Pharmacological therapy for anorexia nervosa is not enough successful. Mild to moderate anorexia nervosa is very prevalent in Iran. We wondered whether combination of antidepressants with appetizers (to block multiple neurotransmitters) could reverse the disease course.

Twenty seven patients with mild (8), moderate (12) and severe anorexia nervosa (7) were treated with escalating doses of three drugs (Olanzapine, Citalopram and Vitamin B6 in combination). The initial doses were 2.5 mg at night, 10 mg at noon and 40 mg TID and the increments were 2.5, 10 and 40 mg every 4 days, respectively. All patients were studied by way of the MCMI-III and clinical interview at admission and 6 weeks later. Additional behavior and cognitive therapy were used in compliant cases.

Almost all patients responded (overall response rate of 100%) and complete response of around 67%. Five and two partial responses were among the severe and moderate group. Weight gain was between 3–16% of primary body weights with a mean of 9% at 6 weeks. Depression and anxiety scores were reduced substantially studied by way of the MCMI-III and clinical interview. Maximal tolerated doses were 12.5, 40 and 360 mg respectively and most could be maintained with 5, 20 and 240 mg.

This combination regimen is extremely effective, well tolerated and without major side effects. Scheduled escalation increases compliance. High dose VitB6 has been used by us in the content of many psychological and auto immune disorders with much success. Longer follow up and larger studies are recommended.