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What are the differences between OTC and prescription weight loss medications?

The medicines currently available are appetite suppressants in some form. They help control hunger and cravings, so you can stick to your nutrition and exercise plan. The only FDA-approved over-the-counter medicine for weight loss is Alli (orlistat). This blocks the body’s ability to absorb fats. The remainder of over-the-counter products are considered supplements. They are not regulated by the FDA and do not have proper studies to confirm their safety and effectiveness. There are prescription medicines that help with weight loss: Qsymia (phentermine/topiramate), Contrave (bupropion/naltrexone), and Saxenda (liraglutide). These are only available through a prescription from a healthcare provider. Each one has certain indications based on the medical evaluation. Obesity is a chronic disease that caused by multiple factors and is the leading risk factor for numerous other medical conditions. Therefore, it is important that your healthcare provider works with you to ensure you are on the safest and most effective medication.

What is the connection between antidepressant medication and weight loss?

Many antidepressants are weight-positive (cause weight gain), some are weight-neutral, and at least one is weight-negative (cause weight loss). When starting an antidepressant, it is a good idea to speak with a healthcare provider about the different options and find a medication that will not cause weight gain. Antidepressants are broken down into categories: selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants, monoamine oxidase inhibitors (MAO inhibitors), and others. Medications within each of these categories can cause weight gain. In the SSRI group, Paroxetine shows the highest associated weight gain. Other SSRIs, including Citalopram (Celexa), Escitalopram (Lexapro), Fluoxetine (Prozac), and Sertraline (Zoloft), have variable effects on weight, and some do not show weight gain until after six months of use. Weight-positive medications in the tricyclic antidepressant category include Amitriptyline, Doxepin, and Imipramine. Desipramine, Nortriptyline, and Protriptyline have variable effects on weight. Bupropion (Wellbutrin), an aminoketone, is considered weight-negative and is prescribed both to assist in weight loss and to treat depression. However, people respond to antidepressants differently. If a person’s depression can be controlled with a weight-negative or weight-neutral antidepressant, they will likely take the medication more consistently, resulting in better efficacy.

Which weight loss medications are known for suppressing appetite?

The following FDA-approved medications suppress appetite: Liraglutide (Saxenda�), Naltrexone-Bupropion (Contrave�), Phentermine-Topiramate (Qysmia�), as well as these stimulants: benzphetamine (Didrex�), diethylpropion (Tenuate�), phentermine (Adiphex-P�, ProFast�), and phendimetrazine. Each medicine impacts appetite differently. Liraglutide is an injectable medication that acts on hormones from the gut that send signals to the brain to make you feel full quicker and decrease hunger signals. Lorcaserin is an oral medication that makes you feel full sooner by acting on serotonin, a neurotransmitter, in a part of the brain that controls appetite. Naltrexone-bupropion also works in the brain, but on the pleasure-reward areas, to decrease cravings and appetite. Phentermine-topiramate is a combination of two medications that work together to decrease appetite and cravings. Topiramate also alters taste sensation, making food less enjoyable for some. The stimulants all work in the brain to decrease appetite. All weight loss medications work best in the context of a healthy eating plan and exercise.


References:

  1. Obesity Algorithm. 2017-2018. Obesity Medicine Association
  2. Saunders KH, Shukla AP, Igel LI,  Aronne LJ. Obesity: When to consider medication. The Journal of Family Practice. 2017: 66:608-615.
  3. Diet, Drugs, Devices and Surgery for Weight Management. The Medical Letter, June 4 2018:60 (1548).
  4. Association of Pharmacological Treatments for Obesity With Weight Loss and Adverse Events: A Systematic Review and Meta-analysis. JAMA, 2016: 315(22):2424-2434.

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