Mirtazapine and Weight Gain in Avoidant and Restrictive Food Intake Disorder
Abstract
Avoidant and restrictive food intake disorder (ARFID) is a newly classified disorder in the DSM-5 that describes a pattern of restrictive eating across the lifespan that results in significant weight loss, nutritional deficiency, dependence on enteral feeding or nutritional supplements, or marked interference in psychosocial functioning.1 Currently, there are no evidence-based treatment approaches or medications for this disorder.2 We have administered a range of psychoactive medications to those with ARFID in our treatment program in an attempt to find an effective medication. One medication of interest has been mirtazapine because it promotes appetite and weight gain, decreases nausea and vomiting, and improves gastric emptying. Although mirtazapine is an off-label approach in a pediatric population and carries a black box warning for an increased risk of suicide, it is an effective treatment for depression and anxiety symptoms in adults and is generally well tolerated.3,4 There are no studies to date reporting on the use of mirtazapine in patients with ARFID.
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Evidence for psychopharmacologic treatment of ARFID is limited, but one case report supported Mirtazapine for weight gain, gastric emptying, and reducing nausea and vomiting.
“There is little evidence for the use of psychopharmacologic agents in the treatment of ARFID, however, a case report supported the use of Mirtazapine to promote weight gain and improve gastric emptying while decreasing nausea and vomiting (Gray, Chen, Menzel, Schwartz, & Kaye, 2018).”
From Feeling and body investigators (FBI): ARFID division—An acceptance-based interoceptive exposure treatment for children with ARFID (2019) · cites this paper as Gray, Chen, Menzel, Schwartz, & Kaye, 2018
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Research works printed but not linked: 3
- [2]2. Forman S, McKenzie N, Hehn R, et al . Predictors of outcome at 1 year in adolescents with DSM5 restrictive eating disorders: report of the National Eating Disorders Quality Improvement Collaborative. J Adolesc Health. 2014;44:750-756.
- [3]3. Anttila S, Leinonen E. A review of the pharmacological and clinical pro fi le of mirtazapine. CNS Drug Rev. 2001;7:249-264.
- [4]4. Watanabe N, Omori I, Nakagawa A, et al . Mirtazapine versus other antidepressive agents for depression. Cochrane Database Syst Rev. 2014;12:CD006528. All statements expressed in this column are those of the authors and do not re fl ect the opinions of the Journal of the American Academy of Child and Adolescent Psychiatry . See the Instructions for Authors for information about the preparation and submission of Letters to the Editor.
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Canadian practice guidelines for the treatment of children and adolescents with eating disorders
Couturier, J., Isserlin, L., Norris, M., Spettigue, W., Brouwers, M., Kimber, M., McVey, G., Webb, C., Findlay, S., Bhatnagar, N., et al. (2020) · Journal of Eating Disorders · doi:10.1186/s40337-020-0277-8 · Cited by 215 · see citing works
Cognitive–behavioral treatment of avoidant/restrictive food intake disorder
Thomas, J. J., Wons, O. B., & Eddy, K. T. (2018) · Current Opinion in Psychiatry · doi:10.1097/yco.0000000000000454 · Cited by 97 · see citing works
Zucker, N. L., LaVia, M. C., Craske, M. G., Foukal, M., Harris, A. A., Datta, N., Savereide, E., & Maslow, G. R. (2019) · International Journal of Eating Disorders · doi:10.1002/eat.22996 · Cited by 88 · see citing works
Nutritional Risks of ARFID (Avoidant Restrictive Food Intake Disorders) and Related Behavior
Feillet, F., Bocquet, A., Briend, A., Chouraqui, J.-P., Darmaun, D., Frelut, M.-L., Girardet, J.-P., Guimber, D., Hankard, R., Lapillonne, A., et al. (2019) · Archives de Pédiatrie · doi:10.1016/j.arcped.2019.08.005 · Cited by 51 · see citing works
- Authors
- Gray, E., Chen, T., Menzel, J., Schwartz, T., & Kaye, W. H.
- Affiliations
- University of California San Diego (US)
- Corresponding author
- Gray, Emily
- Venue
- Journal of the American Academy of Child & Adolescent Psychiatry
- Publisher
- Elsevier BV
- Published
- 2018-04
- Volume
- 57
- Issue
- 4
- Pages
- 288-289
- ISSN
- 0890-8567 (ISSN-L)
- OpenAlex
- W2789395492
- Cited by
- 67
- References
- 0
- Citations by year
- 2026: 4 · 2025: 10 · 2024: 11 · 2023: 12 · 2022: 3 · 2021: 9 · 2020: 9 · 2019: 4 · 2018: 5
- FWCI
- 7.52
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Keywords
- mirtazapine, weight gain, appetite, off-label drug use, eating disorders in children, nausea and vomiting, gastric emptying, suicide risk
- MeSH terms
- Mirtazapine, Adolescent, Adult, Antidepressive Agents, Anxiety Disorders, Feeding and Eating Disorders, Child, Female, Humans, Male, Retrospective Studies, Weight Gain, Mood Disorders, Young Adult, Off-Label Use
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