stein, DJ, Craske, M. Special DSM-V issues on anxiety, obsessive-compulsive spectrum, post-traumatic, and dissociative disorders. Depress Anxiety. 2010; 27(2): 9192.
25.Ramacciotti, CE, Coli, E, Paoli, R, Marazziti, D, Dell’Osso, L. Serotonergic activity measured by platelet [3H] paroxetine binding in patients with eating disorders. Psychiatry Res. 2003; 118(1): 3338.
26.Gwirtsman, HE, Guze, BH, Yager, J, Gainsley, B. Fluoxetine treatment of anorexia nervosa: an open clinical trial. J Clin Psychiatry. 1990; 51(9): 378382.
27.Attia, E, Haiman, C, Walsh, BT, Flater, SR. Does fluoxetine augment the inpatient treatment of anorexia nervosa? Am J Psychiatry. 1998; 155(4): 548551.
28.Barbarich, NC, McConaha, CW, Halmi, KA, et al. Use of nutritional elements to increase the efficacy of fluoxetine in the treatment of anorexia nervosa. Int J Eat Disord. 2004; 35(1): 1015.
29.Kaye, WH, Nagata, T, Weltzin, TE, et al. Double-blind placebo-controlled administration of fluoxetine in restricting- and restricting-purging-type anorexia nervosa. Biol Psychiatry. 2001; 49(7): 644652.
30.Walsh, BT, Kaplan, AS, Attia, E, et al. Fluoxetine after weight restoration in anorexia nervosa: a randomized controlled trial. JAMA. 2006; 295(22): 26052612.
31.Fassino, S, Leombruni, P, Daga, G, et al. Efficacy of citalopram in anorexia nervosa: a pilot study. Eur Neuropsychopharmacol. 2002; 12(5): 453459.
32.Safer, DL, Darcy, AM, Lock, J. Use of mirtazapine in an adult with refractory anorexia nervosa and comorbid depression: a case report. Int J Eat Disord. 2010; 44(2): 178181.
33.Safer, DL, Arnow, KD. Suprathreshold duloxetine for treatment-resistant depression, anorexia nervosa binge-purging type, and obsessive-compulsive disorder: a case report. Innov Clin Neurosci. 2012; 9(3): 1316.
34.Vandereycken, W. Neuroleptics in the short-term treatment of anorexia nervosa: a double-blind placebo-controlled study with sulpiride. Br J Psychiatry. 1984; 144(3): 288292.
35.Ramacciotti, CE, Dell’Osso, L, Paoli, RA, et al. Characteristics of eating disorder patients without a drive for thinness. Int J Eat Disord. 2002; 32(2): 206212.
36.Frieling, H, Römer, KD, Scholz, S, et al. Epigenetic dysregulation of dopaminergic genes in eating disorders. Int J Eat Disord. 2010; 43(7): 577583.
37.Cassano, GB, Miniati, M, Pini, S, et al. Six-month open trial of haloperidol as an adjunctive treatment for anorexia nervosa: a preliminary report. Int J Eat Disord. 2003; 33(2): 172177.
38.Mauri, M, Miniati, M, Mariani, MG, Ciberti, A, Dell’Osso, L. Haloperidol for severe anorexia nervosa restricting type with delusional body image disturbance: a nine-case chart review. Eat Weight Disord. 2013; 18(3): 329332.
39.Dally, A, Sargant, W. Treatment and outcome of anorexia nervosa. Br Med J. 1966; 2(5517): 793795.
40.Ruggiero, GM, Laini, V, Mauri, MC, et al. A single blind comparison of amisulpride, fluoxetine and clomipramine in the treatment of restricting anorectics. Prog Neuropsychopharmacol Biol Psychiatry. 2001; 25(5): 10491059.
41.Vandereycken, W, Pierloot, R. Pimozide combined with behavior therapy in the short-term treatment of anorexia nervosa: a double-blind placebo-controlled cross-over study. Acta Psychiatr Scand. 1982; 66(6): 445450.
42.Powers, PS, Santana, CA, Bannon, YS. Olanzapine in the treatment of anorexia nervosa: an open label trial. Int J Eat Disord. 2002; 32(2): 146154.
43.Barbarich, NC, McConaha, CW, Gaskill, J, et al. An open trial of olanzapine in anorexia nervosa. J Clin Psychiatry. 2004; 65(11): 14801482.
44.Mondraty, N, Birmingham, CL, Touyz, S, Sundakov, V, Chapman, L, Beumont, P. Randomized controlled trial of olanzapine in the treatment of cognitions in anorexia nervosa. Australas Psychiatry. 2005; 13(1): 7275.
45.Malina, A, Gaskill, J, McConaha, C, et al. Olanzapine treatment of anorexia nervosa: a retrospective study. Int J Eat Disord. 2003; 33(2): 234237.
46.Bissada, H, Tasca, GA, Barber, AM, Bradwejn, J. Olanzapine in the treatment of low body weight and obsessive thinking in women with anorexia nervosa: a randomized, double-blind, placebo-controlled trial. Am J Psychiatry. 2008; 165(10): 12811288.
47.Attia, E, Kaplan, AS, Walsh, BT, et al. Olanzapine versus placebo for outpatients with anorexia nervosa. Psychol Med. 2011; 41(10): 21772182.
48.Brambilla, F, Monteleone, P, Maj, M. Olanzapine-induced weight gain in anorexia nervosa: involvement of leptin and ghrelin secretion? Psychoneuroendocrinology. 2007; 32(4): 402406.
49.Brambilla, F, Garcia, CS, Fassino, S, et al. Olanzapine therapy in anorexia nervosa: psychobiological effects. Int Clin Psychopharmacol. 2007; 22(4): 197204.
50.Hansen, L. Olanzapine in the treatment of anorexia nervosa. Br J Psychiatry. 1999; 175(6): 592.
51.Jensen, VS, Mejlhede, A. Anorexia nervosa: treatment with olanzapine. Br J Psychiatry. 2000; 177(1): 87.
52.La Via, MC, Gray, N, Kaye, WH. Case reports of olanzapine treatment of anorexia nervosa. Int J Eat Disord. 2000; 27(3): 363366.
53.Wang, TS, Chou, YH, Shiah, IS. Combined treatment of olanzapine and mirtazapine in anorexia nervosa associated with major depression. Prog Neuropsychopharmacol Biol Psychiatry. 2006; 30(2): 306309.
54.Bosanac, P, Kurlender, S, Norman, T. An open-label study of quetiapine in anorexia nervosa. Hum Psychopharmacol. 2007; 22(4): 223230.
55.Powers, PS, Bannon, Y, Eubanks, R, McCormick, T. Quetiapine in anorexia nervosa patients: an open label outpatient pilot study. Int J Eat Disord. 2007; 40(1): 2126.
56.Trunko, ME, Schwartz, TA, Duvvuri, V, Kaye, WH. Aripiprazole in anorexia nervosa and low-weight bulimia nervosa: case reports. Int J Eat Disord. 2010; 44(3): 269275.
57.Barcai, A. Lithium in adult anorexia nervosa: a pilot report on two patients. Acta Psychiatr Scand. 1977; 55(Suppl 2): 97101.
58.Gross, HA, Ebert, MH, Faden, VB, Goldberg, SC, Nee, LE, Kaye, WH. A double-blind controlled trial of lithium carbonate primary anorexia nervosa. J Clin Psychopharmacol. 1981; 1(6): 376381.
59.Yung, CY. A review of clinical trials of lithium in medicine. Pharmacol Biochem Behav. 1984; 21(Suppl 1): 5155.
60.Casper, RC, Schlemmer, RF Jr, Javaid, JI. A placebo-controlled crossover study of oral clonidine in acute anorexia nervosa. Psychiatry Res. 1987; 20(Suppl 3): 249260.
61.Goldberg, SC, Halmi, KA, Eckert, ED, Casper, RC, Davis, JM. Cyproheptadine in anorexia nervosa. Br J Psychiatry. 1979; 134(1): 6770.
62.Walsh, BT. The future of research on eating disorders. Appetite. 2004; 42(1): 510.
63.Schüle, C, Sighart, C, Hennig, J, Laakmann, G. Mirtazapine inhibits salivary cortisol concentrations in anorexia nervosa. Prog Neuropsychopharmacol Biol Psychiatry. 2006; 30(6): 10151019.
64.Yasuhara, D, Nakahara, T, Harada, T, Inui, A. Olanzapine-induced hyperglycemia in anorexia nervosa. Am J Psychiatry. 2007; 164(3): 528529.
65.Court, A, Mulder, C, Kerr, M, et al. Investigating the effectiveness, safety and tolerability of quetiapine in the treatment of anorexia nervosa in young people: a pilot study. J Psychiatr Res. 2010; 44(15): 10271034.
66.Delsedime, N, Nicotra, B, Giovannone, MC, et al. Psychotic symptoms in a woman with severe Anorexia Nervosa: psychotic symptoms in Anorexia Nervosa. Eat Weight Disord. 2013; 18(1): 9598.


Psychopharmacological options for adult patients with anorexia nervosa

  • Mario Miniati (a1), Mauro Mauri (a1), Agnese Ciberti (a1), Michela Giorgi Mariani (a1), Donatella Marazziti (a1) and Liliana Dell’Osso (a1)...


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