The Role, Effectiveness, and Safety of Pharmacotherapy in Eating Disorders (Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, and Sleep-Related Eating Disorder): A Review of Current Evidence and Meta-Analyses

Eating disorders (EDs), including anorexia nervosa, bulimia nervosa, binge eating disorder and sleep-related eating disorder are complex psychiatric conditions with multifactorial determinants. Psychotherapy and structured nutritional rehabilitation remain the cornerstone of treatment, while pharmacotherapy serves an adjunctive role to address core symptoms, comorbid psychiatric conditions, and behavioral dysregulation. In adults, selective serotonin reuptake inhibitors (SSRIs), particularly fluoxetine, are effective for reducing binge-purge behaviors in BN, with doses up to 60 mg/day. Lisdexamfetamine is FDA-approved for moderate-to-severe BED, reducing binge frequency via dopaminergic and noradrenergic pathways. Topiramate can reduce binge eating and promote modest weight loss but is limited by cognitive and gastrointestinal side effects. In AN, pharmacotherapy is largely adjunctive, atypical antipsychotics such as olanzapine may modestly improve weight and pre-meal anxiety, while SSRIs mainly address mood symptoms post-weight restoration. Sleep Related Eating Disorders management involves SSRIs, topiramate, and clonazepam, alongside treatment of underlying sleep disorders. In children and adolescents, pharmacotherapy evidence is limited. SSRIs show minimal efficacy for core AN symptoms and are mainly used for comorbid anxiety or depression. Fluoxetine may reduce binge-purge behaviors in adolescent BN when combined with psychotherapy, and olanzapine can offer modest benefit, though metabolic and sedation risks require monitoring. Overall, pharmacotherapy enhances symptom management and engagement when integrated with psychotherapy and nutritional rehabilitation but is not a standalone treatment. Careful selection, dosing, and monitoring are essential to balance efficacy with potential adverse effects. Ongoing research is needed to clarify pharmacological strategies in AN, pediatric populations, and treatment-resistant EDs.