Psychopharmacology for the Clinician/Psychopharmacologie pratique - PDF

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					                                      Psychopharmacology for the Clinician
                                         Psychopharmacologie pratique


The information in this column is not intended as a definitive treatment strategy but as a suggested approach for clinicians treating patients
with similar histories. Individual cases may vary and should be evaluated carefully before treatment is provided.

Implementing antiobesity treatment                  psychotics, is contraindicated. 1 US                weight regain for most people. Al-
in a patient with a mood disorder                   labelling identifies only centrally acting          though both drugs work differently,
Mrs. C is a 42-year-old woman with                  weight-loss drugs and monoamine oxi-                there is little advantage to taking them
type 1 bipolar affective disorder. It has           dase inhibitors as contraindications.2              simultaneously.3 We discussed realistic
taken her 15 years, a battle with sub-              This warning relates to a potential drug            outcomes and goals with Mrs. C and
stance abuse and 3 hospital admissions,             interaction that can lead to serotonin              referred her to a dietician.
all owing to medication noncompli-                  syndrome or elevated blood pressure.                   Weight management is difficult in the
ance, to achieve mood stability. She is             Orlistat has no central mechanism of                general population, and it becomes even
currently well and takes a combination              action and is a lipase inhibitor that has           more complicated for individuals taking
of lithium, atypical antipsychotic and              a dose-dependent effect on fecal fat                psychotropic medications. Sibutramine
selective serotonin reuptake inhibitor              loss; in diets comprising 30% fat, about            has been used successfully to manage
therapy. She initially took bupropion,              one-third of the dose will not be ab-               olanzapine-induced 4 weight gain in
but because of agitation she switched               sorbed. It has little effect in people with         patients with schizophrenia; however,
first to paroxetine and then to escitalo-           low-fat diets, and its mechanism of ac-             it was less successful with clozapine-
pram. During those 15 years, Mrs. C                 tion, which can lead to gastrointestinal            induced weight gain in a similar popula-
gained 38 lbs, and her body mass index              symptoms and oily stool, is not well                tion.5 It has been shown to be a weight-
increased from 29.1 to 35.4 kg/m2. Dys-             tolerated by some patients.                         loss agent comparable to topiramate in
lipidemia developed, and, with a fast-                 After evaluating both treatments,                the bipolar population, although toler-
ing blood glucose level of 6.3 mmol/L,             
				
DOCUMENT INFO
Description: Two medications approved for longterm use in the treatment of obesity are available in Canada: sibutramine and orlistat. Sibutramine is a serotoninnoradrenaline reuptake inhibitor, and it is thought to work primarily by increasing satiety, with a mild increase in thermogenesis.
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