Olanzapine in the treatment of anorexia nervosa: a systematic review

Abstract

Anorexia nervosa, with the highest mortality rate among psychiatric diseases, is characterized by low body mass index, fear of weight gain, and disturbed body image. Even though multiple drugs have been proposed for the treatment of anorexia nervosa, current treatment modalities include nutritional support and psychotherapy. In this study, our aim is to analyze the efficiency and possible adverse effects of olanzapine, an atypical anti-psychotic drug, in the treatment of anorexia nervosa. The studies investigating the efficiency and possible adverse effects of olanzapine in anorexia nervosa have been searched by using 3 databases (Embase, PubMed, and Cochrane Library). DerSimonian-Laird random effects meta-analyses have been used in the statistical analysis. Effect of olanzapine treatment in accordance with the duration and dosage of drug have been analyzed by the determination of 95% confidence intervals (p value < 0.05 is considered as statistically significant). Despite the presence of some contradictory studies, olanzapine treatment has been found beneficial in anorexia nervosa. In addition, analysis reveals that statistically significant beneficial effect of olanzapine treatment is used at high doses and for short duration. Possible side effects include neuroleptic malignant syndrome, hypoglycemia, and heart block in patients suffering from anorexia nervosa. Even though there is obvious need for more comprehensive further studies, current literature favors olanzapine treatment. The efficiency of olanzapine is considered to be related to changes in dopaminergic and serotonergic system in anorexic patients both in terms of neurotransmitter levels and receptor activity.

Distinguishing delusional beliefs from overvalued ideas in Anorexia Nervosa: An exploratory pilot study

“…Specifically, given that more-and-more studies are bringing to light the association between AN and beliefs of delusional intensity, and given that current treatment regimens incorporate antipsychotic pharmacological interventions, links between treatment choices and further justification for such choices needs to be explored further. For example, beyond the broad rationale of serotonergic pathway regulation [37], (how and why) does olanzapine -albeit in lower doses than those necessary to treat psychosis-help to target delusional beliefs in those with AN, if AN is not a psychotic disorder? Particularly, when a majority of studies examining the use of Olanzapine in AN are case studies, and approval by the United States of America Food and Drug Administration (FDA) has not been granted for Olanzapine use specifically in AN, yet it is still widely prescribed in the absence of efficacy and safety evidence [37], with no clear significant benefits on psychological symptoms and only modest significant impact on weight [38].…”

Efficacy and tolerance of second-generation antipsychotics in anorexia nervosa: A systematic scoping review

“…According to them, olanzapine can be useful in regaining and stabilizing weight as well as in the diminution of anorexic symptoms. In 2020, C ¸o ¨pu ¨r et al [70] published a new systematic review of the literature concerning olanzapine prescription that this time considered more studies, including five RCTS. These authors encouraged the use of olanzapine for the treatment of AN and underlined the benefit of prescribing an olanzapine dose > 5 mg/d for a relatively short duration (< 8 weeks).…”

Mycotherapy: Potential of Fungal Bioactives for the Treatment of Mental Health Disorders and Morbidities of Chronic Pain

“…Mood disorders * Lithium Multiple mechanisms including modulation of (GABA)-ergic and glutamatergic neurotransmission, and alteration of voltage-gated ion channels or intracellular signalling pathways [22,23] First-line treatment for prevention of manic and depressive episodes of bipolar disorder (BD) [24] Cardiac problems, cognitive problems, acne, psoriasis, thyroid problems, nausea, vomiting, weight gain, hyponatremia, sedation, decreased libido, and teratogenic [25] valproic acid First-line treatment for acute mania and maintenance of BD [26] Cardiac problems, cognitive problems, hair loss, hypothyroidism, aplastic anaemia, Leukopenia, increased transaminases, hepatitis, SLE-like syndrome, hyponatremia, tremor, decreased libido, infertility and teratogenic [25] Carbamazepine Effective as a monotherapy to treat manic symptoms of bipolar or as adjunct to lithium or valproic acid [27] Cardiac problems, cognitive problems, acne, hair loss, hypothyroidism, PCOS. diarrhoea, nausea, vomiting, pancreatitis, increased transaminases, metabolic syndrome, weight gain, sedation, tremor, decreased sexual function, infertility and teratogenic [25] Psychotic disorders First-generation antipsychotics (FGA) e.g., Chlorpromazine, haloperidol D2 antagonists: work by inhibiting dopaminergic neurotransmission [28] Effective in the treatment and maintenance of schizophrenia, acute mania with psychotic symptoms, major depressive order with psychotic features, and delusional disorder [28] Adverse (5-HT 2A/2C antagonism) receptors [31] Effective as an adjunctive therapy in treatment of AN, increasing appetite and decreasing anxiety and ruminating thoughts involving body image and food [32] Dizziness, orthostatic hypotension, hypercholesterolemia, hypertriglyceridemia, hyperglycaemia, weight gain, extra-pyramidal symptoms, dry mouth, hyperprolactinemia, and insomnia [32] Antidepressants(SSRIs, SNRIs, TCAs, MAOIs) Defined above…”