take the blue pill and be svelte or take the twinkie and stay fat

January 13, 2012 7:31 AM

Do bariatric specialists use Wellbutrin specifically to stop the craving for foods to help weight loss?

OK so "a friend" has just started Wellbutrin, and this "friend" has been hefty his whole life, lost weight gained it, lost it again yadda yadda.

Now on my first few weeks of Wellbutrin, I realized that sticking to eating right is much easier. Now, it could be that my mood is lifting so I have more motivation to do what I should be doing, and less depression leading emotional eating of chips etc, so it is confirmation bias, but this feels qualitatively different.

I remarked to my wife that this is what heroin addicts must feel like on Methadone.

Food, it just doesn't have as much meaning. A man who has been known to clean his plate all his life, now often has trouble finishing meals, and forgets to have lunch @ work. And while I feel better, even times in my life when I felt happy I still had a weakness for packing on the avoirdupois, as do all of my family.

Now, since Wellbutrin is marketed specifically for smokers to stop smoking (under Zyban ), I am hypothesizing that there must be some chemical brain changer distinct from just relieving depression that helps to moderate a brain's addiction centers. Since it has been proven that food to fatties is what a cigarette is to smokers - in that it lights up similar addiction reception centers of the brain, well, it doesn't take a Nobelist to wonder if it can help morbidly obese people.

I've tried to Google Wellbutrin for weight loss, buproprion in bariatric medicine, etc. Can't seem to get anything other than Wellbutrin won't make you gain weight and obese people are often depressed so an antidepressant like Wellbutrin is good.

Again I am, however, talking about separate effect that is different from any mood/motivation elevating effect that Wellbutrin or any other depression drug might have.

For that matter might Wellbutrin help in alcoholism or any drug treatment? How off base is this hypothesis?

posted by xetere to health & fitness (17 answers total)

You're right in your assessment that wellbutrin affects "addiction centers" (namely the 'reward' chemical dopamine), but I wouldn't say it's separate at all from depression. Addiction and depression are often comorbid, after all.

I'm no doctor though, but I have taken the drug and am aware that there are certain risks to heart health. That would suggest to me that it's not a great drug for many overweight individuals.
posted by sunshinesky at 7:37 AM on January 13, 2012

Since it has been proven that food to fatties is what a cigarette is to smokers

I disagree. These two are not necessarily related. I, myself am rather heavy, though not to the point of obesity, and have been like this my whole life (from childhood to adulthood, yes). Despite this fact, I am not addicted to food. I do like certain foods (especially my mother/grandmother's homemade stuff) but not to the point to say I need or seek satisfaction in eating.

That said, perhaps the reason Wellbutrin is not widely used outside the smokers market may be because it doesn't cause the same reaction on everyone?
posted by Trexsock at 7:44 AM on January 13, 2012

FWIW, I've been taking Wellbutrin for some time now, and it hasn't had the least effect on my appetite, one way or the other.
posted by cerebus19 at 7:49 AM on January 13, 2012

I am having a similar experience on Effexor and have had similar questions. When I looked it up, though, "anorexia" as a side effect of Effexor is only present in about 12% of people who take it. That didn't inspire me to think that it should start being prescribed specifically as a weight-loss drug.
posted by not that girl at 7:50 AM on January 13, 2012

The wikipedia entry on Wellbutrin has a short paragraph on this subject.
posted by not that girl at 7:51 AM on January 13, 2012 [3 favorites]

Do bariatric doctors prescribe it as a weight-loss drug? No, they do not. FDA regulations approve drugs for particular purposes. That chemical is approved for depressives as Wellbutrin and for smokers as Zyban. It is not approved under any name as a weight-loss drug. Thus, it is not (cannot be) prescribed as such.
Might doctors choose to try Welbutrin over an SSRI when a depressed patient happens to be overweight? Perhaps, but that's not the same as its being a weight-loss drug.

Anti-depressants are difficult to deal with because they have different effects for different people. I'd just thank whatever powers that be that you found something that works for you, right away, without having to try 3 other drugs first, that both helps your depression and has side-effects you find unobjectionable, in fact agreeable.
posted by aimedwander at 7:54 AM on January 13, 2012

It is not approved under any name as a weight-loss drug. Thus, it is not (cannot be) prescribed as such.

Doctors do prescribe medications for other purposes than those they were made and marketed for. For instance, I take Effexor not as an anti-depressant but to treat chronic daily headache; it was prescribed by my neurologist. This is called "off-label use."
posted by not that girl at 8:05 AM on January 13, 2012 [6 favorites]

Psychiatric drugs are weird. I've been on Wellbutrin for awhile now (brand name, the generic didn't work for me) and it has absolutely not affected my appetite. Ten years ago I was on it to quit smoking and I dropped 15 pounds without even trying. I just happened to notice one day that, hey, none of my clothes fit anymore. When I took Zoloft several years ago, I also dropped weight like crazy without trying, but I know people who have gained lots of weight on it.
posted by indognito at 8:32 AM on January 13, 2012

Oh, should clarify in my above post that in addition to not affecting my appetite this past year, Wellbutrin has also not affected my weight. :(
posted by indognito at 8:34 AM on January 13, 2012

Anecdata: I've taken Wellbutrin and many other anti-depressants, and in my case the loss of appetite the first few weeks faded pretty quickly-- never lasted more than 2 months, tops.
posted by devymetal at 8:43 AM on January 13, 2012

Beware: Wellbutrin has the complete opposite effect in some people and could cause weight gain. This is a known effect for a small portion of the population & it happened to me. I lost over 100 pounds some time back, then a couple of years after my weight loss I went on Wellbutrin. In the beginning it was like you report, I had more energy, my appetite was lower. But this changed after my body became accustomed to the drug and gradually over the 2 years that I was taking the med, I gained back most of the weight I had previously lost. I stopped taking Wellbutrin about a year & a half ago, and I stopped gaining weight (in fact it had begun very slowly going back down on its own).
posted by cuddles.mcsnuggy at 8:58 AM on January 13, 2012

Antidepressants often give people the motivation to follow through on things they have been wanting to do. This could be something good like exercising more or eating right. It is also the reason that suicide risk can be elevated with treatment. If you have been planning it, suddenly, you have the wherewithal to actually do it.
posted by Gor-ella at 9:19 AM on January 13, 2012

aimedwander, seconding not that girl, doctors perscribe drugs for off-label use all the time. Whether that is a good thing is up to debate.

At any rate, more germane to the question, which was not do doctors perscribe it for obesity but whether there were any studies to see if it would be as effective in curbing cravings in the morbidly obese as it seems to be in curbing cravings for tobacco amongst smokers, the Wikipedia page was interesting in that there was a paragraph about Wellbutrin and obesity. The footnote led me to this for a study of Wellbutrin in combination with other drugs.
posted by xetere at 9:20 AM on January 13, 2012

A) Not everybody gets fat for the same reason. Some people just don't know good food from bad, how many calories in a Whopper, don't know what a "proper portion" is, emotional-eat, etc.
B) Some people (yours truly) are too big because they obsess over food. They can't stop thinking about it. They know good food from bad and that they aren't really hungry, but their brain can't stop thinking about that half a cupcake in the office kitchen that's been sitting there for 20 minutes...
C) For people in the B category, Phenfen was prescribed, not because it was a stimulant or changed your metabolism, but it was found to dramatically increase your serotonin level, which had a strange outcome of helping patients stop thinking about food all the time.
(source: The Fattening of America)

Wellbutrin works in a similar fashion, so might have similar effects. But if you are fat because you can't not eat that large helping of fries, it might not be helpful. Treat the right problem.
posted by rev- at 9:21 AM on January 13, 2012 [2 favorites]

Doesn't affect my appetite.

If you're in this head-space now, keep in it. The euphoric effects of meds usually wear off.
posted by thylacine at 9:43 AM on January 13, 2012

The top line on your question implies that you are in fact asking if doctors prescribe Wellbutrin for obesity, so that might be the confusion.

If you are looking for scientific research, I recommend either using Google Scholar or PubMed.

Also, bariatric specialists are surgeons and - this may not be true for all bariatric specialists, but - most surgeons stick to surgical solutions for problems and leave the medical management to internists or other primary care physicians. So you may not want to include terms related to bariatrics in your search, and instead just use terms like obesity, morbid obesity, binge eating, stuff like that.
posted by treehorn+bunny at 12:27 PM on January 13, 2012

Of the people who are in the "obese" BMI range, only 5% to 8% are people who are also experiencing compulsive eating or binge eating.

Doctors do prescribe Wellbutrin to people of all weights who are experiencing compulsive eating and binge eating. Some patients with those diagnoses find that it helps, others do not.
posted by Sidhedevil at 3:38 PM on January 13, 2012