Use of Antipsychotics in the Treatment of Eating Disorders

Karen Borges, Yael Doreen Lewis, Jessica Bentley, Hubertus Himmerich*

*Corresponding author for this work

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review


Anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED) are the most common eating disorders (EDs). The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) also describes avoidant/ restrictive food intake disorder (ARFID), pica, and rumination disorder as types of ED, for which there are currently no psychopharmacological randomized controlled trials (RCTs) reported in the literature. First-generation antipsychotics (FGAs) and second-generation antipsychotics (SGAs) have been assessed in patients with AN, but not for those with BN or BED. Studies in patients with AN on the FGAs sulpiride and pimozide, and on the SGAs amisulpride, quetiapine and risperidone have not revealed convincing treatment success in comparison to placebo. One small (N = 13), open, uncontrolled study investigating the FGA haloperidol demonstrated an increase in weight and an improvement in ED symptoms. In a retrospective, case-controlled study in adolescent inpatients with AN (N = 106), 22 of which had been treated with the SGA aripiprazole, it was found that those who took aripiprazole experienced significantly greater weight gain. The most convincing evidence for the treatment of AN with an SGA was for olanzapine. In a recent large RCT (N = 152) of outpatients with AN who received between 2.5 and 10 mg of olanzapine daily for 16 weeks, a greater increase in weight was observed in the treatment group compared with the placebo group. However, there was no difference between groups with respect to psychological AN symptoms or general psychopathology. Olanzapine may influence the reward system, self-regulatory, system and homeostatic system through the modulation of dopaminergic, serotonergic, and histaminergic neurotransmission. However, it is not currently approved for the treatment of AN, and its use for this indication is therefore off-label.

Original languageEnglish
Title of host publicationNeuroPsychopharmacotherapy
PublisherSpringer International Publishing
Number of pages13
ISBN (Electronic)9783030620592
ISBN (Print)9783030620585
Publication statusPublished - 1 Jan 2022


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