Antidepressants and Other “New” Diet Pills: Do They Work, and Are They Safe?

Karen Mullin had always been able to eat what she wanted with no worries of packing on pounds—until she began battling “middle age spread” last year at age 44. Despite eating right and exercising, the scale wouldn’t budge. Frustrated, Mullin took Ritalin, a drug used to treat attention deficit hyperactivity disorder, “borrowing” it from a friend. One of its side effects is weight loss, making it a popular diet drug for everyone from soccer moms to starlets. “You hear about how some drugs like Ritalin can just melt the pounds off,” she says, “so you figure why not?”

Should you try it?
Mullin tried the drug only once on a lark without a doctor’s guidance (not recommended). But more docs, frustrated with the handful of U.S. Food and Drug Administration (FDA)–approved weight-loss drugs with inconsistent results, are prescribing medications that are used to treat everything from depression to seizures—all with the side effect of weight loss—to help patients drop pounds. (More weight-loss-drug options are coming soon, though; see page 98 of Health’s April issue.)

For doctors, this off-label prescribing is legal. In fact, a study that appeared recently in the Archives of Internal Medicine suggests that 21 percent of prescriptions for 160 common drugs (some 150 million prescriptions) are being written to treat conditions for which they aren’t specifically approved. But some experts believe it can set both patients and their doctors up for big letdowns.

Risky business?
For most of us—including Mullin—the possible benefits of taking a weight-loss drug, off-label or not, usually don’t justify the risks, which can include osteoporosis and more (see “Off-Label Drugs: What You Need to Know,” at right). Besides, casual dieters who want to drop just a few pounds aren’t good candidates for any medication: That’s usually reserved for those with a BMI of 30 or more.

And getting drugs without a doctor’s supervision from prescription-free Internet sites or a friend can be dangerous, says Michael Steelman, MD, past president and chairman of the board of the American Society of Bariatric Physicians. You could set yourself up for potentially deadly electrolyte imbalances, or nutritional deficiencies, he says.

Losing the right way
Even doctors who prescribe off-label are cautious about setting up unrealistic expectations. “A pill can make a person less hungry, but it can’t tell them how to eat,” says Michael Anchors, MD, who holds a patent on Phen-Pro, an off-label weight-loss combo that blends the FDA-approved weight-loss drug phentermine along with an antidepressant like Prozac.

A comprehensive weight-loss program that includes nutrition education and exercise is the only way to keep pounds off long-term, Anchors explains. That’s why he prescribes lifestyle changes along with Phen-Pro. It’s working for Marianne Greenhouse, one of Anchors’ patients, who tipped the scale at 300 last year then lost 50 pounds in six months. “Now I feel like I have a future,” she says.

The bottom line
Most people can successfully lose weight with a combination of diet and exercise—and an FDA-approved weight-loss drug, if necessary, says Karen Cooper, doctor of osteopathy, at the Bariatric and Metabolic Institute at the Cleveland Clinic, a top bariatric-surgery hospital. Before taking any drug, though, make sure you understand its risks and benefits. And, above all, don’t self medicate.

Be honest with your doctor about previous weight-loss efforts, too, so she can decide if medication is the right choice for you. “A drug might help you lose weight, but it’s not going to keep the weight off,” Cooper says. “That takes commitment. And no drug, whether approved or off-label, can help you with the long-term commitment you need.”

As for Mullin, she’s given up on any quick fixes and stays as active as possible. “I take the stairs. I park farther from the door. And I make two trips to the mailbox; I no longer roll down my car window and pick it up.”

Off-label drugs: What you need to know

• Adderall Ritalin
  Generic: Amphetamine, methylphenidate
  FDA-approved use: Attention deficit hyperactivity disorder, narcolepsy
  Notable side effects: Insomnia, chest pain; also can be habit forming

• Wellbutrin Zyban
  Generic: Bupropion
  FDA-approved use: Depression, smoking cessation
  Notable side effects: Hallucinations, seizures

• Topamax
  Generic: Topiramate
  FDA-approved use: Epilepsy, bipolar disorder, migraines
  Notable side effects: Osteoporosis, slurred speech

By Joan Raymond