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Drugs for the treatment of obesity--reply.

Drugs for the Treatment of Obesity To the Editor The review1 by Dr Yanovski and Dr Yanovski on the treatment of obesity focused on drugs currently approved by the US Food and Drug Administration for longterm treatment, which includes orlistat, phenterminetopiramate, and lorcaserin. The discussion of the mechanisms of action of the latter 2 drugs was limited to their appetitesuppressive effects. However, these medications also have major psychotropic properties. Phentermine is structurally and functionally similar to dexamphetamine, with similar clinical effects on mood and motivation.2 Topiramate can lead to mood changes, including improvement or worsening of depression.3 Lorcaserin reduces impulsive responses.4 The psychotropic effects of these medications on mood, motivation, and impulse control are related to dosage and are of great relevance to the success of the lifestyle interventions that are combined with medication for achieving long-term weight control. The review reported that these important psychotropic properties tend to be overlooked. Future research should consider all the clinical effects of these drugs, with the aim of titrating the dose to maximize their therapeutic potential. This includes optimizing the psychotropic effects that could assist with establishing the lifestyle changes that are integral to the success of the long-term treatment of obesity.