Recent news wires are alive with rumors concerning the new miracle product, Contrave, and its favourable recommendations by the FDA. At the last count, there was a 13/7 in favor of recommending Orexigen Therapeutic’s new anti-obesity combination Contrave (bupropion SR/naltrexone SR).
The combination between bupropion and naltrexone – the key ingredients in Contrave – presents an interesting mix indeed:
Bupropion is an antidepressant that works, if I understand correctly, slightly differently from the typical antidepressants we are accustomed to reading about. Products like Prozac, Selective Serotonin Reuptake Inhibitors (SSRIs), work by inhibiting seretonin uptake in the brain (ummm – I guess that was sort of captured with the SSRI part of the description). ANYWAY, this product allows for a greater concentration of serotonin to be available in the brain stem, helping to prolong the mood lightening effect of any released serotonin.
Problematically, SSRIs often cause weight gain.
Bupropion, on the other hand, does not. Bupropion works differently from SSRIs because it targets a different set of hormones in the brain. Bupropion binds selectively to the dopamine transporter, its behavioural effects have often been attributed to its inhibition of norepinephrine reuptake. Interestingly, bupropion works effectively as a smoking-cessation aid, with the added benefit of not causing additional weight gain.
Naltrexone is the other part of the equation. It is an opioid receptor antagonist used primarily in the management of alcohol and opioid dependence. Naltrexone has been shown to reduce craving and consumption of both drugs and alcohol. Naltrexone works by blocking the receptors in your brain that express pleasure (when alcohol and narcotics are consumed). If these receptors are blocked, than the need to drink alcohol -or opioid exploiting narcotics- is also blocked, and the cravings are reduced.
Craving reduction presents a major problem to both sufferers of addiction and addiction counsellors. Getting over the hump of ˊwantingˊ the illicit substance (drugs, alcohol) can be torturous. I use that word with utmost care, but I feel itˊs warranted in this case. Managing cravings can require extreme life alterations – for example, complete environmental change, years of behavioural modification, and ongoing vigilance to the ˊtriggerˊ items (people, places, things, songs, smells, and especially moods) that elicit bingeing.
So, Contrave presents a concoction that cherry picks two psychopharm products that were conceived to address addictive behaviour. The goal for Contrave is to treat a condition which is thought to be entirely preventable.
Doesnˊt the very existence of Contrave underscore the challenges presented by the current food environment?
If we judge our environment by the approval of Contrave, the message is quite clear: maintaining a lean body in our current food environment may be achieved with meticulous vigilance. We can achieve this by educating ourselves and making careful choices, or we can discourage the desire to overeat with help from the pharmaceutical industry, making anti-addiction type medication readily available.
I know Iˊll get hate mail from people who arenˊt exactly delighted with my pro-pharma stance, but seriously – is it Pharma that is to blame? When do we start investigating our own choices, and the influence that having access to Mounds of Free Food has on our ability to control whatˊs on our plate?