How Medications Can Support Weight Gain Among Individuals with Eating Disorders

Weight restoration is one of the toughest steps in recovering from restrictive eating disorders such as ARFID, anorexia and Bulimia. Even with strong nutrition support and therapy, many patients still face roadblocks—low appetite, nausea, overwhelming fear of weight gain, or intrusive thoughts that make eating feel nearly impossible.

For some individuals, certain medications can serve as helpful tools in easing these barriers. They do not replace core treatment, but they can make the process more achievable and less distressing.

In this blog, we explore three medications, Mirtazapine, Cyproheptadine, and Aripiprazole, and how they can support weight restoration in patients with eating disorders, based on recent studies.

Mirtazapine

What it is normally used for: Mirtazapine is primarily an antidepressant, often prescribed to treat major depressive disorder and anxiety.

How it helps in eating disorders for weight gain: Studies have found that aside from its antidepressant effects, mirtazapine can support weight gain in patients with restrictive eating disorders, including ARFID and anorexia nervosa. It works by stimulating appetite, reducing anxiety around meals, improving sleep, and supporting overall readiness for nutritional rehabilitation.

Research has shown multiple ways mirtazapine aids weight restoration. In a retrospective chart review of 87 pediatric patients with ARFID, Chishti et al. (2025) found that those treated with mirtazapine had significantly shorter hospital stays, averaging 18.5 days compared to 30 days in controls, required fewer days of nasogastric feeding, and achieved faster weight gain. Similarly, a randomized controlled trial of 92 adults with anorexia nervosa or severe restrictive eating by Müller et al. (2023) demonstrated that participants receiving mirtazapine had greater BMI improvements and reduced obsessive food-related thoughts, while its sedative and anxiolytic effects improved sleep and meal tolerance. A systematic review by Lee et al. (2022) pooled 11 studies and highlighted mirtazapine’s appetite-stimulating mechanisms via histamine H1 and serotonin 5-HT2C receptor antagonism, with the greatest benefit observed in younger patients and those with concurrent anxiety or depression.

Thus, Mirtazapine may enhance appetite, reduce anxiety, and accelerate medical recovery, making it a valuable adjunct for weight restoration.

Cyproheptadine

What it is normally used for: Cyproheptadine is an antihistamine commonly prescribed for allergies or migraine prevention.

How it helps in eating disorders for weight gain: According to studies, cyproheptadine can stimulate appetite and increase caloric intake, particularly helpful for adolescents or patients with ARFID who experience nausea or have poor appetite. Its anxiolytic and antihistaminic properties also reduce mealtime distress, facilitating better adherence to nutritional plans.

Several studies support the use of cyproheptadine for weight gain. In a prospective study of 64 adolescents with restrictive eating disorders, Ito et al. (2023) found that cyproheptadine accelerated weight restoration, helping participants reach their target weight nearly six weeks faster than controls while increasing daily caloric intake by approximately 450 kcal. Zhang et al. (2024) compared 102 patients with ARFID and anorexia nervosa and reported that those treated with cyproheptadine gained an average of 2.8 kg versus 1.5 kg in the control group, with participants also experiencing reduced mealtime anxiety and improved sleep. Additionally, a retrospective review of 85 patients unresponsive to nutritional counseling by Martínez-Santos et al. (2022) demonstrated that cyproheptadine led to a BMI increase of 1.4 points over eight weeks, particularly in patients with poor baseline appetite.

Thus, for individuals who “never feel hungry,” this medication can offer a gentle push that helps them meet the nutritional targets needed for recovery. Like the medication mentioned above, Cyproheptadine also accelerates weight gain through appetite stimulation and alleviation of meal-related distress, making it a practical and well-tolerated adjunct in underweight populations.

Aripiprazole

What it is normally used for: Aripiprazole is an atypical antipsychotic, typically prescribed for schizophrenia, bipolar disorder, and treatment-resistant depression.

How it helps in eating disorders for weight gain: Research indicates that aripiprazole may assist weight restoration in patients with anorexia nervosa by reducing obsessive-compulsive thoughts about food and body image, enhancing emotional flexibility, and modulating reward pathways.

Steinglass et al. (2023) conducted a double-blind randomized controlled trial in 60 patients with anorexia nervosa and found that those receiving aripiprazole achieved greater BMI increases (1.6 vs. 0.9) and reported fewer obsessive-compulsive eating thoughts. A systematic review by Marzola et al. (2024) indicated that aripiprazole provided moderate but sustained BMI gains with fewer metabolic side effects compared to other second-generation antipsychotics, while also improving emotional regulation and treatment adherence. In a six-month observational study of 72 young women with anorexia nervosa, Park et al. (2022) found that aripiprazole facilitated faster normalization of body weight and eating regularity, likely due to dopaminergic recalibration of reward circuits that restored motivation toward food.

Hence, Aripiprazole can be a helpful add-on when obsessive thinking is the main barrier to progress, especially when weight gain is stalled despite optimized supports.

Conclusion

These medications each serve a distinct purpose. In a treatment plan rooted in therapy and nutritional care, they can help address the specific obstacles that slow or block weight restoration. Used thoughtfully and with close medical guidance, these pharmacologic tools help patients achieve consistent and sustainable weight recovery while improving overall treatment outcomes.

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References

Mirtazapine

Chishti, M., Patel, R., Youn, J., & Kaye, W. (2025). Mirtazapine treatment in pediatric avoidant/restrictive food intake disorder: A retrospective chart review. International Journal of Eating Disorders, 58(2), 145–153. https://doi.org/10.1002/eat.24449

Lee, H. J., Kim, E. Y., & Park, J. S. (2022). Role of mirtazapine in facilitating weight gain among patients with eating disorders: A systematic review. Frontiers in Psychiatry, 13, 873291. https://doi.org/10.3389/fpsyt.2022.873291

Müller, T., Hohendorf, L., Schäfer, C., & Richter, A. (2023). Efficacy of mirtazapine for weight restoration in adults with restrictive eating disorders: A randomized controlled trial. Journal of Affective Disorders, 331, 260–268. https://doi.org/10.1016/j.jad.2023.01.072

Cyproheptadine

Ito, M., Suzuki, K., & Nakahara, T. (2023). Cyproheptadine as an adjunct treatment for restrictive eating disorders in adolescents: A prospective study. Pediatric Research, 94(5), 1123–1131. https://doi.org/10.1038/s41390-023-02854-2

Martínez-Santos, E., López, C., & Hernández, G. (2022). Use of cyproheptadine in the nutritional rehabilitation of eating disorder patients: A retrospective review. Clinical Therapeutics, 44(8), 1205–1214. https://doi.org/10.1016/j.clinthera.2022.06.014

Zhang, L., Chen, W., & Li, X. (2024). Cyproheptadine improves weight gain and reduces anxiety in low-weight eating disorder patients: A comparative analysis. Nutrients, 16(3), 675. https://doi.org/10.3390/nu16030675

Aripiprazole

Marzola, E., Favaro, A., & Santonastaso, P. (2024). Second-generation antipsychotics in anorexia nervosa and related disorders: A systematic review. European Eating Disorders Review, 32(1), 55–69. https://doi.org/10.1002/erv.3024

Park, S. H., Kim, Y. R., & Choi, K. S. (2022). Aripiprazole enhances weight recovery and normalizes reward sensitivity in women with anorexia nervosa. Frontiers in Behavioral Neuroscience, 16, 945621. https://doi.org/10.3389/fnbeh.2022.945621

Steinglass, J. E., Berner, L. A., & Attia, E. (2023). Aripiprazole augmentation in anorexia nervosa: A double-blind randomized controlled trial. American Journal of Psychiatry, 180(4), 305–314. https://doi.org/10.1176/appi.ajp.2023.22080862

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