Weight Loss Associated with Reboxetine Use in Adolescents.

Abstract

[Author Affiliation]Hasan Bozkurt. Department of Child and Adolescent Psychiatry, Gaziosmanpasa University, Medical Faculty Hospital, Tokat, Turkey.Serkan Sahin. Department of Child and Adolescent Psychiatry, Gaziosmanpasa University, Medical Faculty Hospital, Tokat, Turkey.Address correspondence to: Hasan Bozkurt, MD, Department of Child and Adolescent Psychiatry, Gaziosmanpasa University, Medical Faculty Hospital, Tokat 60100, Turkey, E-mail: drhasan33@gmail.comTo the Editor:Reboxetine is a selective norepinephrine (NE) reuptake inhibitor, broadly used as an antidepressant and antianxiety agent, which has been reported to have effects on weight loss (Schatzberg 2000). Most of the studies have advocated its role as an adjunct therapy to attenuate olanzapine-induced weight gain in patients with schizophrenia (Poyurovsky et al. 2007). It was also demonstrated to be beneficial in the treatment of binge eating disorder in nonschizophrenic obese subjects, and was associated with a significant reduction in body mass index (BMI) (Silveira et al. 2005).To the best of our knowledge, although reboxetine was reported to be effective in children and adolescents with attention-deficit/hyperactivity disorder (ADHD) and anxiety disorder (AD), there is no study in the literature about its effect on weight loss in pediatric patients. Here, we present three adolescent patients who experienced weight loss with the use of reboxetine.Case ReportsCase 1A 15-year-old girl with bipolar disorder was referred to our clinic by her psychiatrist because of her family's immigration to our residence. She had no history of any neurologic disorder and had mild mental retardation with an intelligence quotient (IQ) of 61 on Stanford- Binet intelligence test. She had been on valproic acid 1250 mg/day, aripiprazole 20 mg/day, and biperiden 4 mg/day for 3 years, and her family had no complaint except weight gain resulting from medication use. She gained 30 kg (from 58 kg to 88 kg) during this period. According to her parents, dietary interventions failed, because she refused to comply with the instructions. We decided to add a pharmacologic agent for weight loss. Metformin and topiramate were used, but the former was discontinued because it provided no benefit, and the latter was discontinued because of severe apathy. Reboxetine, 4 mg/day, was initiated and increased to 8 mg/day a week later. The patient's weight decreased dramatically from 88 kg to 70 kg after 12 weeks. She experienced no side effects other than loss of appetite, and had also not used any herbal drug for weight loss. She was still on reboxetine treatment and her weight remained the same even after 6 months.Case 2An overweight 16-year-old girl was referred to our clinic by her pediatrician for psychiatric examination. She was diagnosed with ADHD (predominantly inattentive type) with comorbid AD after clinical evaluation. She had history of methylphenidate and atomoxetine use with no benefit, and also side effects that caused her to discontinue the medications. Therefore, we decided to start reboxetine for both ADHD and AD. Reboxetine, 4 mg/day, was initiated and increased to 8 mg/day a week later. She benefited some from reboxetine for her ADHD, and anxiety symptoms decreased after use of reboxetine for 8 weeks. However she lost 15 kg weight and her BMI decreased, surprisingly, from 29 kg/m2 to 23 kg/m2 after reboxetine treatment. She felt very satisfied with this situation and her mood ameliorated during this period. She had also not used any herbal drug or dietary intervention for weight loss, and experienced loss of appetite and mild headache with reboxetine. Her BMI was still 23 kg/m2 in spite of withdrawal of the drug after 6 months.Case 3An obese 13-year-old girl was referred to our outpatient unit by her pediatrician because of unexpected panic attacks. …