Q:  Diet Supplement or Pill for Weight Loss

I really need help on what kind of diet supplement or pill I can take temporarily or for at least three months while on Effexor and Lamactil (for depression and bipolar disorder) to lose 25 pounds, what can I take?
 

Dear Ms. K' -- 
Let's say you weigh 100 pounds more than you weighed when you graduated from high school.  In that case maybe you can justify the risks of using a pill to lose weight (which may have been caused by previous medications, granted).  

Generally I think about using "a pill" when the risks of not doing something like that are so great as to justify the still-fairly-unknown risks of the "pills" we now have some evidence for.  In my opinion, factoring in the length of time some of these solutions have been around*, Glucophage is one of the more likely to be justified, especially when weight gain has been caused by Zyprexa or Depakote.  

Beyond that, there is so little evidence to go on for long-term safety, let alone effectiveness, that in my opinion there are few other strategies to be considered -- amongst "pills", that is; the strategy of enrolling in Weight Watchers has some of the better evidence, among non-pill approaches, and of course there's regular exercise, but I'm sure you didn't write in to hear that.  

You might hear about amantadine and high dose acid-production blockers (like Pepcid) in this context, but that -- to my knowledge -- is just for trying to block the appetite problem associated with Zyprexa, which you're not currently taking.  

I'm not aware of good evidence for other approaches at this point, and even the Glucophage evidence is very slim and preliminary.  It's just that in the case of Glucophage, it's been around so long we can say with pretty good certainty what kind of risks it poses, to compare against the risks of staying 100 lbs. overweight.  

Notice that if you're 20 pounds over where you were at the end of high school, I'm not sure if any risks are justified as far as taking a pill to solve this problem.  The rest of my thoughts on weight, particularly as regards medications for bipolar disorder, can be found here.  Good luck with this common problem, which I assume here is in your body and not in your head, so to speak, i.e. that you really are way over a healthy weight, as opposed to thinking you really are way over a healthy weight, which is a whole different though very common and similarly complicated problem. 

*(the point there was that some of the newer approaches like sibutramine (Meridia) haven't been around long enough to really know what kind of risks they might pose a year or several years from now; Health Canada recently published a new warning, e.g.^HealthCA). 

Dr. Phelps

Published June, 2003