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.