Cognitive-behavioral therapy (CBT) can help Ms. P, who claimed she used diet pills to boost her energy. CBT would challenge her unrealistically high goals, teach and explain the consequences of drug use, and offer support to reinforce abstinence from diet pills. Educating patients about potential adverse drug effects also is essential.
Weight-loss obsession, Internet drive search for the perfect body
Use of prescription and over-the-counter weight-loss products is alarmingly common. American culture values the “perfect body,” and the Internet has made appetite suppressants and weight-loss agents more available. Users can conveniently purchase large quantities of OTC weight-loss aids online.
In one multi-state survey,4 18% of women and 8% of men who were trying to lose weight reported using nonprescription weight loss products. Also:
- 28.4% of obese women (defined as BMI ≥30 kg/m2) reported using OTC diet pills, as did nearly 8% of women at normal weight (BMI 2)
- concomitant nonprescription and prescription pill use was often reported.
Conclusion: back to baseline
After 10 weeks, Ms. P’s condition returns to baseline. She starts a new job and abstains from diet pills. Her thought process and cognition improve significantly, and she reports no depressive symptoms at her most-recent visit. She maintains her weight at 139 lb. BMI is 21.1kg/m2 (normal).
Haloperidol is slowly tapered across 2 weeks with no return of psychosis. Although Ms. P wants to stop haloperidol, we taper instead to guard against psychotic relapse. She continues to take citalopram, 20 mg/d, to prevent depressive symptom re-emergence and is receiving supportive psychotherapy to aid her relapse prevention.
Related resources
- Supplement Research Foundation. Supplement reviews. www.tsrf.com/supplements.htm
- Devan GS. Phentermine and Psychosis. Br J Psychiatry 1990;156:442-3.
- Cleare AJ. Phentermine, psychosis, and family history. J Clin Psychopharmacol 1996;16:470-1.
- Hoffman BF. Diet pill psychosis. CMAJ 1977;116:351-5.
- Citalopram • Celexa
- Haloperidol • Haldol
- Mirtazapine • Remeron
- Phenteramine • Adipex
- Risperidone • Risperdal
Dr. Khan is a speaker for Pfizer and Wyeth Pharmaceuticals.
Drs. Tan and Williamson report no financial relationship with any company whose products are mentioned in this article, or with manufacturers of competing products.