Phentermine, Qsymia and Belviq welcome Contrave to the Family

On September 11th, a new appetite-suppressing drug was approved by the FDA... Contrave.  I thought this might be a good time to talk a little bit about the prescription medications that exist for weight loss and things you may want to consider before talking to your doctor about one of them.

Phentermine
If phentermine sounds familiar it's probably because it was famously part of the the Fen-Phen diet pill that was removed from the market back in 1996.  The issue was that the combination of Phentermine and Fenfluramine was causing a significant number of cases of pulmonary hypertension.  Many more than the trials and the labeling would have led the consumer to believe.  The removal of the Fenfluramine took away some of the side effects, but Phentermine is still not approved for long-term use so keep that in mind.  Phentermine will also speed you up quite a bit.  If you get some anxiety when you drink too much coffee, well hold on to your butt with this one.  Your body does eventually adjust, but initially you'll have a ton of energy from it, perhaps too much.  Phentermine helps to suppress the appetite and it is unclear whether it has any effect on metabolism.  So with suppression of appetite, you may experience weight loss as a result of eating less food.

Belviq
Belviq acts with serotonin to accomplish weight loss.  It seems that it enhances the activity of serotonin which can help improve mood and depression symptoms.  If this is the case, then it would be beneficial to those who tend to overeat as a reaction to depression or stress.  Belviq's action is thought to affect centers in the brain that control your appetite - like the hypothalamus.  In the trials for this medication, those taking it lost 3-3.7% more than those taking a placebo.

Qsymia
Qsymia is a combination of phentermine (mentioned above) and topiramate.  Topiramate is a migraine medication which carries a laundry list of side effects.  The worst seem to be some variations of neuropathy - tingling of your hands, feet, legs, arms, face... you name it.  Topiramate, since it acts directly with brain chemistry to help migraine sufferers is going do the same to you even though you might not have migraines.  It is not clear why this particular option showed better results in studies... 6.7-8.9% more weight lost than those taking the placebo.  Again, aside from acting on your appetite the researchers cannot determine if it plays a role with increasing metabolism.  This is by far my least favorite of all the options because it carries so many horrible side effects with it, and a quick glance at the reviews of it on webmd.com don't really indicate that people care much for it.

Contrave
This is the new one.  It is a combination of an anti-addition drug, Naltrexone, and an anti-depressant, Bupropion.  The brand name, Wellbutrin, of Bupropion might be better known.  It is one of the few anti-depressants that doesn't seem to cause weight gain in users the way that so many others may.  This drug showed weight loss of 2-4.1% in users as compared to those taking the placebo.  It, like the others, is an appetite suppressant... and again researchers don't really know if it does anything else.

So what do I think of these?  Well... that's a tough call to make for me.  If the medication is somehow also affecting your basal metabolic rate, then perhaps there is some benefit.  But in medicine we need to determine whether the benefits outweigh the risks.  This is generally the reason that unless your BMI is 30+, or 27+ with a history of high blood pressure, high cholesterol, or diabetes, you won't be getting your hands on it.  It just isn't worth it.

The fact that most are noted to affect appetite, and very little else, may help some who are struggling to reduce their calorie intake... but that just makes me wonder what you all are going to do when you stop taking the medication.  Will the length of time you take it be long enough for you to reset your body so that you are no longer wanting to eat such large quantities of food?  Who knows.  Are people willing to do the hard work of changing their eating habits and exercising while taking the medication?  Or are people just thinking they can pop the pill and solve all their problems?  I think these appetite-suppressing pills are a great alternative to those considering things like gastric bypass or lap-band surgery.  Much less invasive.  But if all they're really doing is suppressing your appetite, then do you think that maybe you could have saved that money and exercised some more effort on controlling over-eating behaviors?  What do you think?