The pharmacological treatment of anxiety in people with eating disorders: A systematic review
Rebecca Morris, Janet Treasure, Hubertus Himmerich, Johanna Louise Keeler
Pharmacological Research May 14, 2025 DOI: 10.1016/j.phrs.2025.107782 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Systematic review Peer reviewed |
|---|---|
| Sample size | 51 |
| Population | People with eating disorders |
| Interventions | antidepressants antipsychotics antianxiety psychedelics |
| Topics | Anxiety |
| Keywords | Eating disorders Psychotherapist Clinical psychology Obsessive-compulsive spectrum disorders |
| Citations | 4 |
| Key findings | Evidence supports fluoxetine for anxiety in anorexia and bulimia nervosa and olanzapine for anxiety in anorexia nervosa, but results were mixed across drug classes and not significant for binge eating disorder. |
Abstract
People with eating disorders experience high rates of psychiatric comorbidities, including anxiety disorders such as generalised anxiety disorder, social anxiety disorder and specific phobias. Anxiety can influence the prognosis of an eating disorder, by worsening symptoms, and acting as a barrier to treatment. Therefore, targeting treatment efforts towards anxiety may improve eating disorder outcomes. The primary aim of this systematic review was to summarise the evidence base for the pharmacological treatment of anxiety symptoms in people with eating disorders. An electronic search of three databases (PubMed, Medline, and PsycInfo) was conducted. Papers were included if they investigated pharmacotherapy (antidepressants, antipsychotics, antianxiety, psychedelics, etc.) in eating disorder samples, with primary or secondary outcomes of anxiety. A total of 51 studies were included, and results were mixed across drug classes documenting both favourable and non-significant anxiety outcomes. There was evidence for the use of fluoxetine for anxiety in anorexia and bulimia nervosa, but not for binge eating disorder. Evidence for the use of olanzapine was documented for anxiety in AN, and preliminary case reports suggested its use in ARFID for anxiety symptoms. Preliminary evidence for developing pharmacological agents, such as psilocybin and ketamine, reported favourable outcomes in AN patients. More RCTs are required to explore efficacy and safety of pharmacological agents in treating anxiety in people with eating disorders.