The original weight loss (anti-obesity) cocktail was fenfluramine/phentermine, affectionately referred to as as “fen-phen.” This potent concoction, which releases all three monoaminergic neurotransmitters in spades (dopamine, norepinephrine and serotonin), was withdrawn from the market due to causing fatal pulmonary hypertension and valvular disease.
Since fen-phen was banned, other drugs have been increasingly re-purposed for off-label use as anti-obesity medications. Specifically, psychostimulants like Adderall and Ritalin, antidepressants like Wellbutrin and anticonvulsants like Topamax have been used as anti-obesogenic medications, despite being unapproved for these purposes.
Ritalin and Weight Loss
So how do these drugs stack up when it comes to weight loss?
Ranked from most likely to incur weight loss to least, we obtain:
Topamax > Adderall > Wellbutrin > Ritalin
The psychostimulants Adderall and Ritalin, and the antidepressant Wellbutrin cause weight loss as a side effect because they increase the activity of catecholamines like dopamine and norepinephrine which curbs appetite.
Conversely, the tendency to engage in binge-eating has been linked to impaired dopaminergic signaling and depression.
In one small study with 12 participants, the overweight patients lost 12 lbs in eight weeks while taking Wellbutrin. Moreover, a study conducted in Canada concluded that Ritalin reduced total calorie intake by 11 percent.
Of the four drugs discussed above, Topamax has the harshest side effect burden (with cognitive impairment being a major side effect), while wellbutrin is the best tolerated with the fewest serious side effects. Ritalin and Adderall both have significant abuse potential, and therefore one must soberly weigh the risks of psychostimulant tolerance and dependence against the ill health effects of obesity.
Many have expressed concern and skepticism about the promiscuous use of these potent medications (many of which have dangerous side effects) for weight loss. That being said, it is worth appreciating that obesity is itself dangerous, and is unambiguously associated with increased risk of early death and diminished quality of life. Obesity is increasingly being re-conceptualized from a lifestyle disease to a genetic disorder with predisposing personality traits.