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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by Phillipa on October 31, 2008, at 19:36:39
Sorry thought this was important enough a study to post full abstrace as deals with a subject so many have. Phillipa forgive any advertisements.
mate Attenuate Psychotropic-Induced Weight Gain?
Posted 10/01/2008Darrell T. Hulisz, PharmD
Author Information
Efficacy of Add-on Topiramate Therapy in Psychiatric Patients With Weight Gain
Cates ME, Feldman JM, Boggs AA, Woolley TW, Whaley NP
Ann Pharmacother. 2008;42:505-510Study Summary
Cates and colleagues conducted a retrospective chart review at a community mental health clinic of 41 patients who had been prescribed topiramate for documented weight gain during stabilized treatment with psychotropic drugs.[1] A positive response was defined as weight loss of any magnitude from baseline to endpoint. Overall, the response rate was 58.5%, with mean reductions in weight of 2.2 kg. However, in those 24 patients who achieved a positive response, the mean weight loss was 7.2 kg, or an average 6.9% decrease from baseline.Heavier patients at baseline and those receiving a greater number of psychotropic drugs were more likely to experience greater weight loss with topiramate. Patients who responded favorably had a typical weight loss of 0.45-1.4 kg per month. Topiramate dosages were usually initiated at 50 mg/day, and the average maximum dose was 100 mg/day. Seven patients experienced adverse effects, mostly consisting of "cognitive dulling" and/or increased appetite.
Viewpoint
Weight gain is notoriously associated with psychotropic drugs, particularly atypical antipsychotic drugs (eg, olanzapine, clozapine, and risperidone). This study used a retrospective methodology similar to that reported by Khazaal and colleagues,[2] and the study authors reached a similar conclusion: Topiramate appears to be effective in reversing the weight gain that is associated with antipsychotic drugs.However, one important difference is that the average daily dose of topiramate reported in this study was about half that used in the Khazaal case series. In the latter study, 22% of patients discontinued use of topiramate because of side effects, compared with only 7.3% of patients in this study.
There are several limitations to this study, including those inherent to all retrospective chart reviews, namely, that data collection is limited to what is documented in patients' medical records. Other potential confounders exist, such as unknown medication adherence rates, differences in individual lifestyle modifications, fluctuations in weight gain, and the presence of other drugs known to induce weight gain, which was not reported.
Although this study suggested that topiramate is effective at attenuating weight gain associated with psychotropic drugs, I would prefer to see the results of a randomized, placebo-controlled trial. Controlling for these potential confounders is necessary to determine the magnitude of weight gain reversal associated with topiramate, as well as better defining the optimal dose and adverse reaction profile of the drug.
Abstrac Very small trial but interesting. Phillipa
Posted by Medline on November 1, 2008, at 3:02:05
In reply to Help for weight loss from meds., posted by Phillipa on October 31, 2008, at 19:36:39
Topiramate and Zonisamide have weight loss as a side effect in most of their studies. They are especially effective for that purpose when combined with a stimulant like Bupropion or Phentermine.
Bupropion + Zonisamide:
http://www.orexigen.com/candidates/candidates_empatic_clinical.php
Bupropion + Naltrexone:
http://www.orexigen.com/candidates/candidates_contrave_clinical.php
Topiramate + Phentermine:
http://www.medicalnewstoday.com/articles/43246.php
Posted by Phillipa on November 1, 2008, at 19:21:24
In reply to Re: Help for weight loss from meds., posted by Medline on November 1, 2008, at 3:02:05
Sounds like they are still undergoing trials and not approved yet. Phillipa
Posted by yxibow on November 2, 2008, at 2:47:55
In reply to Re: Help for weight loss from meds., posted by Medline on November 1, 2008, at 3:02:05
Topamax and Zonegran also carry risks -- Topamax especially.
Buproprion is naturally going to reduce weight in some people because it is distantly related to Tenuate, an old and not used weight loss drug.
One has to remember though in the population that has anxiety, stimulants that were mentioned could create fire.
And yes, those seemed to be in trial, phase II which is early in the pipeline. Also the amount lost didn't seem to be grand -- an amount yes.
I've even tried Hoodia, the real ones that are certified and only contain it, and yes, it makes you feel a little less hungry -- it also makes one potentially nauseated and in my case it increased my psychosis NOS or anxiety level, one or the other. So this isn't an endorsement for that.
Sometimes H2 antagonists like otc Zantac make me feel less hungry, but its also basically feeling a bit more nauseated. Yes, there was the Axid study but that was mostly because it was made by the same company.There's no free lunch, no pun intended -- I don't know how to manage my weight. It has become a real problem.
I know I'm kept told to try walking regularly -- its hard when you're depressed. And basically I have to watch my diet, which of course is also hard.
Its good for my health to be a vegetarian but I have to eat a lot of "fake meats" to substitute carbohydrates with protein, and salads, which are essentially pure fiber anyhow.
Cereal in the morning is a problem, which again I have to figure other ways to substitute.
-- tidingsJay
Posted by raisinb on November 3, 2008, at 14:10:05
In reply to Re: Help for weight loss from meds., posted by yxibow on November 2, 2008, at 2:47:55
I'm continually surprised that bupropion isn't prescribed off-label for weight loss. It's so effective for that.
I agree, though, that if your depression includes insomnia or anxiety, it's a bad idea.
This is the end of the thread.
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