Clinical Features Weight control issues are associated with several medical and psychological complications. Patients with eating disorders struggle with body-related cognitive distortions i.
Information from references 12 through Phentermine Ionamin is structurally similar to amphetamine and modulates noradrenergic neurotransmission to decrease appetite; however, it has little or no effect on dopaminergic neurotransmission, which decreases its potential for abuse.
Phentermine was previously used in combination with fenfluramine Pondimin to improve weight loss and counteract the adverse effects of use of phentermine. Because of the withdrawal of fenfluramine from the U.
In dosages ranging from The most common adverse effects of phentermine include headache, insomnia, nervousness and irritability. Palpitations, tachycardia and elevations in blood pressure may also occur.
Phentermine should not be taken by persons with hyperthyroidism, glaucoma, agitated states, advanced arteriosclerosis, symptomatic cardiovascular disease, moderate to severe hypertension or a history of drug abuse.
The serotonergic drugs partially inhibit the reuptake of serotonin and release serotonin into the synaptic cleft, thus acting on the hypothalamus to decrease satiety.
In a longer clinical trial, significantly greater weight loss was achieved in the subjects taking fluoxetine at 20 weeks, compared with the subjects taking placebo.
However, after one year, weight loss was not different in the two groups. Food and Drug Administration FDA for the treatment of depression, bulimia and obsessive-compulsive disorder, the FDA has not labeled fluoxetine for weight loss therapy.
Sibutramine may also stimulate thermogenesis by activating the beta3-system in brown adipose tissue. Initially tested for its antidepressant activity, sibutramine was found to cause weight loss 1 to 2 kg 2. In a continued, open-label, week extension study, weight was regained even in subjects taking high-dose sibutramine.
It is recommended for obese patients with an initial BMI of greater than 30 kg per m 2or greater than 27 kg per m 2 in the presence of other risk factors e.
The recommended starting dosage of sibutramine is 10 mg administered once daily with or without food. If there is inadequate weight loss after four weeks, the dosage may be titrated to 15 mg administered once daily.
The 5-mg dosage should be reserved for use in patients who do not tolerate the mg dosage. A mild increase in blood pressure and heart rate have been noted in some nonhypertensive study participants. Ephedrine increases the release of norepinephrine, which modulates food intake and acts as a sympathomimetic agent to stimulate heart rate and blood pressure, and enhance thermogenesis.
Caffeine, an adenosine antagonist, reduces the breakdown of norepinephrine within the synaptic junction. Ephedrine 20 mg with caffeine mg [combination product] or two to three cups of caffeinated coffee taken three times daily was found to be more effective than placebo or either agent alone.
This combination is not currently available on the U.
Selective beta3-adrenergic agonists are currently under investigation. They are believed to increase the rate of metabolism and cause a reduction in weight by decreasing the body lipid content.
A reduction in fat is recommended in most weight loss diets; however, patient compliance with these diets is generally poor.
Therefore, digestive inhibitors may have a role in creating the negative energy balance necessary for subsequent weight loss. Gastric and pancreatic lipases aid in the digestion of dietary triglycerides by forming them into free fatty acids that are then absorbed at the brush border of the small intestine.
Inhibition of these enzymes leads to inhibition of the digestion of dietary triglycerides and decreased cholesterol absorption, and may decrease absorption of lipid-soluble vitamins A, D, E and K. During these placebo-controlled studies, there was no difference in the incidence of breast cancer in patients taking orlistat versus patients taking a placebo.
Statistically significant improvements in blood pressure, cholesterol levels, glucose and insulin measurements were noted in patients taking orlistat, but the difference was not clinically relevant.
Gastrointestinal side effects included flatus with discharge, oily spotting and oily stool, fecal urgency, fecal incontinence and abdominal pain. Lipid-soluble vitamin concentrations may change during therapy but rarely need supplementation. Orlistat does not appear to interfere with the efficacy of other chronically administered medications i.
The goal of fat substitutes is to decrease caloric value from fat while maintaining the creaminess and richness derived from fat. The most recent fat-based substitute, olestra Oleancontains zero kcal per g.
Olestra is a sucrose polyester, labeled by the FDA for use as a food additive in prepackaged snacks potato, corn and tortilla chips, and crackers to replace percent of the fat. A g serving of potato chips fried in fat contains 10 g of fat and calories, while a similar serving of olestra potato chips contains no fat and only 70 calories.Cognitive Behavioural Therapy for Obesity The safety and scientific validity of this study is the responsibility of the study sponsor and investigators.
Listing a study does not mean it has been evaluated by the U.S. Federal Government. Researchers have used brain scans to measure changes in the cerebral activity of people with obsessive-compulsive disorder after undergoing a type of cognitive behavioral therapy.
They found that. Four agents are available in the United States for short-term ( weeks) treatment of obesity: diethylpropion, phendimetrazine, benzphetamine, and phentermine. Any of these drugs may be used as an adjunct in a regimen of weight reduction based on caloric restriction in patients with an initial BMI of 30 kg/m 2 or higher who have not responded.
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Introduction. Obesity is as much a psychological as a physical problem. Psychological issues can not only foreshadow the development of obesity, but they can also follow ongoing struggles to .
A wide range of effective treatments is available for major depressive disorder. Medication alone (see Medication) and brief psychotherapy (e.g., cognitive-behavioral therapy, interpersonal therapy) alone can relieve depressive symptoms.