Anti-Addiction Pills Face Obstacles

By John M Grohol PsyD
April 25, 2008

Imagine taking a weight-loss pill and losing dozens of pounds, only to find yourself profoundly depressed for no reason.

Imagine taking a stop-smoking pill and not feeling the urge to light up a cigarette every again, only to find your mind plagued with suicidal thoughts.

No need to imagine these things — these are the kinds of side effects actually being experienced today by people looking to kick an addiction.

Marilynn Marchione has the AP story, Risk of depression dims hopes for anti-addiction pills about the barriers facing the race to develop anti-addiction pills. Namely serious psychiatric side effects that their manufacturers hadn’t quite counted on. These “super pills” were supposed to the Next Big Thing in pharmaceuticals:

The buzz started four years ago, when studies showed rimonabant helped people shed weight and keep it off longer than previous pills had. It also was being tested for smoking cessation. The Associated Press and other media reported extensively on prospects for a pill that might tackle two big problems at once.

Rimonabant won approval in Europe. But advisers to the U.S. Food and Drug Administration opposed it because of depression risks that became clearer with further study. Sanofi withdrew its U.S. application and said it hoped to resubmit after more research.

But in a new study last month, 43 percent of people taking rimonabant developed psychiatric issues versus 28 percent of those on dummy pills. One rimonabant patient committed suicide and one in the placebo group tried to. Unlike previous studies, this one did not exclude people who had depression in the past.

Ooops.

While people will go to extraordinary measures to lose weight, even to the point of developing an eating disorder, few are willing to literally die for a thin body. Of course, everything needs to be put into a risk/benefit context (since obesity and smoking are health risks that could lead to an earlier death left untreated), but still. Treatment shouldn’t cause unexpected death.

The makers of the new drugs insist they are safe, although perhaps not for everyone, such as people with a history of depression. Having to restrict the drugs’ use would be a big setback because it would deprive the very people who need help the most, since addictions and depression often go hand-in-hand, doctors say.

A bigger fear is that the whole approach may be in trouble. Researchers say blocking pleasure, especially the way the obesity drugs do, might take the fun out of many things, not just the harmful substances and behaviors these drugs target.

It’ll be interesting to see how this develops in the upcoming years. I think researchers are potentially playing with fire here, since our ability to finely tune and target such areas of the brain with a medication are not all that refined. As we’re seeing, trying to hit one area of the brain is going to affect it in ways that perhaps we hadn’t intended or foresaw.

In the meantime, it appears it would be ill-advised for anyone who has a history of psychiatric issues or mental disorders such as depression to go on one of these medications. If, however, for medical reasons, it’s important for a person try out such a medication, they do so under close monitoring and supervision of their doctor.

Dr. John Grohol is the CEO and founder of Psych Central. He has been writing about online behavior, mental health and psychology issues, and the intersection of technology and psychology since 1992.