Olanzapine use for the treatment of adolescents with anorexia nervosa - reflecting on research and clinical practice.

Anorexia nervosa is a complex and potentially devastating mental health (MH) diagnosis that is recognized as having high rates of non-response to treatment, pronounced medical as well as MH morbidity, and elevated mortality rates. Olanzapine is a second-generation atypical antipsychotic that has demonstrated benefit with weight gain in adults with anorexia nervosa (AN), although controlled research involving children and youth remains limited. In this commentary, the authors provide a brief history and review of research relating to olanzapine for the adjunctive treatment of children and adolescents with AN. Although the medication has been used for more than two decades, its mechanism of action remains incompletely understood and is likely multifactorial. Despite a paucity of research to guide clinical decision making, olanzapine prescription among youth with moderate to severe AN appears to be prevalent among eating disorder specialists in Canada. In addition to commenting on gaps and challenges related to controlled randomized research in this area, the authors reflect on factors likely contributing to olanzapine's adoption into clinical practice. Moving forward, it is critical that further research involving olanzapine for the adjunctive treatment of AN in youth be undertaken to better understand efficacy, appropriate indications for use, and safety profile.