depression


The Internet is so convenient, so easy but yet it is so dangerous.

It came to light in Singapore that a man and a woman in their early 20s had suffered symptoms of psychosis such as hearing of voices, hallucinations, confusion and thyrotoxic symptoms such as anxiety and increased heart rate after using a product named Relacore, a product they bought over the Internet.

So what is wrong with this anti-‘belly fat and stress control’ dietary supplement?

This product was not declared to have included a Western drug, a potent substance known as Sibutramine. Sibutramine is a prescription drug marketed under trade names such as Meridia in the USA, Leptos in India, Reductil (read Want to slim down? Don’t count on weigh-loss drugs) in Europe and other countries. It is used as an appetite suppressant in the management of obesity. That means that it works by making you feel more ‘full’ with less food (it reduces appetite and enhances satiety).

On Wikipedia, it is documented that frequent encountered side effects from sibutramine are: dry mouth, paradoxically increased appetite, nausea, strange taste in the mouth, anorgasmia and delayed ejaculation, upset stomach, constipation, trouble sleeping, dizziness, drowsiness, menstrual cramps/pain, headache, flushing, or joint/muscle pain.

It can substantially increase blood pressure and pulse in some patients. Therefore all patients treated with sibutramine should have regular monitoring of blood pressure and pulse.

Infrequent but serious ones that require immediate medical attention: cardiac arrhythmias, paresthesia, mental/mood changes (e.g., excitement, restlessness, confusion, depression, rare thoughts of suicide).

Symptoms that require urgent medical attention are seizures, problems urinating, abnormal bruising or bleeding, melena, hematemesis, jaundice, fever and rigors, chest pain, hemiplegia, abnormal vision, dyspnea and edema.

Could what they have consumed a counterfeit version? Health Science Authority (HSA) is investigating now. In HSA’s press release today, it has said that Given the borderless nature of the Internet and the ease with which this product could be bought and sold in different countries around the world, HSA has alerted its international network of enforcement counterparts to be on a lookout for the adulterated product and where appropriate, to act against websites selling this product within their respective jurisdictions.”

This is the second case in the last 6 years concerning slimming product that created adverse reaction. Slim 10 pills in 2002 hit headlines in Singapore after it killed a woman and caused severe liver damage to local actress Andrea De Cruz which would have killed her if not for an emergency liver transplant done with the liver donation from her then-fiance actor Pierre Png (now husband). The China-made diet pills contained fenfluramine, an appetite suppressant that has been banned in the U.S. since 1997 for damaging heart valves and which doctors later confirmed also caused liver failure.

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On 16th November 2007, the Prime Section’s headline of the Straits Times, “Want to slim down? Don’t count on weigh-loss drugs” would have a lot of Singaporeans and those reading in the air (e.g. Singapore Airlines) fitting their eyes on this piece of news.

What a great catchy headline as many Singaporean particularly the female population considered themselves overweight, judging by the continuous flood of slimming advertisements in all appropriate local media. Is this to wake Singaporean up as their online version was not punchy – Weight loss drugs may slim users down – but at high costs” ?

It has been reported obesity and overweight affect over 1.1 billion individuals worldwide and are highly and increasingly prevalent chronic conditions associated with premature mortality, chronic morbidity, and increased healthcare use.

Apart from traditional non-medicinal herbal options, the commonly used treatments are through the use of anti-obesity drugs such as orlistat, sibutramine and rimonabant. They are approved for long term treatment of obesity and choked up an estimated US$1.2 billion in global sales in 2005. The 3 drugs are prescribed for severe cases of obesity as obese people can reduce their risk of getting diabetes by 30 to 40 percent if they were to lose 4 kg.

Orlistat also known as tetrahydrolipstatin is marketed under the trade name Xenical. Its primary function is preventing the absorption of fats from the human diet, thereby reducing caloric intake.

Sibutramine is marketed under the trade name Meridia in the USA and Reductil in Europe and other countries. It acts by increasing serotonin and norepinephrine levels in the brain. The S$4 pill makes the patients feel full with less food and is needed to be taken for between 6-12months.

Rimonabant which is also known as Accomplia, Riobant, Slimona, Rimoslim, Zimulti and SR141716, is an anorectic anti-obesity drug. Its main avenue of effect is the reduction in appetite. On 15 June 2007 the BBC News reported that a committee advising the US FDA has voted not to recommend the drug’s approval because of concerns over suicidality, depression and other related side effects associated with use of the drug.

The Straits Times report was following up on the British Medical Journal’s article published a day ago on their meta-analysis that :-

  • 30 per cent of patients on Xenical lost an average of 3 kgs and had unpleasant digestive and intestinal side effects, such as incontinence.
  • Patients on Reductil lost 4 kgs and had improved cholesterol levels. But up to 20 percent suffered from raised blood pressure and pulse rates, insomnia and nausea.
  • Patients on Accomplia lost the most weight – 5 kgs on average. Their blood pressure and cholesterol levels also improved but their risk of mood disorders rose 6 percent.

Straits Times reported that another study released on Friday by a different medical journal, The Lancet, found that patients on Accomplia were far more likely to suffer from depression, anxiety and, in severe cases, suicidal tendencies.

Thus the conclusion from the BMJ article is that “Orlistat, sibutramine, and rimonabant modestly reduce weight, have differing effects on cardiovascular risk profiles, and have specific adverse effects.”