Short-Term Treatment of Obesity with Fluoxetine as a Supplement to a Low Calorie Diet

　　　　　背景:在臨床試驗上，血清素(serotonin)再吸收之抑制劑已有效的引起適度的 但統計學上有意義之體重下降。Fluoxetine，一個作用於中樞的血清素再吸收抑制劑，目 前有效而且安全的用來治療成人之憂鬱症，同時由於其作用於中樞之厭食作用，也有減重 的作用。由於利用血清素再吸收抑制劑報告來治療肥胖症多半是在白種人的臨床試驗，而 利用血清素再吸收抑制劑來治療肥胖症在亞洲人的文獻相當的少，本研究的目的主要是評 估nuoxetine對於肥胖臺灣人之療效。 方法:在這個研究P，在新陳代謝科門診，60個中度肥胖以上的病人(體重大於理想體重 l30%者)全都被教寺使用低總熱量飲食，被任意區分為兩組。1組每天加服用nuoxetine 6Omg，另1組則為對照組。 結果:在12週實驗之總體重下降方面，fluoxehne組的病人有著較高而且統計學上有意義的 體重減輕(mean±.E.,-5.75±0.69vs -3.06±0.59公斤，p=O.008)，在第1個及第2個4週 內，fluoxetine組的病人體重下降較多，而且統計學上有意義(mean±S.E.，第1個4週內 :-2.57±0.34 vs. -1.24±0.22公斤，p=0.0033;第2個4週內:-1.90±0.25 vs. -0.9± 0.35公斤，p=0.0226)，但在第3個4週內，fluoxetine組雖然體重下降仍比對照組之，但 卻已沒有統計學上的意義(mean±S.E. 第3個4週內:-1.21±0.34 vs. -0.73±0.25公斤， p=0.299)。同時我們發現fluoxetine組的病人有較高比例的厭食及嘔心感出現，而其餘的 副作用多半是輕微而可以被患者忍受。 結論:在肥胖臺灣人身上，利用fluoxenne追加於低總熱量飲食是能有效的，耐受性良好的 ，安全的短期用來治療肥胖症。
　　　　　Background: Inhibitors of serotonin re-uptake including fluoxetine have generally been successful in inducing modest but statistically significant weight reductions in clinical trials. However, there are few published trials with serotonin re-uptake inhibitors in obesity therapy on Asians. This study aimed to assess the effect of fluoxetine as an adjunct therapy to a low calorie diet in the obese Taiwanese population. Methods: Sixty healthy obese subjects [body weight> 130% of ideal body weight (IBW)] were instructed to follow a low calorie diet. All subjects were randomized to receive fluoxetine 60 mg once daily with diet or diet only for 12 weeks. Results: The mean total body weight reduction at the end of the study was significantly greater in the fluoxetine group than in the diet group (mean ± S.E., -5.75 ± 0.69 vs. -3.06 ± 0.59 kg, p= 0.008). The body weight reduction in the first 4 weeks and second 4 weeks were greater in the tluoxetine group and they were statistically significant (mean ±S.E.,1st 4 weeks: -2.57±0.34 vs. -1.24±0.22 kg,p=0.0033; 2nd 4 weeks: -1.90±0.25 vs. -0.9 ±- 0.35 kg, p= 0.0226). In the third 4 weeks, the weight reduction in the fluoxetine group was still greater, but it was not statistically significantly (mean ± S.E., third 4 weeks:-1.2110.34vs.-0.73-0.25kg,p=0.299). More symptoms of anorexia and nausea were noted in the fluoxetine group. The other side effects noted in the fluoxetine group were usually mild and tolerable. Conclusion: Fluoxetine is effective, well tolerated and relatively safe in the short-term treatment of obesity in the Taiwanese population when added to a low calorie diet.