Psychopharmacological Interventions for Adolescents with Eating Disorders

The purpose of this article is to review evidence-based pharmacological treatments for eating disorders with a special focus on the adolescent population. Eating disorders commonly present in adolescence, yet little published data are available to guide the adolescent psychiatrist. The use of medications in the context of evidence-based psychotherapeutic interventions and co-morbid psychiatric conditions will be discussed. Defined will be the unique role of the adolescent psychiatrist in orchestrating treatment by a multidisciplinary team, determining the appropriate level of care, monitoring safety, and evaluating treatment response. Risks and benefits of the use of pharmacological interventions in individuals who are malnourished or engaging in eating disordered behaviors, such as purging or laxative abuse, will be delineated along with proposed monitoring. Each potentially affected organ system will be addressed. Sequentially described is the existing evidence for use of medications for anorexia nervosa, bulimia nervosa, and binge eating disorder in adults and, where available, adolescents. Atypical antipsychotics, particularly olanzapine, have shown promise for adults with anorexia nervosa. However, in a recent trial of adolescents, no benefit for olanzapine over placebo was found. Several antidepressants have been shown to be effective treatments for bulimia nervosa, and fluoxetine has the FDA approval for treatment of this disorder in adults. Although fluoxetine has been deemed safe and effective in an open trial of adolescent patients, controlled studies in this population are lacking. Special considerations for the use of these medications in adolescents are discussed.