Antipsychotics for Anorexia: Weight Gain and Sedation as Treatment

Kermit Cole
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A study published online today (May 26, 2012) in Current Psychiatry Reports recommends Zyprexa as “elusive” pharmacologic solution to anorexia nervosa. On the basis of four randomized clinical trials, the study finds Zyprexa superior to placebo, Thorazine and Abilify in its ability to promote “weight gain and/or reduction in obsessional symptoms.”

Abstract → 

Brewerton, T. “Antipsychotic Agents in the Treatment of Anorexia Nervosa: Neuropsychopharmacologic Rationale and Evidence from Controlled Trials.” Current Psychiatry Reports, published online May 26, 2012

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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

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Kermit Cole
Kermit Cole, MFT, founding editor of Mad in America, works in Santa Fe, New Mexico as a couples and family therapist. Inspired by Open Dialogue, he works as part of a team and consults with couples and families that have members identified as patients. His work in residential treatment — largely with severely traumatized and/or "psychotic" clients — led to an appreciation of the power and beauty of systemic philosophy and practice, as the alternative to the prevailing focus on individual pathology. A former film-maker, he has undergraduate and master's degrees in psychology from Harvard University, as well as an MFT degree from the Council for Relationships in Philadelphia. He is a doctoral candidate with the Taos Institute and the Free University of Brussels. You can reach him at [email protected]

13 COMMENTS

  1. From the abstract: “The pharmacologic profile of olanzapine and other antipsychotic medications is discussed in light of the known pathophysiology of AN involving serotonin and dopamine systems, as well as brain-derived neurotrophic factor.”

    “Known pathophysiology”? Mumbo-jumbo alert!

  2. As a group, patients diagnosed with anorexia nervosa present the greatest challenge with regard to compliance with *treatment*. The attitudes thinking and beliefs of these patients precipitate and perpetuate their illness. It is no secret that Zyprexa increases both appetite and weight gain; the two main aspects of their lives that anorexics seek to control. Force feeding anorexic patients via nasogastric tube feedings can become the route of administration for a drug most patients under the age of 18 will adamantly refuse.

    The article does not speak to the risks of causing liver damage or failure in a patient who is undernourished and under 80% of their ideal body weight. Sadly, this is just another example of overlooking the human being who has an eating disorder- reducing the person to a set of signs an symptoms that a prescription can mitigate. And without question a failure of psychiatrists to adhere to their hippocratic oath *first do no harm*.

    James Lock, MD, PhD, & Kara Fitzpatrick, PhD of Luclille Packard Children’s Hospital- Stanford University, published a review of the literature for psychotropic drug use in patients with eating disorders in 2008- very dismal news for anyone seeking a magic bullet for this very serious illness.

  3. Association Between Zyprexa olanzapine and Hyperglycemia.

    There is concern Zyprexa,like other atypical antipsychotic drugs, has the potential to cause metabolic disorders, particularly hyperglycemia (excess sugar) and diabetes. Atypical antipsychotics cause the body to metabolize fat instead of carbohydrates, leading to insulin resistance to the excess carbohydrates. At the same time they promote fat accumulation.I was a patient back in 1996-2000 who was a subject of Eli Lilly’s Zyprexa ‘viva’ Zyprexa’ off label sales promotion.I was given it as an ineffective costly treatment for PTSD It gave me diabetes as a side effect.–Daniel Haszard

    FMI zyprexa-victims(dot)com

  4. The irony of using the known harmful and negative effects of a drug for “treatment” purposes is about what one would expect from a field that sees almost all human behavior as an “illness” and a pill as the solution to most problems. People with serious eating problems have complex psychological concerns and trhe research shows they are likely trauma survivors. The complexity of such people’s lives is not going to be magically unraveled by a dangeous drug.

  5. Totally irresponsible. Zyprexa has leathal side-effects. Besides metabollic side-effects it totally disrupted my son’s sleeping patterns and he developed such akathisia that he tried to kill himself. Zyprexa disrupts not only dopamine and serotonin, it messes up your adrenalin and histamine as well. Histamine regulates your appetite and plays an important part in waking up and drpping off to sleep. This is never mentioned on the atypical antipsychotic websites

  6. “weight gain and/or reduction in obsessional symptoms.”

    The and/or seems like a lot of wiggle room for the researchers. Someone who experiences weight gain without any reduction in the obsessional symptoms would be counted a success. But can you imagine the psychological effects that would have on someone who was terrified of losing control of her body weight?
    And the possibilities of forced “treatment” with this substance?

  7. A drug that negatively affects the way that the thyroid, pituitary and adrenal glands function to achieve weight gain is not a solution to a health problem. Another classic example of the fix one–break six mentality of psychiatry. Oh, the brainstorming that must have gone into conjuring this reprehensible “off-label” use. Jesus wept!

  8. Duh……….so now we’re using the terrible effects of these toxic drugs as a treatment for AN? Do the drug companies have no shame at all, let alone the psychiatrists and doctors who allowed their names to be attached to this mumbo-jumbo stupidity? The system will try anything to find new ways to get people on their toxic drugs! I’d laugh, if it wasn’t so awful.

  9. Anorexia is highly associated with childhood trauma, and sex abuse in particular. As usual, psychiatry chooses to treat the symptoms and ignore the cause and try to make the effects go away through brute force.

    The point about increasing a person’s weight while not addressing their psychological need to be excessively skinny is a point very well taken – the psychological stress from such a dilemma would be enormous! It is also kind of obvious but worth noting that gaining weight per se is not the actual goal of treatment for anorexia; a more healthy view of the body and of eating’s role in life is more to the point.

    Taking a traumatized person who obsessively avoids eating and creating obsessive urges to eat is even more extreme that psychiatry’s usual isnanity. It’s completely missing the point. But given psychiatry’s bizarre history, this should surprise no one.

    This is a very scary piece of research!

  10. I agree 100 percent psychiatry fails in most cases to address underlying causes such as nutritional deficiencies that may cause or contribute to a persons illness. That being said, I was batshit crazy in my eating disorder. After 3 years of starving myself to death, and running myself into the ground, I collapsed and almost died. I resisted meds in treatment, as well as resisted treatment. I was anorexic and orthopedic to the point every food was somehow bad for me. I would not listen. Finally, not able to gain weight, no appetite, severe digestive issues, and after so many psychotic breakdowns, my pdoc convinced me to try zyprexa. Overnight difference. Suddenly I could actually do therapy, and eat. I started to gain, and my digestion actually got better. I was headed in the right direction. Until I freaked out about a ten pound weight gain, and cold turkey went off zyprexa. Back to batshit crazy,and lost my “life” for a few years. I have battled my Ed in alternative ways all this time. Mentally, I’m so much more stable. Thank you mainstream therapy. But I lost my son due to my Ed, and I am also losing the fight. My digestion has shut down, I am not able to eat unless it is a formula. My heart is a mess. My kidneys are wrecked. In some ways I am worse than I was at first collapse. Alternative treatment only fed into my orthopedic, and made me physically much more ill than zyprexa did. Had I listened, and kept with treatment, I may have gotten better. A little plump? Probably, but with or without meds, after starvation the body overshoots before settling back down. I do know many people, yes MANY who have a life because of meds. My own mother for one. And many girls I met in treatment. I’m the only one so stuck on “natural” and the sickest. I am dying. What the hell do I have to lose by trying zyprexa again? 4 years of alternative failure and I have had enough. I will accept the hormone altering effects, because it saved my life before. It may now.

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