The International Journal of Neuropsychopharmacology

Thematic Section: Eating Disorders and Obesity

Evidence-based pharmacotherapy of eating disorders

Martine F. Flamenta1 c1, Hany Bissadaa2 and Wendy Spettiguea3

a1 University of Ottawa Institute of Mental Health Research, Ottawa, Ontario, Canada

a2 The Ottawa Hospital, Ottawa, Ontario, Canada

a3 Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada


The objective was to review scientific evidence for efficacy and safety of pharmacotherapy in adults or children with an eating disorder (ED). We conducted a computer search for all randomized controlled trials (RCTs) published between 1960 and May 2010 for treatment of anorexia nervosa (AN), bulimia nervosa (BN) or binge-eating disorder (BED). For drugs for which no RCT was found, open trials or case reports were retrieved. Clinically relevant RCTs in the treatment of AN have used atypical antipsychotics, selective serotonin reuptake inhibitors (SSRIs), and zinc supplementation. Olanzapine demonstrated an adjunctive effect for in-patient treatment of underweight AN patients, and fluoxetine helped prevent relapse in weight-restored AN patients in 1/2 studies. For treatment of BN, controlled studies have used SSRIs, other antidepressants, and mood stabilizers. In 9/11 studies, pharmacotherapy yielded a statistically significant although moderate reduction in binge/purge frequency, and some additional benefits. For BED, RCTs have been conducted using SSRIs and one serotonin norepinephrine reuptake inhibitor (SNRI), mood stabilizers, and anti-obesity medications. In 11/12 studies, there was a statistically significant albeit limited effect of medication. Meta-analyses on efficacy of pharmacotherapy for BN and BED support moderate effect sizes for medication, but generally low recovery rates. Treatment resistance is an inherent feature of AN, where treatment should focus on renourishment plus psychotherapy. For BN and BED, combined treatment with pharmacotherapy and cognitive behaviour therapy has been more effective than either alone. Data on the long-term efficacy of pharmacotherapy for EDs are scarce. Short- and long-term pharmacotherapy of EDs still remains a challenge for the clinician.

(Received July 22 2010)

(Reviewed August 19 2010)

(Revised January 26 2011)

(Accepted February 01 2011)

(Online publication March 18 2011)


c1 Address for correspondence: Professor M. F. Flament, University of Ottawa Institute of Mental Health Research, Royal Ottawa Hospital, 1145 Carling Ave, Ottawa, ON K1Z 7K4, Canada. Tel.: (613) 722-6521 (ext. 6455) Fax: (613) 798-2973 Email: