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  • Phen-Wellbutrin: Does it work? An interview with Dr. Jerry Darm

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    Tuesday, January 04, 2005 8:06 am Email this article
    Jerry Darm, M.D. is a physician in the Portland, Oregon area who has used the combination of phentermine and Wellbutrin for weight loss. Larry Hobbs spoke to Dr. Darm by phone. Hobbs: Why did you decide to combine phentermine and Wellbutrin?

    Darm: I spoke to a local psychiatrist who treats a number of patients with eating disorders. He said that he often takes his patients off of Prozac and other SSRIs serotonin reuptake inhibitors and switches them to Wellbutrin.

    Hobbs: Why is that?

    Darm: Because Prozac and Zoloft can increase appetite in some people.

    Hobbs: Have you tried Phen-Prozac?

    Darm: Yes. I tried Phen-Prozac in about 100 patients. I start all my patients on 15 mg of phentermine alone, which works very well in about one-third of patients. Then, in about 100 patients, I added Prozac in addition to their phentermine after their weight loss had stopped. I found that the addition of Prozac reduced the side effects from the phentermine the irritability and edginess, which definitely can be a problem but I didnt get much additional weight loss with the Prozac.

    Hobbs: How many patients have you treated with Phen-Wellbutrin?

    Darm: About 50.

    Hobbs: What dose do you use?

    Darm: 150 mg of the sustained-release Wellbutrin SR twice a day combined with phentermine. I like to give the phentermine as late in the day as possible a dose at noon and another one at 5 pm as long as it doesn’t disturb their sleep. This helps to control nighttime hunger which seems to be the biggest problem for most people.

    Hobbs: Have you tried other combinations?

    Darm: Yes. In some patients taking Phen-Prozac or Phen-Zoloft Ive added the Wellbutrin.

    Hobbs: Do people lose more weight after you add the Wellbutrin?

    Darm: Yes, or frequently it stops them from regaining weight.

    Hobbs: What is the average weight loss youve seen with Phen-Wellbutrin?

    Darm: Im getting weight losses of 15 to 20 percent in a lot of patientspeople who are losing it and keeping it off.

    Hobbs: What side effects have you seen?

    Darm: Insomnia, dry mouth and edginess obviously can occur with phentermine. A couple patients complained of feeling strange on the Wellbutrin. In those patients I stop the Wellbutrin. Ive also had one or two patients experience a Raynauds-type phenomenon—a numbness, tingling, burning, painful sensation in their extremities such as fingers, toes, ears and nose. Ive stopped the Wellbutrin in those patients also.

    Hobbs: How do you deal with insomnia, irritability and dry mouth caused by the phentermine?

    Darm: Giving trazodone at bedtime helps with insomnia. Trazodone, Wellbutrin or Prozac added to the phentermine reduces irritability. But I haven’t figured out how to conquer the dry mouth except to have patients drink a lot of water.

    Hobbs: How do patients like Phen-Wellbutrin?

    Darm: Most of them tolerate it very well. Some patients feel that it makes a world of difference—like the difference between night and day. Some patients with SADSeasonal Affective Disorder—have also said that Phen-Wellbutrin has made a big difference. I have 1 or 2 patients who have lost weight on Wellbutrin alone. They didnt respond to phentermine so I tried the Wellbutrin. Wellbutrin, seems to reduce cravings, and patients say that they have more control.

    Hobbs: What kind of diet do you use?

    Darm: I use fasting in some of my heavier patients. I use the HMR programHealth Management Resources program. Ive looked at the Optifast and Medifast, but I consider HMRs program to be the best. They require that you buy their shakes and they also have supplements, but I think their shakes are the best, and believe me, Ive tried a lot of different ones.

    HMR can be reached at

    Health Management Resources
    59 Temple Place, Suite 704
    Boston, MA 02111
    (800) 418-1367 phone
    (617) 357-9876 phone
    (617) 357-9690 fax

    Jerry Darm, MD can be reached at
    16755 Graef Circle
    Lake Oswego, OR 97035
    (503) 697-0742
    (503) 697-4889 fax

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