Addictions May Be Related to Allergy Process

[original article: in Washington Post]

This was shared by Larry Plumlee, M.D., former medical director of the EPA in the Carter administration. He pointed out that this confirms Theron Randolph was correct in stating that allergies are related to addiction. In response, one reader gave warnings about using drugs to deal with allergies:

Hi all,

I was pretty appalled to read this article. I just want to warn anyone who considers taking Topomax that one of the side effects is altered mood. I was on Topomax for a few months as a migraine preventive. I have tried many anti-seizure drugs for migraine prevention (so far with little success,and by the way, most of them *cause* weight loss. I've gained twenty pounds in the last year alone.) Anyway, within a few weeks of taking Topomax I had severe mood swings, random thoughts of suicide, and became paranoid and reckless of my safety.

It took me acting truly bizarre, after three months, before my friends and I realized it was the medication making me act crazy. Within a couple weeks of being off it my life was back to normal. I couldn't BELIEVE that these serious psychological effects were not listed more prominently in the literature of warnings and side effects. And, by the way, the drug did not help my migraines and I did not lose any weight.  -- Signed

Epilepsy Drugs May Curb Obesity
Weight-Loss Side Effects Raise Questions About 'Addictions' to Food

By Rob Stein
Washington Post Staff Writer
Tuesday, October 7, 2003; Page A03


Soon after a new epilepsy drug hit the market in 1996, doctors noticed
something unexpected: Patients using the anti-seizure medication suddenly
began losing weight -- rapidly.

That chance observation has led to tantalizing new insights into the
underlying reasons why some people overeat and have such a hard time
shedding pounds, and the provocative question of whether food can be an
"addiction."

When obesity specialists heard about the drug's side effect, some decided
to try it for their patients. It seemed to work for many who had failed to
lose weight by dieting, exercise or taking other drugs. And recent studies
designed specifically to test the epilepsy drug as a weight-loss aid have
found that it helps people, especially those prone to binge eating, to lose
-- and keep off -- significant amounts of weight.

Perhaps more importantly, the drug, called Topamax, has led scientists to
explore what could be a new approach for controlling appetite and other
cravings. The drug, along with another anti-seizure medication, an
antidepressant and an experimental compound that blocks the "munchies"
produced by marijuana, appears to help some people control obsessive
behaviors, including overeating, smoking and alcohol abuse.

Although the drugs work in different ways, they affect the parts of the
brain involved in pleasure sensations. All of them may work by tamping down
uncontrolled electrical firings of nerve cells that lead to compulsive
eating, drinking or smoking in the same way that blocking uncontrolled
electrical firing in the brain prevents seizures.

"It could be that the drive to eat in the higher levels of the brain is an
electrical event that keeps recurring," said Lewis J. Aronne, director of
the Comprehensive Weight Loss Center at the Weill Medical College of
Cornell University in New York. "You think about food and go to the
refrigerator. You want it to go away, but it comes back. That persistent
thinking about eating is, like alcoholism, a neurological event that won't
go away -- like a seizure. Could it be that Topamax quells that and allows
you to turn it off? That's one way it could work."

Addiction and obesity experts stress that both problems are extremely
complex and in all likelihood have multiple environmental and biological
causes. But many experts agree that they appear to have certain intriguing
similarities.

"What characterizes addiction is the compulsion: A person may consciously
not want to take it anymore, but the drive is so intense the person takes
it anyway," said Nora Volkow, director of the National Institute on Drug
Abuse. "That's what we see with cocaine and heroin. What's interesting is
that in pathological overeating, you see the same syndrome -- a compulsion
to eat an enormous amount of food."

The apparent effectiveness of these drugs to treat compulsive behavior for
weight loss supports an emerging theory that becoming overweight or obese
is, in many cases, a two-stage process: People start to gain weight because
they live in an environment where high-calorie, high-fat food is plentiful
and exercise is rare. But once they have put on an extra 20 or 30 pounds,
their bodies and their brains get caught in a vicious cycle in which more
weight gain becomes increasingly easy and weight loss is increasingly
difficult.

"People still think that weight is just a matter of behavior -- if you
would only push yourself away from the table it would be okay," said
Aronne, vice president of the North American Association for the Study of
Obesity. "But there are messages coming from your body once you gain weight
that try to keep the status quo. So when you cut back on your food intake,
your body is trying to stop you. It's tougher than it looks."

When his weight neared 300 pounds, Richard Davis knew he had to do
something. But nothing worked: not the diets, not the exercise, not the
drugs. His doctor finally referred him to Aronne, who suggested he try
Topamax, known generically as topiramate.

"I started losing weight almost immediately," said Davis, 58, of Brooklyn,
N.Y. He dropped 70 pounds in about eight months on the new drug and has
kept the weight off for more than a year. "I used to be a binge eater who
would eat enormous amounts of food even when I wasn't hungry. Now I just
eat regular amounts when I'm hungry. To me, it's a miracle."

Aronne said other obesity experts caution that the search for weight loss
drugs has long been marked by false hopes and shattering disappointments,
and more testing is needed to fully evaluate the drug's usefulness.

Still, Aronne says, "This is the kind of drug that could be a breakthrough.
I don't want to make it sound like a miracle cure, but it could turn out to
be very helpful."

The new insights come as public health experts have become increasingly
alarmed by the rising number of Americans who are overweight or obese.
About 65 percent of U.S. adults are overweight, and about a third are obese.

The obesity epidemic has triggered a flurry of research, yielding
fundamental new understanding of how the body regulates weight, hunger and
appetite. That, in turn, has led to at least a half-dozen experimental
compounds that show promise as long-sought safe and effective appetite
suppressants.

The two epilepsy drugs and the experimental compound based on marijuana's
effects, in particular, have progressed to advanced testing, and they are
providing intriguing clues.

"I'm a psychiatrist, and I deal a lot with people who are obese and people
who have mood and eating disorders," said Susan L. McElroy, a professor of
psychiatry at the University of Cincinnati who has studied both epilepsy
drugs. "I'm certainly not saying that everyone who is obese has a mental
illness. But there's clearly a link between obesity, eating disregulation
and mood disregulation that needs to be more fully explored."

Topamax, made by Ortho-McNeil Pharmaceutical Inc., has helped obese people
lose as much as 10 percent of their body weight, according to a study
published in the June 6 issue of the journal Obesity Research. Unlike other
drugs, it appears to continue to work for extended periods, enabling people
to keep the weight off.

The drug causes side effects in some people, including a tingling in the
hands and feet, memory problems and difficulty thinking. As a result, it
has earned the nickname "dopamax." But Topamax has been used for so long on
so many epilepsy patients that experts consider it generally safe. Lower
doses and different formulations may minimize or eliminate the side effects.

Researchers say it is not clear whether patients would have to use the drug
indefinitely. For epilepsy, it sells for about $1.70 for a 25-mg pill, but
is it not known what it would cost if marketed for obesity.

The second epilepsy drug, zonisamide, which Elan Biopharmaceuticals sells
as Zonegran, produced similar weight loss in obese adults in a study
published April 9 in the Journal of the American Medical Association. The
only side effect appears to be relatively minor fatigue. There is also some
evidence it may help people quit smoking and drinking.

Along with apparently reducing uncontrolled electrical firings in the
brain, both drugs seem to affect chemical signals involved in pleasure --
serotonin and dopamine.

"Many of these neurotransmitters that regulate and modulate appetite
signals and satiety signals are also involved in modulating many different
things, such as depression and mood," said Kishore M. Gadde, a professor of
psychiatry at the Duke University Medical Center in Durham, N.C., who led
the Zonegran weight loss study.

The experimental compound, called rimonabant, is very different. It has no
anti-seizure effects, but it blocks one of the signals that marijuana
triggers in a part of the brain involved in increasing appetite --
producing intense hunger. Studies have shown that rimonabant significantly
reduces appetite, and it is undergoing a final round of testing involving
several thousand people in the United States and Europe. Like Topamax, it
also shows promise in helping people quit smoking and drinking. The only
side effects have been minor digestive problems.

Gadde noted that one of the new antidepressants, Wellbutrin, is also sold
as Zyban to help people quit smoking, and it, too, appears to help some
people lose weight.

Researchers are studying all these drugs in the hope of confirming their
effectiveness and learning more about how the brain regulates food intake.
Neither Topamax nor Zonegran has formally been approved as a weight-loss
aid, but doctors are free to prescribe them to overweight patients
frustrated by the lack of effective alternatives.

Once he started taking Topamax, Davis said, he suddenly found he could
control the urge to eat.

"Before, I would sit down and eat a quart of ice cream and a pizza. I was
constantly eating throughout the day. I just couldn't stop thinking about
it. I was obsessed with food," said Davis, a retired teacher. "Now, I look
at it entirely differently. There's no question that I still enjoy food and
going out for a good meal. But now I'll look for the least fattening food
when I go out to a restaurant. And I can stop eating whenever I want."