Efficacy and safety of antipsychotics and antidepressants in the treatment of anorexia nervosa: a systematic review

Abstract

Introduction: The recommendations of the current guidelines are based on low quality evidence. Periodic updating is required, taking recent evidence into consideration.

Objective: To synthesise the best available clinical evidence on the efficacy and safety of second-generation antidepressants and antipsychotics in patients with anorexia nervosa.

Methods: Systematic review (CRD42020150577). We searched PubMed, SCOPUS, Ovid(Cochrane), EMBASE and LILACS for randomised clinical trials performed in patients with anorexia nervosa that evaluated the use of second-generation antipsychotics or oral antidepressants, at any dose and for any length of time, in outpatient and/or hospital treatment, taking weight (body mass index), psychopathological entities and safety as results.

Results: Five studies were included, with four assessed as having a high risk of bias. The evidence indicates that patients receiving treatment with olanzapine or fluoxetine tend to stay in treatment programmes for longer. Olanzapine showed favourable results (one study) in terms of weight gain, but did not show the same results in psychopathology, where the evidence is contradictory.

Conclusions: In accordance with previous reviews, our work allows us to conclude that there is contradictory information on the efficacy of psychotropic drugs in the treatment of anorexia nervosa. Future work should focus on developing clinical trials of high methodological quality.

Keywords: Anorexia nerviosa; Anorexia nervosa; Antidepresivos; Antidepressants; Antipsicóticos; Antipsychotics; Evidence-based medicine; Medicina basada en la evidencia; Revisión sistemática; Systematic review.