From the Guidelines
Low-dose antipsychotics should not be used as a first-line treatment for eating disorders, but may be considered as an adjunct to comprehensive treatment in specific situations, such as severe anxiety or obsessive thoughts, under close monitoring and with careful consideration of potential side effects. The American Psychiatric Association practice guideline for the treatment of patients with eating disorders, published in 2023 1, emphasizes the importance of a comprehensive, culturally appropriate, and person-centered treatment plan that incorporates medical, psychiatric, psychological, and nutritional expertise. While the guideline does not specifically recommend the use of low-dose antipsychotics, it suggests that patients with anorexia nervosa be treated with an eating disorder-focused psychotherapy, and that adults with bulimia nervosa be treated with eating disorder-focused cognitive-behavioral therapy and a serotonin reuptake inhibitor.
Some key points to consider when using low-dose antipsychotics in eating disorders include:
- Starting with a low dose and gradually increasing as needed and tolerated
- Monitoring for common side effects such as sedation, metabolic changes, and weight gain
- Using these medications as adjuncts to comprehensive treatment, not as standalone treatments
- Regularly assessing the patient's mental status, weight, and metabolic parameters
- Considering the potential benefits of low-dose antipsychotics in reducing anxiety and obsessive thoughts, and improving treatment adherence
It is essential to note that the evidence for low-dose antipsychotics in eating disorders is limited, and these medications should be used with caution and under close monitoring. The guideline recommends that patients with eating disorders have a documented, comprehensive treatment plan that incorporates medical, psychiatric, psychological, and nutritional expertise, commonly via a coordinated multidisciplinary team 1.
From the Research
Low Dose Antipsychotics for Eating Disorders Evidence
- There is limited direct evidence on the use of low-dose antipsychotics for eating disorders. However, some studies suggest that certain medications may be effective in treating specific eating disorders 2, 3.
- Olanzapine has been shown to promote weight gain among individuals with anorexia nervosa, and is considered a potential therapeutic agent for this condition 2.
- Fluoxetine is FDA-approved for the treatment of bulimia nervosa, and lisdexamfetamine is FDA-approved for the treatment of binge eating disorder 2, 3.
- Selective serotonin reuptake inhibitors (SSRIs) may also be effective in treating bulimia nervosa and binge eating disorder, although they are often prescribed off-label 3.
- The use of antipsychotics in eating disorders is not well-studied, and more research is needed to determine their safety and efficacy in this population 4, 5.
- A multidisciplinary approach to treatment, including nutrition therapy, cognitive-behavioral therapy, and family-based therapy, is often recommended for individuals with eating disorders 3, 6.
- Psychiatric and medical comorbidities are common in individuals with eating disorders, and early identification and management of these comorbidities may improve treatment outcomes 4.