Olanzapine Use for the Adjunctive Treatment of Adolescents with Anorexia Nervosa

Abstract

Objective: To examine assessment and treatment profiles of adolescent patients with anorexia nervosa and eating disorder not otherwise specified who received olanzapine as compared with an untreated matched sample. Method: A retrospective, matched-groups comparison study was completed. Medical files of 86 female patients treated in the eating disorder program at the Children's Hospital of Eastern Ontario were examined. Patients treated with olanzapine were initially identified through chart review and then matched to a diagnosis, age, and, when possible, treatment group that served as the active comparator. Weight gain was examined in a sample of 22 inpatients. Results: Patients treated with olanzapine displayed greater evidence of psychopathology and medical compromise at the time of first assessment compared with those not treated. Rate of weight gain was not statistically different between groups when olanzapine was started during inpatient admissions. Medication effect on eating disorder cognitions could not be assessed given the presence of multiple confounders relating to treatment. Notable side effects included sedation and dyslipidemia in 56% of patients. Conclusions: Despite our best attempts at matching olanzapine-treated subjects with a control sample, analysis revealed significant differences between groups, suggesting greater illness severity in those augmented with olanzapine. Given these inherent differences, we were unable to draw any firm conclusions regarding the potential efficacy of olanzapine. Factors associated with the prescription of adjunctive pharmacotherapy in this cohort appear to be linked to illness severity, acuity, and associated comorbidity. The observed side-effect profile indicates the need for more consistent predrug screening and for closer monitoring during treatment.

Eating Disorders in Children and Adolescents: State of the Art Review

“…There is no evidence to suggest that pharmacotherapy in AN should be first line, but it may play a role in individual patients resistant to treatment or with premorbid psychiatric conditions. 107,[128][129][130] In BN, several RCTs in adults have found that antidepressants are effective in decreasing binge eating and purging symptoms. Specifically, fluoxetine has a strong evidence base and is approved by the Food and Drug Administration for use in adults with BN; thus far there is some evidence that the effects are similar in adolescents.…”

Second Generation Antipsychotics in Adolescent Anorexia Nervosa: A New Hypothesis of Eligibility Criteria

“…A recent work by Norris et al (2011) tried to retrospectively assess baseline characteristics in drug-treated AN patients compared with untreated ones. The authors concluded that despite their best attempt, they could not match the two groups for baseline characteristics.…”

Atypical early-onset eating disorders

“…Two (Kafantaris 2011;Norris 2011) showed no greater benefit of olanzapine over placebo. Similarly, a randomised trial of risperidone v. placebo found no effect on eating disorder rating scales or weight (Hagman 2011).…”