Antipsychotics Not Helpful for Anorexia


A review of all research on the use of antipsychotics for the treatment of anorexia nervosa found no demonstrable efficacy in terms of body weight. The data are available in the June issue of Journal of Clinical Psychiatry.

Abstract → 

Kishi, T., Kafantaris, V., et al; “Are Antipsychotics Effective for the Treatment of Anorexia Nervosa? Results From a Systematic Review and Meta-Analysis.” Journal of Clinical Psychiatry, 2012; 73(6): e757-e766

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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].


  1. I need to read this study but as someone who has struggled with chronic, severe anorexia for more than 20 years, I want to hesitate people to not jump to conclusions. It appears this study does not look at Abilify, and that the mean age is fairly young. I am 38 and recently found help from a combination of Abilify and Zoloft. I go back & forth on the merits of psychotropics – I both fear them and put hope in them. I still have yet to decide where I stand. While people in the recovery movement are quick to jump on the anti-medication wagon – and for good reason – I just would like to ask that we approach this subject with balance and nuance. Medications DO help SOME people. And if people in our camp decide to take them for that reason, that is their choice and should be respected. I do fear long-term side effects, and admittedly have gone off medication in the past couple weeks – in part due to some of my readings on this site! But at the same time, I notice my depression has worsened – possibly as a result. It’s always hard to say what is more socially & environmentally caused versus biochemical in origin. I think we have to remember “mental illness” is very complicated and there is no ONE cause – as you all well know. For some people there is in fact a biological component. For some people there’s not. Let’s just be quick not to immediately react in typical fashion because that’s where we’re supposed to stand as a movement. That’s the same as partisan politics – and we are better than that.

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  2. I guess for me, the idea of using psychotropics for an eating disorder doesn’t really seem to get to the basic issue. Is the person’s body image or set of beliefs about food really a simple matter of brain chemistry? Is the solution to create a situation where the client feels a strong sense of hunger, even if they still feel that their body is overweight?

    It seems to me that anorexia/bulimia (and I do have some direct clinical experience working with these issues) are more a matter of using food to meet other needs, and most commonly, a need to feel in control. There is a really high overlap with childhood abuse and neglect, especially sexual abuse. And of course, it’s MUCH more common in women, who are taught by our media and other social messages that being fat is the same as being bad and worthless.

    To try and handle this with chemical means seems to me even more misguided than for depression, anxiety or psychosis.

    Jean, I’d be very interested in hearing your perspective on these observations – have you had the opportunity to work though the issues that contribute to the eating disorder behavior? Or do you view it as a medical problem that therapy can’t help with?

    —- Steve

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    • I find this to be more than a trifle bizarre. Did it come on because one of the side effects of modern antipsychotics is that your weight doubles if you’re on them for any length of time, thanks to a now ravenous appetite? I think ads promoting this might have an amusing bizarre motif, maybe featuring “testimonials” from obese spokespeople (“before I saw the shrink, I only weighed 97 pounds-now I’m 300, at least!”) who were once anorexics.

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      • It is a typical, dense, heavy-handed, insensitive, context-absent psychiatric intervention. If someone doesn’t eat enough, let’s give them a drug to make them hungry! If they eat too much, let’s give them a drug to make them LESS hungry! If they take stimulants (which increase dopamine) and become aggressive, forget DECREASING the stimulants, let’s give them antipsychotics to decrease the dopamine we’re increasing with the stimulants!

        It’s like watching someone try to do sculpture with a pickaxe. They have no tool to do the job, but insist on doing it anyway, and regardless of the damage done, never seem to conclude that perhaps they ought to find a small chisel and hammer, but continue to hack away with the pickaxe and require everyone else to admire their “work.”

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