A review of the literature on the use of second generation antipsychotics (SGA) in adolescent and adult patients
with anorexia nervosa (AN) is presented. Open-label studies and case reports suggested beneficial effects of variable
doses of olanzapine, quetiapine, risperidone and aripiprazole in AN subjects. Randomized, double-blind, controlled
studies conducted mainly with olanzapine demonstrated its efficacy on specific psychopathological aspects of AN.
Moreover, although not consistently, increases in Body Mass Index (BMI) or appetite with no significant side effects were
also reported. Taken together, the data of olanzapine studies, even if with a number of different limitations, show that this
pharmacological treatment can be effective in improving specific aspects of AN in adult but not in adolescent patients.
Further studies are warranted to consolidate these findings. Quetiapine and aripiprazole seem to be potentially promising
options in the treatment of severe adult and adolescent AN patients because of their lower propensity to induce weight
gain, revealing positive psychopathological effects and good tolerability. Given the inherent cardiac risks associated with
the treatment of low weight AN patients, care should be taken when SGA use is being considered. Moreover, although
SGA use might be associated to several other side effects (increasing weight, developing glucose intolerance and/or
diabetes, metabolic disturbances) little has been published on this topic in AN patients and only few of the analyzed
studies have reported adverse reactions. The different mechanisms underlying these effects are therefore discussed. Future
directions for pharmacologic treatment research in AN should include randomized controlled trials with different
antipsychotic medications, inpatient versus outpatient trials and the assessment of medication effect for relapse prevention
in weight-restored patients.