Successful treatment of anorexia with a combination of olanzapine, fluoxetine and mirtazapine at high doses: a case report

Background

Anorexia nervosa is one of the most difficult to treat psychiatric disorders, and (in contrast to bulimia) the role of pharmacotherapy is its treatment is limited to the management of comorbid disorders or secondary disorders.

Material and Methods

We report the case of a 21 years old female suffering from anorexia nervosa (restricting type).

Results

When admitted in our department she weighted 27 kg (height 160 cm). Her laboratory testing was normal. During the first two weeks of her admission she was refusing eat and insisted in exercising regularly. The case was considered a life-threatening one, the patient was fasted and a nasogastric tube was placed for feeding purposes. The pharmaceutical treatment rose gradually during the next week and reached 20 mg of olanzapine, 60 mg of mirtazapine and 60 mg of fluoxetine. The tube was left for only a week and then it was removed. The patient started eating with gradually increasing quantities. She remained in the hospital totally for 2.5 months more and during this period she gained 19 kg. No specific psychotherapeutic intervention was applied, so the improvement could be attributed mainly to medication. At release the patient not only was eating 3 fair meals daily but this was causing her minimal annoyance.

Discussion

To our knowledge this is the sole report in the literature on the use of the combination of olanzapine with antidepressants in the treatment of anorexia nervosa, without the co-administration of any kind of psychotherapy.