Eating disorders often have serious medical complications, including the highest mortality rates of any psychiatric disorder. The search for an optimal therapeutic strategy during the last decades has been difficult and it has included antidepressants, antipsychotics, anticonvulsants, benzodiazepines and mood stabilisers.

To review the medical literature related to the treatment of eating disorders with atypical antipsychotics.

Medline search and ulterior review of the related literature. Keywords: “eating disorders”; “anorexia nervosa”; “bulimia nervosa”; “binge eating disorder”; “antypsychotic agents”.

To the date, most of the studies have been with olanzapine. Olanzapine has shown effects, not only on weight gain, but also on management of other psychological features such as obsessive-compulsive symptoms, depression, aggression, persistence and interpersonal distrust. However, most of these studies have been compared to placebo, and binge-eating behaviour has also been described when using olanzapine (not with aripiprazole or ziprasidone). Recently, Marzola et al, when comparing olanzapine + SSRIs versus aripiprazol + SSRIs, described that aripiprazole (compared to olanzapine) is significantly more effective in reducing purging episodes, eating preoccupations and rituals.

So far, aripiprazol and olanzapine have been proved to be the most effective atypical antypsichotics in eating disorders, especially in anorexia nervosa. However, most of studies were placebo-controlled and in quite small samples. Further investigation is needed.

The authors have not supplied their declaration of competing interest.