Serotonergic and dopaminergic systems in anorexia nervosa: a role for atypical antipsychotics?

Objective: To review serotonergic and dopaminergic system function in anorexia nervosa in terms of potential modulation by atypical antipsychotic medications. Method: A systematic review of clinical, neurobiological and functional neuroimaging findings of serotonergic and dopaminergic system activity in anorexia nervosa was conducted via MEDLINE, PsycINFO and EMBASE psychiatry databases, with a critical review of dysregulation of these systems as therapeutic targets for atypical antipsychotics, in context of evidence regarding the utility and efficacy of these medications in this syndrome. Results: There is evidence of persistently altered serotonergic and dopaminergic function in anorexia nervosa independent to weight-recovery. Case reports, open-label and single-blinded studies, albeit sparse, suggest that atypical antipsychotics may be beneficial in the management of anorexia nervosa psychopathology beyond weight gain. Conclusions: Double-blind placebo controlled studies of atypical antipsychotics in anorexia nervosa with well defined outcome measures are required.