Written by Simon Liebling, BA.
One of our research priorities at the Columbia Center for Eating Disorders is to look for new treatments that might hold promise for one of the most tenacious eating disorders – anorexia nervosa. That effort bore fruit earlier this year, when a team of our doctors, led by Dr. Evelyn Attia, working alongside scientists from four other hospitals in the United States and Canada, identified the first-ever medication shown to have promise in the treatment of adults with anorexia nervosa—olanzapine.
The hunt for a medication that could be used to treat anorexia nervosa dates back decades. Until recently, research efforts here and by our colleagues at other institutions were frustratingly unsuccessful. Hoping to take advantage of the fact that anorexia nervosa shares some key characteristics with other psychiatric illnesses, doctors have tried time and again to repurpose a host of drugs that we already use for those other conditions, including many antidepressants and antipsychotics. In fact, Dr. Attia herself has been involved in multiple medication studies here at Columbia over the years, including trials indicating that Prozac was not helpful to patients with anorexia nervosa for weight restoration or relapse prevention. All told, medication studies in adults with this disorder offered no hint of a drug that could help patients return to a healthy weight or to alleviate the psychological symptoms of anorexia nervosa, leaving us without any good medicinal options to which we can turn.
The search is especially urgent for adult patients. While the psychological approaches that we currently rely on typically work well for teenagers with anorexia nervosa, they become less likely to be effective as patients get older. As a result, adult anorexia nervosa is one of the most difficult eating disorders to treat successfully.
Olanzapine, the drug tested in our recent study, is another medicine familiar to psychiatrists: it’s an antipsychotic that has been used to treat illnesses like bipolar disorder since the 1990s. It was a promising candidate for anorexia nervosa, though, because of something we’d normally think of as a side effect—when patients without eating disorders take olanzapine, they often gain weight. By giving olanzapine to patients with anorexia nervosa, we hoped that we could put that a normally unintended effect to therapeutic use.
Together with colleagues at Weill Cornell, Johns Hopkins, the University of Pittsburgh, and the Toronto Center for Addiction and Mental Health, we recruited over 150 adult volunteers with anorexia nervosa to join the trial, making this the largest experiment about treating anorexia nervosa with medication ever conducted. Each participant was randomly sorted into one of two evenly sized groups, which determined whether they received olanzapine or a placebo (an “inactive pill”). Neither study participants nor study doctors knew which pills – active or inactive – patients were assigned to receive (A few select members of the staff outside of the research team were aware.). We followed each patient for 16 weeks, during which time the patients met once a week with a psychiatrist for an evaluation and we kept track of changes in their weight and psychological health.
When the experiment concluded, we found that the participants who had been assigned to receive olanzapine saw an average body mass index increase of 0.259 per month, while those who were given a placebo had an average increase of only 0.095 per month. Changes in BMI can be tough to make sense of in real-world terms, though. More intuitively, that difference means that an average-height woman with anorexia nervosa who is taking olanzapine would gain one pound per month more than someone who is not.
These results are notable because they mark the first time that we have found a medication with a positive impact of any size for patients with anorexia nervosa. We were also encouraged to find that participants didn’t experience some of the adverse side effects that normally accompany olanzapine use, including elevated cholesterol and blood glucose. That said, olanzapine’s effect on weight gain is modest to be sure, and we found that olanzapine didn’t produce any improvement in the psychological symptoms of anorexia nervosa, including obsessionality or concerns about body shape and weight.
Ultimately, olanzapine could be a useful addition to our current treatment strategies or serve as a stopgap option for patients who lack access to more comprehensive care. And for patients and researchers who have experienced repeated disappointment in the search for a drug for anorexia nervosa, olanzapine serves as a hopeful and encouraging reminder that it is possible to find effective medications for what may at times seem like an unyielding illness.
For More Information
To hear more about this study, its results, and their implications, listen to Dr. Evelyn Attia’s discussion with the executive editor of the American Journal of Psychiatry.
To read the journal article, check out:
Attia E, Steinglass JE, Walsh BT, Wang Y, Wu P, Schreyer C, Wildes J, Yilmaz Z, Guarda AS, Kaplan AS, Marcus MD. (2019). Olanzapine versus placebo in adult outpatient with anorexia nervosa: a randomized controlled trial. American Journal of Psychiatry, 176(6), 449-456.