CNS Drugs

, Volume 18, Issue 10, pp 629–651 | Cite as

Psychotropic Drugs in the Treatment of Obesity

What Promise?
  • Jose C. Appolinario
  • João R. Bueno
  • Walmir Coutinho
Leading Article


Obesity is a chronic and highly prevalent medical condition associated with increased risk for the development of numerous and sometimes fatal diseases. Despite its severity, there are few anti-obesity agents available on the market. Although psychotropic agents are not approved for the treatment of obesity, they have been used by clinicians as a therapeutic tool in daily clinical practice. The purpose of this article is to review the rationale, as well as the evidence, for the potential use of these agents in obesity treatment.

Evidence for the efficacy of psychotropic agents in obesity treatment comes from different sources. The first type of evidence is weight loss observed with treatment in clinical trials of patients with neuropsychiatric syndromes (e.g. mood disorders, epilepsy). A recent example of such findings is the weight reduction reported in clinical trials involving obese patients with binge eating disorder. While randomised, controlled trials specifically designed to investigate the weight loss properties of psychotropic agents in obese patients are the most appropriate source of evidence of anti-obesity action, such trials remain scarce.

The most studied psychotropic agents in obesity trials are drugs used in the treatment of mood disorders, i.e. mainly antidepressants and antiepileptics. SSRIs (e.g. fluoxetine, sertraline and fluvoxamine) were amongst the first psychotropic agents investigated in the treatment of obesity. Additional data have also been published for other antidepressants (e.g. venlafaxine, citalopram and bupropion) and antiepileptics (e.g. topiramate and zonisamide). Based on the available data for the efficacy of psychotropic agents in obesity and other related conditions, SSRIs may be considered for the management of certain subgroups of obese individuals with comorbid conditions such as depression, binge eating disorder and type 2 diabetes mellitus. In addition, some newer agents, such as bupropion, topiramate and zonisamide, appear to be promising candidates for selective use in the treatment of obesity. However, further studies are needed to define their possible role as new pharmacological options in the treatment of obesity.



Dr Appolinario has received research grants from Abbott Laboratórios, Brazil and Janssen-Cilag Farmacêutica, Brazil. Dr Bueno has no conflicts of interest directly related to the content of this review. Dr Coutinho has received research grants from Abbott Laboratórios, Brazil and Roche, Brazil. Dr Coutinho is also on the advisory board of Abbott Laboratories. There were no outside sources of funding used in the preparation of this review.


  1. 1.
    Bray GA. Use and abuse of appetite-suppressant drugs in the treatment of obesity. Ann Intern Med 1993; 119(7): 707–13PubMedGoogle Scholar
  2. 2.
    Stahl SM. How to appease the appetite of psychotropic drugs. J Clin Psychiatry 1998; 59(10): 500–1PubMedCrossRefGoogle Scholar
  3. 3.
    World Health Organization. Obesity: preventing and managing the global epidemic. Report of WHO Consultation. Geneva: WHO, 2000Google Scholar
  4. 4.
    Rossner S. Obesity: the disease of the twenty-first century. Int J Obes Relat Metab Disord 2002; 26Suppl. 4: S2–4PubMedCrossRefGoogle Scholar
  5. 5.
    Monteiro CA, Mondini L, de Souza AL, et al. The nutrition transition in Brazil. Eur J Clin Nutr 1995; 49: 105–13PubMedGoogle Scholar
  6. 6.
    Bray GA. Contemporary diagnosis and management of obesity. Newtown: Handbooks in Health Care Co, 1998Google Scholar
  7. 7.
    Woods SC, Seeley RJ. Understanding the physiology of obesity: review of recent developments in obesity research. Int J Obes Relat Metab Disord 2002; 26Suppl. 4: S8–S10PubMedCrossRefGoogle Scholar
  8. 8.
    Keesey RE, Hirvonen MD. Body weight set-points: determination and adjustment. J Nutr 1997; 127: 1875S–83SPubMedGoogle Scholar
  9. 9.
    Comuzzie AG, Allison DB. The search for human obesity genes. Science 1998; 280: 1374–7PubMedCrossRefGoogle Scholar
  10. 10.
    Hill JO, Peters JC. Environmental contributions to the obesityepidemic. Science 1998; 280: 1371–4PubMedCrossRefGoogle Scholar
  11. 11.
    Friedman JM. Obesity in the new millennium. Nature 2000; 404(6): 632–4PubMedGoogle Scholar
  12. 12.
    Yanovski SZ, Yanovski MD. Obesity. N Engl J Med 2002; 346: 591–602PubMedCrossRefGoogle Scholar
  13. 13.
    Bray GA, Tartaglia LA. Medicinal strategies in the treatment of obesity. Nature 2000; 404(6): 672–7PubMedGoogle Scholar
  14. 14.
    Bray GA, Ryan DH, Gordon D, et al. A double-blind randomized placebo-controlled trial of sibutramine. Obes Res 1996; 3: 263–70Google Scholar
  15. 15.
    James WPT, Astrup A, Finer N, et al. Effects of sibutramine on weight maintenance after weight loss: a randomised trial. Lancet 2000; 356: 2119–25PubMedCrossRefGoogle Scholar
  16. 16.
    Finer N, James WP, Kopelman PG, et al. One-year treatment of obesity: a randomized, double-blind, placebo-controlled, multicentre study of orlistat, a gastrointestinal lipase inhibitor. Int J Obes Relat Metab Disord 2000; 24(3): 306–13PubMedCrossRefGoogle Scholar
  17. 17.
    Sjostrom L, Rissanen A, Andersen T, et al. Randomised placebo-controlled trial of orlistat for weight loss and prevention of weight regain in obese patients. European Multicentre Orlistat Study Group. Lancet 1998; 352(9123): 167–72PubMedCrossRefGoogle Scholar
  18. 18.
    Blundell J. Pharmacological approaches to appetite suppression. Trends Pharmacol Sci 1991; 12: 147–57PubMedCrossRefGoogle Scholar
  19. 19.
    Woods SC, Schwartz MW, Baskin DG, et al. Food intake and the regulation of body weight. Annu Rev Psychol 2000; 51: 255–77PubMedCrossRefGoogle Scholar
  20. 20.
    Halford JC, Blundell JE. Pharmacology of appetite suppression. Prog Drug Res 2000; 54: 25–58PubMedCrossRefGoogle Scholar
  21. 21.
    Halford JC, Cooper GD, Dovey TM, et al. The psychopharmacology of appetite: targets for potential anti-obesity agents. Curr Med Chem —CNS Agents 2003; 3(4): 283–310CrossRefGoogle Scholar
  22. 22.
    Lustig RH. The neuroendocrinology of obesity. Endocrinol Metab Clin North Am 2001; 30(3): 765–85PubMedCrossRefGoogle Scholar
  23. 23.
    Schwartz MW, Woods SC, Porte Jr D, et al. Central nervous system control of food intake. Nature 2000; 404(6778): 661–71PubMedGoogle Scholar
  24. 24.
    McMinn JE, Baskin DG, Schwartz MW. Neuroendocrine mechanisms regulating food intake and body weight. Obes Rev 2000; 1(1): 37–46PubMedCrossRefGoogle Scholar
  25. 25.
    Astrup A, Lundsgaard C. What do pharmacological approaches to obesity management offer: linking pharmacological mechanisms of obesity management agents to clinical practice. Exp Clin Endocrinol Diabetes 1998; 106Suppl. 2: 29–34PubMedCrossRefGoogle Scholar
  26. 26.
    Mertens IL, Van Gaal LF. Promising new approaches to the management of obesity. Drugs 2000; 60(1): 1–9PubMedCrossRefGoogle Scholar
  27. 27.
    Blundell JE. Is there a role for serotonin (5-hydroxytryptamine) in feeding? Int J Obes 1977; 1(1): 15–42PubMedGoogle Scholar
  28. 28.
    Meguid MM, Fetissov SO, Varma M, et al. Hypothalamic dopamine and serotonin in the regulation of food intake. Nutrition 2000; 16(10): 843–57PubMedCrossRefGoogle Scholar
  29. 29.
    Leibowitz SF, Alexander JT. Hypothalamic serotonin in control of eating behavior, meal size, and body weight. Biol Psychiatry 1998; 44(9): 851–64PubMedCrossRefGoogle Scholar
  30. 30.
    Walsh AE, Smith KA, Oldman AD, et al. m-Chlorophenylpiperazine decreases food intake in a test meal. Psychopharmacology 1994; 116(1): 120–2PubMedCrossRefGoogle Scholar
  31. 31.
    Lee MD, Kennett GA, Dourish CT, et al. 5-HT1B receptors modulate components of satiety in the rat: behavioural and pharmacological analyses of the selective serotonin 1B agonist CP-94,253. Psychopharmacology (Berl) 2002; 164(1): 49–60CrossRefGoogle Scholar
  32. 32.
    Calapai G, Corica F, Corsonello A, et al. Leptin increases serotonin turnover by inhibition of brain nitric oxide synthesis. J Clin Invest 1999; 104(7): 975–82PubMedCrossRefGoogle Scholar
  33. 33.
    Simansky KJ. Serotonergic control of the organization of feeding and satiety. Behav Brain Res 1996; 73(1–2): 37–42PubMedGoogle Scholar
  34. 34.
    Dryden S, Wang Q, Frankish HM, et al. Differential effects of the 5-HT 1B/2C receptor agonist mCPP and the 5-HT1A agonist flesinoxan on hypothalamic neuropeptide Y in the rat: evidence that NPY may mediate serotonin’s effects on food intake. Peptides 1996; 17(6): 943–9PubMedCrossRefGoogle Scholar
  35. 35.
    Leibowitz SF. The role of serotonin in eating disorders. Drugs 1990; 39 Suppl. 3: 33–48CrossRefGoogle Scholar
  36. 36.
    Blundell JE, Lawton CL, Halford JC. Serotonin, eating behavior, and fat intake. Obes Res 1995; 3Suppl. 4: 471S–6SPubMedGoogle Scholar
  37. 37.
    Wellman PJ. Norepinephrine and the control of food intake. Nutrition 2000; 16(10): 837–42PubMedCrossRefGoogle Scholar
  38. 38.
    Commins SP, Marsh DJ, Thomas SA, et al. Norepinephrine is required for leptin effects on gene expression in brown and white adipose tissue. Endocrinology 1999; 140(10): 4772–8PubMedCrossRefGoogle Scholar
  39. 39.
    Jequier E, Munger R, Felber JP. Thermogenic effects of various beta-adrenoceptor agonists in humans: their potential usefulness in the treatment of obesity. Am J Clin Nutr 1992; 55(1 Suppl.): 249S–51SPubMedGoogle Scholar
  40. 40.
    Berridge KC. Food reward: brain substrates of wanting and liking. Neurosci Biobehav Rev 1996; 20(1): 1–25PubMedCrossRefGoogle Scholar
  41. 41.
    Kalra SP, Dube MG, Pu S, et al. Interacting appetite-regulating pathways in the hypothalamic regulation of body weight. Endocr Rev 1999; 20(1): 68–100PubMedCrossRefGoogle Scholar
  42. 42.
    Stanley BG, Willett III VL, Donias HW, et al. The lateral hypothalamus: a primary site mediating excitatory amino acidelicited eating. Brain Res 1993; 630(1–2): 41–9PubMedCrossRefGoogle Scholar
  43. 43.
    Stanley BG, Ha LH, Spears LC, et al. Lateral hypothalamic njections of glutamate, kainic acid, D,L-alpha-amino-3-hydroxy-5-methyl-isoxazole propionic acid or N-methyl-D-aspartic acid rapidly elicit intense transient eating in rats. Brain Res 1993; 613(1): 88–95PubMedCrossRefGoogle Scholar
  44. 44.
    Maldonado-Irizarry CS, Swanson CJ, Kelley AE. Glutamate receptors in the nucleus accumbens shell control feeding behavior via the lateral hypothalamus. J Neurosci 1995; 15(10): 6779–88PubMedGoogle Scholar
  45. 45.
    Zheng H, Patterson C, Berthoud HR. Behavioral analysis of anorexia produced by hindbrain injections of AMPA receptor antagonist NBQX in rats. Am J Physiol Regul Integr Comp Physiol 2002; 282(1): R147–55PubMedGoogle Scholar
  46. 46.
    Backberg M, Collin M, Ovesjo ML, et al. Chemical coding of GABA (B) receptor-immunoreactive neurones in hypothalamic regions regulating body weight. J Neuroendocrinol 2003; 15(1): 1–14PubMedCrossRefGoogle Scholar
  47. 47.
    Jegou S, Blasquez C, Delbende C, et al. Regulation of alpha-melanocyte-stimulating hormone release from hypothalamic eurons. Ann N Y Acad Sci 1993; 680: 260–78PubMedCrossRefGoogle Scholar
  48. 48.
    Pu S, Jain MR, Horvath TL, et al. Interactions between neuropeptide Y and gamma-aminobutyric acid in stimulation of feeding: a morphological and pharmacological analysis. Endocrinology 1999; 140(2): 933–40PubMedCrossRefGoogle Scholar
  49. 49.
    McMurdo ME, Hutchison GL, Lindsay G. Taste disturbance with acetazolamide. Lancet 1990; 336: 1190–1PubMedCrossRefGoogle Scholar
  50. 50.
    Lynch CJ, Brennan Jr WA, Vary TC, et al. Carbonic anhydrase III in obese Zucker rats. Am J Physiol 1993; 264: E621–30PubMedGoogle Scholar
  51. 51.
    Smoller JW, Truett GE, Hirsch J, et al. The Zucker fatty (fa) gene is not a mutation of corticotropin-releasing factor. Am J Physiol 1993; 264: R12–5PubMedGoogle Scholar
  52. 52.
    Wadden TA, Stunkard AJ. Psychopathology and obesity. Ann N Y Acad Sci 1988; 165: 55–66Google Scholar
  53. 53.
    Malhotra S, McElroy SL. Medical management of obesity associated with mental disorders. J Clin Psychiatry 2000; 63 Suppl. 4: 24–32Google Scholar
  54. 54.
    Friedman MA, Brownell KD. Psychological correlates of obesity: moving to the next research generation. Psychol Bull 1995; 117(1): 3–20PubMedCrossRefGoogle Scholar
  55. 55.
    Roberts RE, Kaplan GA, Shema SJ, et al. Are the obese at greater risk for depression? Am J Epidemiol 2000; 152: 163–70PubMedCrossRefGoogle Scholar
  56. 56.
    Ross CE. Overweight and depression. J Health Soc Behav 1994; 35: 63–79PubMedCrossRefGoogle Scholar
  57. 57.
    Jimerson DC, Lesem MD, Kaye WH, et al. Eating disorders and depression: is there a serotonin connection? Biol Psychiatry 1990; 28: 443–54PubMedCrossRefGoogle Scholar
  58. 58.
    Brewerton TD. Toward a unified theory of serotonin dysregulation in eating and related disorders. Psychoneuroendocrinology 1995; 20(6): 561–90PubMedCrossRefGoogle Scholar
  59. 59.
    Wurtman RJ, Wurtman JJ. Brain serotonin, carbohydrate-craving, besity and depression. Adv Exp Med Biol 1996; 398: 35–41PubMedCrossRefGoogle Scholar
  60. 60.
    Black DA, Goldstein RB, Mason EE. Prevalence of mental disorder in 88 morbidly obese bariatric clinic patients. Am J Psychiatry 1992; 149: 227–34PubMedGoogle Scholar
  61. 61.
    Ahlberg AC, Ljung T, Rosmond R, et al. Depression and anxiety symptoms in relation to anthropometry and metabolism in men. Psychiatry Res 2002; 112(2): 101–10PubMedCrossRefGoogle Scholar
  62. 62.
    Shen S, Battersby S, Weaver M, et al. Refined mapping of the human serotonin transporter (SLC6A4) gene within 17q11 adjacent to the CPD and NF1 genes. Eur J Hum Genet 2000; 8(1): 75–8PubMedCrossRefGoogle Scholar
  63. 63.
    Rosmond R, Bouchard C, Bjorntorp P. Increased abdominal obesity in subjects with a mutation in the 5-HT (2A) receptor gene promoter. Ann N Y Acad Sci 2002; 967: 571–5PubMedCrossRefGoogle Scholar
  64. 64.
    Dobrow IJ, Kamenetz C, Devlin MJ. Psychiatric aspects of obesity. Rev Bras Psiquiatr 2002; 24 Suppl. 3: 63–7Google Scholar
  65. 65.
    Yanovski SZ, Nelson JE, Dubbert BK, et al. Association of binge eating disorder and psychiatric comorbidity in obese subjects. Am J Psychiatry 1993; 150: 1472–9PubMedGoogle Scholar
  66. 66.
    Stunkard AJ. Eating patterns and obesity. Psychiatr Q 1959; 33: 284–95PubMedCrossRefGoogle Scholar
  67. 67.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association, 1994Google Scholar
  68. 68.
    de Zwaan M. Binge eating disorder and obesity. Int J Obes 2001; 25Suppl. 1: S51–5CrossRefGoogle Scholar
  69. 69.
    Bulik CM, Sullivan PF, Kendler KS. Medical and psychiatric morbidity in obese women with and without binge eating. Int J Eat Disord 2002; 32(1): 72–8PubMedCrossRefGoogle Scholar
  70. 70.
    Telch CF, Agras WS. Obesity, binge eating and psychopathology: are they related? Int J Eat Disord 1994; 15(1): 53–61PubMedCrossRefGoogle Scholar
  71. 71.
    Fontenelle LF, Mendlowicz MV, de Menezes GB, et al. Psychiatric comorbidity in a Brazilian sample of patients with binge eating disorder. Psychiatry Res 2003; 119(12): 189–94PubMedCrossRefGoogle Scholar
  72. 72.
    De Chouly De Lenclave MB, Florequin C, Bailly D. Obesity, alexithymia, psychopathology and binge eating: a comparative study of 40 obese patients and 32 controls [French]. Encephale 2001; 27(4): 343–50PubMedGoogle Scholar
  73. 73.
    Steiger H, Lehoux PM, Gauvin L. Impulsivity, dietary control and urge to binge in bulimic syndromes. Int J Eat Disord 1999; 26: 261–74PubMedCrossRefGoogle Scholar
  74. 74.
    Sansone RA, Wiederman MW, Monteith D. Obesity, borderline personality symptomatology, and body image among women in a psychiatric outpatient setting. Int J Eat Disord 2001; 29: 76–9PubMedCrossRefGoogle Scholar
  75. 75.
    Sharpe JK, Hills AP. Anthropometry and adiposity in a group of people with chronic mental illness. Aust N Z J Psychiatry 1998; 32(1): 77–81PubMedCrossRefGoogle Scholar
  76. 76.
    Devlin MJ, Yanovski SZ, Wilson GT. Obesity: what mental health professionals need to know. Am J Psychiatry 2000; 157(6): 854–66PubMedCrossRefGoogle Scholar
  77. 77.
    Goudie AJ, Smith JA, Haiford JC. Characterization of olanzapine-induced weight gain in rats. J Psychopharmacol 2002; 16(4): 291–6PubMedCrossRefGoogle Scholar
  78. 78.
    Kaur G, Kulkarni SK. Studies on modulation of feeding behavior by atypical antipsychotics in female mice. Prog Neuropsychopharmacol Biol Psychiatry 2002; 26(2): 277–85PubMedCrossRefGoogle Scholar
  79. 79.
    Weissenburger J, Rush AJ, Giles DE, et al. Weight change in depression. Psychiatry Res 1986; 17(4): 275–83PubMedCrossRefGoogle Scholar
  80. 80.
    Stunkard AJ, Fernstrom MH, Price A, et al. Direction of weight change in recurrent depression. Arch Gen Psychiatry 1990; 47: 857–60PubMedCrossRefGoogle Scholar
  81. 81.
    Davidson JR, Miller R, Turnbull CD, et al. Atypical depression. Arch Gen Psychiatry 1982; 39: 527–34PubMedCrossRefGoogle Scholar
  82. 82.
    Fagiolini A, Frank E, Houck PR, et al. Prevalence of obesity and weight change during treatment in patients with bipolar I disorder. J Clin Psychiatry 2002; 63(6): 528–33PubMedCrossRefGoogle Scholar
  83. 83.
    Elmslie JL, Silverstone JT, Mann JI, et al. Prevalence of overweight and obesity in bipolar patients. J Clin Psychiatry 2000; 61(3): 179–84PubMedCrossRefGoogle Scholar
  84. 84.
    Elmslie JL, Mann JI, Silverstone JT, et al. Determinants of overweight and obesity in patients with bipolar disorder. J Clin Psychiatry 2001; 62(6): 486–91PubMedCrossRefGoogle Scholar
  85. 85.
    Vanina Y, Podolskaya A, Sedky K, et al. Body weight changes associated with psychopharmacology. Psychiatr Serv 2002; 53(7): 842–7PubMedCrossRefGoogle Scholar
  86. 86.
    Lucki I. The spectrum of behaviors influenced by serotonin. Biol Psychiatry 1998; 44(3): 151–62PubMedCrossRefGoogle Scholar
  87. 87.
    Raber J. Detrimental effects of chronic hypothalamic-pituitary-adrenal axis activation: from obesity to memory deficits. Mol Neurobiol 1998; 18(1): 1–22PubMedCrossRefGoogle Scholar
  88. 88.
    Arnold LM, McElroy SL, Hudson JI, et al. A placebo-controlled, randomized trial of fluoxetine in the treatment of binge-eating disorder. J Clin Psychiatry 2002; 63(11): 1028–33PubMedCrossRefGoogle Scholar
  89. 89.
    Feighner JP. Mechanism of action of antidepressant medications. J Clin Psychiatry 1999; 60 Suppl. 4: 4–11Google Scholar
  90. 90.
    Yen TT, Fuller RW. Preclinical pharmacology of fluoxetine, a serotonergic drug for weight loss. Am J Clin Nutr 1992; 55(1 Suppl.): 177S–80SPubMedGoogle Scholar
  91. 91.
    Simansky KJ, Vaidya AH. Behavioral mechanisms for the anorectic action of the serotonin (5-HT) uptake inhibitor sertraline in rats: comparison with directly acting 5-HT agonists. Brain Res Bull 1990; 25(6): 953–60PubMedCrossRefGoogle Scholar
  92. 92.
    Curzon G, Gibson EL, Oluyomi AO. Appetite suppression by commonly used drugs depends on 5-HT receptors but not on 5-HT availability. Trends Pharmacol Sci 1997; 18(1): 21–5PubMedCrossRefGoogle Scholar
  93. 93.
    Kennett GA, Lightowler S, de Biasi V, et al. Effect of chronic administration of selective 5-hydroxytryptamine and noradrenaline uptake inhibitors on a putative index of 5-HT2C/2B receptor function. Neuropharmacology 1994; 33(12): 1581–8PubMedCrossRefGoogle Scholar
  94. 94.
    Gutierrez A, Saracibar G, Casis L, et al. Effects of fluoxetine administration on neuropeptide y and orexins in obese zucker rat hypothalamus. Obes Res 2002; 10(6): 532–40PubMedCrossRefGoogle Scholar
  95. 95.
    Dryden S, Frankish HM, Wang Q, et al. The serotonergic agent fluoxetine reduces neuropeptide Y levels and neuropeptide Y secretion in the hypothalamus of lean and obese rats. Neuroscience 1996; 72(2): 557–66PubMedCrossRefGoogle Scholar
  96. 96.
    Wieczorek I, Schulz C, Jarry H, et al. The effects of the selective serotonin reuptake-inhibitor fluvoxamine on body weight in Zucker rats are mediated by corticotropin-releasing hormone. Int J Obes Relat Metab Disord 2001; 25(10): 1566–9PubMedCrossRefGoogle Scholar
  97. 97.
    Smith BK, York DA, Bray GA. Activation of hypothalamic serotonin receptors reduced intake of dietary fat and protein but not carbohydrate. Am J Physiol 1999; 277: R802–11PubMedGoogle Scholar
  98. 98.
    Blundell JE, Hill AJ. Do serotoninergic drugs decrease energy intake by reducing fat or carbohydrate intake: effect of dfenfluramine with supplemented weight-increasing diets. Pharmacol Biochem Behav 1988; 31(4): 773–8PubMedCrossRefGoogle Scholar
  99. 99.
    Glazer G. Long-term pharmacotherapy of obesity 2000: a review of efficacy and safety. Arch Intern Med 2001; 161(15): 1814–24PubMedCrossRefGoogle Scholar
  100. 100.
    Lawton CL, Wales JK, Hill AJ, et al. Serotoninergic manipulation, meal-induced satiety and eating pattern: effect of fluoxetine in obese female subjects. Obes Res 1995; 3(4): 345–56PubMedGoogle Scholar
  101. 101.
    Foltin RW, Haney M, Comer SD, et al. Effect of fluoxetine on food intake of humans living in a residential laboratory. Appetite 1996; 27(2): 165–81PubMedCrossRefGoogle Scholar
  102. 102.
    Ferguson JM, Feighner JP. Fluoxetine-induced weight loss in verweight non-depressed humans. Int J Obes 1987; 11 Suppl. 3: 163–70Google Scholar
  103. 103.
    Levine LR, Enas GG, Thompson WL, et al. Use of fluoxetine, a selective serotonin-uptake inhibitor, in the treatment of obesity: dose-response study (with a commentary by Michael Weintraub). Int J Obes 1989; 13(5): 635–45PubMedGoogle Scholar
  104. 104.
    Gray DS, Fujioka K, Devine W, et al. Fluoxetine treatment of the obese diabetic. Int J Obes Relat Metab Disord 1992; 16(3): 193–8PubMedGoogle Scholar
  105. 105.
    Visser M, Seidell JC, Koppeschaar HP, et al. The effect of fluoxetine on body weight, body composition and visceral fat accumulation. Int J Obes Relat Metab Disord 1993; 17(5): 247–53PubMedGoogle Scholar
  106. 106.
    Fernandez-Soto ML, Gonzalez-Jimenez A, Barredo-Acedo F, et al. Comparison of fluoxetine and placebo in the treatment of besity. Ann Nutr Metab 1995; 39(3): 159–63PubMedCrossRefGoogle Scholar
  107. 107.
    Connolly VM, Gallagher A, Kesson CM. A study of fluoxetine in obese elderly patients with type 2 diabetes. Diabet Med 1995; 12(5): 416–8PubMedCrossRefGoogle Scholar
  108. 108.
    Daubresse JC, Kolanowski J, Krzentowski G, et al. Usefulness of fluoxetine in obese non-insulin-dependent diabetics: a multicenter study. Obes Res 1996; 4(4): 391–6PubMedGoogle Scholar
  109. 109.
    Bondi M, Menozzi R, Bertolini M, et al. Metabolic effects of fluoxetine in obese menopausal women. J Endocrinol Invest 2000; 23(5): 280–6PubMedGoogle Scholar
  110. 110.
    Marcus MD, Wing RR, Ewing L, et al. A double-blind, placebo-controlled trial of fluoxetine plus behavior modification in the treatment of obese binge-eaters and non-binge-eaters. Am J Psychiatry 1990; 147(7): 876–81PubMedGoogle Scholar
  111. 111.
    Darga LL, Carroll-Michals L, Botsford SJ, et al. Fluoxetine’s effect on weight loss in obese subjects. Am J Clin Nutr 1991; 54(2): 321–5PubMedGoogle Scholar
  112. 112.
    Goldstein DJ, Rampey Jr AH, Enas GG, et al. Fluoxetine: a randomized clinical trial in the treatment of obesity. Int J Obes Relat Metab Disord 1994; 18(3): 129–35PubMedGoogle Scholar
  113. 113.
    O’Kane M, Wiles PG, Wales JK. Fluoxetine in the treatment of obese type 2 diabetic patients. Diabet Med 1994; 11(1): 105–10PubMedCrossRefGoogle Scholar
  114. 114.
    Breum L, Bjerre U, Bak JF, et al. Long-term effects of fluoxetine on glycemic control in obese patients with non-insulin-dependent diabetes mellitus or glucose intolerance: influence on muscle glycogen synthase and insulin receptor kinase activity. Metabolism 1995; 44(12): 1570–6PubMedCrossRefGoogle Scholar
  115. 115.
    Orzack MH, Friedman LM, Marby DW. Weight changes on fluoxetine as a function of baseline weight in depressed outpatients. Psychopharmacol Bull 1990; 26(3): 327–30PubMedGoogle Scholar
  116. 116.
    Michelson D, Amsterdam JD, Quitkin FM, et al. Changes in weight during a 1-year trial of fluoxetine. Am J Psychiatry 1999; 156(8): 1170–6PubMedGoogle Scholar
  117. 117.
    Bacaltchuk J, Hay P, Mari JJ. Antidepressants versus placebo for the treatment of bulimia nervosa: a systematic review. Aust N Z J Psychiatry 2000; 34(2): 310–7PubMedCrossRefGoogle Scholar
  118. 118.
    Goldstein DJ, Wilson MG, Thompson VL, et al. Long-term fluoxetine treatment of bulimia nervosa. Fluoxetine Bulimia Nervosa Research Group. Br J Psychiatry 1995; 166(5): 660–6Google Scholar
  119. 119.
    Wadden TA, Bartlett SJ, Foster GD, et al. Sertraline and relapse prevention training following treatment by very-low-calorie diet: a controlled clinical trial. Obes Res 1995; 3(6): 549–57PubMedGoogle Scholar
  120. 120.
    McElroy SL, Casuto LS, Nelson EB, et al. Placebo-controlled trial of sertraline in the treatment of binge eating disorder. Am J Psychiatry 2000; 157: 1004–6PubMedCrossRefGoogle Scholar
  121. 121.
    Abell CA, Farquhar DL, Galloway SM, et al. Placebo controlled double-blind trial of fluvoxamine maleate in the obese. J sychosom Res 1986; 30(2): 143–6CrossRefGoogle Scholar
  122. 122.
    Hudson JI, McElroy SL, Raymond NC. Fluvoxamine in the reatment of binge eating disorder: a multicenter placebo-controlled double-blind trial. Am J Psychiatry 1998; 155: 1756–62PubMedGoogle Scholar
  123. 123.
    Ljung T, Ahlberg AC, Holm G, et al. Treatment of abdominally obese men with a serotonin reuptake inhibitor: a pilot study. J Intern Med 2001; 250(3): 219–24PubMedCrossRefGoogle Scholar
  124. 124.
    Szkudlarek J, Eisborg L. Treatment of severe obesity with a highly selective serotonin reuptake inhibitor as a supplement to a low calorie diet. Int J Obes Relat Metab Disord 1993; 17(12): 681–3PubMedGoogle Scholar
  125. 125.
    McElroy SL, Hudson JI, Malhotra S, et al. Citalopram in the treatment of binge-eating disorder: a placebo-controlled trial. J Clin Psychiatry 2003; 64(7): 807–13PubMedCrossRefGoogle Scholar
  126. 126.
    Rudolph RL, Fabre LF, Feighner JP, et al. A randomized, placebo-controlled, dose-response trial of venlafaxine hydrochloride in the treatment of major depression. J Clin Psychiatry 1998; 59(3): 116–22PubMedCrossRefGoogle Scholar
  127. 127.
    Malhotra S, King KH, Welge JA, et al. Venlafaxine treatment of binge-eating disorder associated with obesity: a series of 35 patients. J Clin Psychiatry 2002; 63(9): 802–6PubMedCrossRefGoogle Scholar
  128. 128.
    Schatzberg AF. New indications for antidepressants. J Clin Psychiatry 2000; 61 Suppl. 11: 9–17Google Scholar
  129. 129.
    Gadde KM, Parker CB, Maner LG, et al. Bupropion for weight loss: an investigation of efficacy and tolerability in overweight and obese women. Obes Res 2001; 9(9): 544–51PubMedCrossRefGoogle Scholar
  130. 130.
    Zarrindast MR, Hosseini-Nia T. Anorectic and behavioural effects of bupropion. Gen Pharmacol 1988; 19(2): 201–4PubMedCrossRefGoogle Scholar
  131. 131.
    Reimherr FW, Cunningham LA, Batey SR, et al. A multicenter evaluation of the efficacy and safety of 150 and 300 mg/d sustained-release bupropion tablets versus placebo in depressed outpatients. Clin Ther 1998; 20(3): 505–16PubMedCrossRefGoogle Scholar
  132. 132.
    Settle EC, Stahl SM, Batey SR, et al. Safety profile of sustained-release bupropion in depression: results of three clinical trials. Clin Ther 1999; 21(3): 454–63PubMedCrossRefGoogle Scholar
  133. 133.
    Croft H, Houser TL, Jamerson BD, et al. Effect on body weight of bupropion sustained-release in patients with major depression treated for 52 weeks. Clin Ther 2002; 24(4): 662–72PubMedCrossRefGoogle Scholar
  134. 134.
    Holm KJ, Spencer CM. Bupropion: a review of its use in the management of smoking cessation. Drugs 2000; 59(4): 1007–24PubMedCrossRefGoogle Scholar
  135. 135.
    Jorenby DE, Leischow SJ, Nides MA, et al. A controlled trial of sustained-release bupropion, a nicotine patch, or both for smoking cessation. N Engl J Med 1999; 340(9): 685–91PubMedCrossRefGoogle Scholar
  136. 136.
    Jain AK, Kaplan RA, Gadde KM, et al. Bupropion SR vs placebo for weight loss in obese patients with depressive symptoms. Obes Res 2002; 10(10): 1049–56PubMedCrossRefGoogle Scholar
  137. 137.
    Anderson JW, Greenway FL, Fujioka K, et al. Bupropion SR enhances weight loss: a 48-week double-blind, placebo-controlled trial. Obes Res 2002; 10(7): 633–41PubMedCrossRefGoogle Scholar
  138. 138.
    Privitera MD. Topiramate: a new antiepileptic drug. Ann Pharmacother 1997; 31(10): 1164–73PubMedGoogle Scholar
  139. 139.
    Richard D, Ferland J, Lalonde J, et al. Influence of topiramate in the regulation of energy balance. Nutrition 2000; 16(10): 961–6PubMedCrossRefGoogle Scholar
  140. 140.
    Rosenfeldt WE, Shaefer PA, Pace K. Weight loss patterns with topiramate therapy [abstract]. Epilepsia 1997; 38 Suppl. 3: 58Google Scholar
  141. 141.
    Norton J, Potter D, Edwards K. Sustained weight loss associated with topiramate [abstract]. Epilepsia 1997; 38 Suppl. 3: 60Google Scholar
  142. 142.
    Roy Chengappa KN, Levine J, Rathore D, et al. Long-term effects of topiramate on bipolar mood instability, weight change and glycemic control: a case-series. Eur Psychiatry 2001; 16(3): 186–90PubMedCrossRefGoogle Scholar
  143. 143.
    Richard D, Picard F, Lemieux C, et al. The effects of topiramate and sex hormones on energy balance of male and female rats. Int J Obes Relat Metab Disord 2002; 26(3): 344–53PubMedCrossRefGoogle Scholar
  144. 144.
    Picard F, Deshaies Y, Lalonde J, et al. Topiramate reduces energy and fat gains in lean (Fa/?) and obese (fa/fa) Zucker rats. Obes Res 2000; 8(9): 656–63PubMedCrossRefGoogle Scholar
  145. 145.
    Gordon A, Price LH. Mood stabilisation and weight loss with topiramate. Am J Psychiatry 1999; 156(6): 968–9PubMedGoogle Scholar
  146. 146.
    Shapira NA, Goldsmith TD, McElroy SL. Treatment of binge-eating disorder with topiramate: a clinical case series. J Clin Psychiatry 2000; 61(5): 368–72PubMedCrossRefGoogle Scholar
  147. 147.
    Appolinario JC, Coutinho W, Fontenelle L. Topiramate for inge-eating disorder. Am J Psychiatry 2001; 158(6): 967–8PubMedCrossRefGoogle Scholar
  148. 148.
    Teter CJ, Early JJ, Gibbs CM. Treatment of affective disorder nd obesity with topiramate. Ann Pharmacother 2000; 34(11): 1262–5PubMedCrossRefGoogle Scholar
  149. 149.
    Appolinario JC, Fontenelle LF, Papelbaum M, et al. Topiramate use in obese patients with binge eating disorder: an open study. Can J Psychiatry 2002; 47: 271–3PubMedGoogle Scholar
  150. 150.
    Schmidt do Prado-Lima PA, Bacaltchuck J. Topiramate in treatment-resistant depression and binge-eating disorder. Bipolar Disord 2002; 4(4): 271–3PubMedCrossRefGoogle Scholar
  151. 151.
    Anghelescu I, Klawe C, Szegedi A. Add-on combination and maintenance treatment: case series of five obese patients with different eating behavior. J Clin Psychopharmacol 2002; 22(5): 521–4PubMedCrossRefGoogle Scholar
  152. 152.
    McElroy SL, Arnold LM, Shapira NA, et al. Topiramate in the reatment of binge eating disorder associated with obesity: a randomized, placebo-controlled trial. Am J Psychiatry 2003; 160(2): 255–61PubMedCrossRefGoogle Scholar
  153. 153.
    Pavuluri MN, Janicak PG, Carbray J. Topiramate plus risperidone for controlling weight gain and symptoms in preschool mania. J Child Adolesc Psychopharmacol 2002; 12(3): 271–3PubMedCrossRefGoogle Scholar
  154. 154.
    Levy E, Margolese HC, Chouinard G. Topiramate produced weight loss following olanzapine-induced weight gain in schizophrenia [letter]. J Clin Psychiatry 2002; 63(1): 1045PubMedCrossRefGoogle Scholar
  155. 155.
    McElroy SL, Kotwal R, Hudson JI, et al. Zonisamide in the treatment of binge-eating disorder: an open-label, prospective trial. J Clin Psychiatry 2004; 65(1): 50–6PubMedCrossRefGoogle Scholar
  156. 156.
    Bray GA, Hollander P, Klein S, et al. A 6-month randomized, placebo-controlled, dose-ranging trial of topiramate for weight loss in obesity. Obes Res 2003 Jun; 11(6): 722–33PubMedCrossRefGoogle Scholar
  157. 157.
    Van Gaal L, Rissanen A, Wilding J, et al. Efficacy and safety of topiramate in obese subjects [abstract T4: 01–2]. Int J Obes 2003; 27Suppl. 1: S14Google Scholar
  158. 158.
    Gadde KM, Franciscy DM, Wagner II HR, et al. Zonisamide for weight loss in obese adults. JAMA 2003; 289(14): 1820–5PubMedCrossRefGoogle Scholar
  159. 159.
    Oommen KJ, Mathews S. Zonisamide: a new antiepileptic drug. Clin Neuropharmacol 1999; 22: 192–200PubMedGoogle Scholar
  160. 160.
    Okada M, Hirano T, Kawata Y, et al. Biphasic effects of zonisamide on serotonergic system in rat hippocampus. Epilepsy Res 1999; 34(2-3): 187–97PubMedCrossRefGoogle Scholar
  161. 161.
    Okada M, Kaneko S, Hirano T, et al. Effects of zonisamide on dopaminergic system. Epilepsy Res 1995; 22(3): 193–205PubMedCrossRefGoogle Scholar
  162. 162.
    NIH. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults [online]. Available from URL: [Accessed 2003 Mar 10]
  163. 163.
    Coutinho W. Consenso Latino Americano de Obesidade. Arq Bras Endocrinol Metabol 1999; 43(1): 21–67CrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2004

Authors and Affiliations

  • Jose C. Appolinario
    • 1
  • João R. Bueno
    • 1
  • Walmir Coutinho
    • 1
  1. 1.Obesity and Eating Disorders Group, Institute of PsychiatryFederal University of Rio de Janeiro, State Institute of Diabetes and Endocrinology of Rio de JaneiroRio de JaneiroBrazil

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