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Interview with Michael Anchors, M.D., Ph.D., about Phen-Pro (2000)
Saturday, November 15, 2003 8:21 pm Email this article
Dr. Michael Anchors notes that adding 5-HTP to Phentermine-Proac helps about half of plauteaed patients to lose more weight.
Michael Anchors, M.D., Ph.D. was the first to describe the use of phentermine combined with Prozac (fluoxetine) and other SSRIs in his best-seller Safer Than Phen-Fen (Prima Publishing, 1997). He is a clinical professor of medicine at Georgetown University and has a family practice in Gaithersburg, Maryland. A little over a year ago he started adding 5-hydroxytryptophan (5-HTP) in some of his patients taking Phen-Prozac.
Larry Hobbs interviewed Dr. Anchors by email to find out what effect, if any, it has had.
Dr. Anchors can be reached at:
Michael Anchors, MD, PhD
16220 Frederick Rd Ste 210
Gaithersburg, MD 20877
(301) 990-6064 Fax
Hobbs: How many patients have you treated with Phen-Prozac??Ωa combination of phentermine and an SSRI?
Anchors: 1706 patients.
Hobbs: How many have reached ideal body weight??Ωa body mass index (BMI) less than 25?
Hobbs: Has weight regain been a problem?
Anchors: No. Only one patient has gained back more than 10 pounds.
Hobbs: How often do you use each of these SSRIs or drugs with phentermine and what doses do you use?
Anchors: My answers to this question are based on my current practice. Most of the drugs marked 0% were tried previously and did not work.
- Prozac (fluoxetine) 10-20 mg in 70 percent of patients.
- Desyrel (trazodone) 50 mg in 8 percent of patients.
- Zoloft (sertraline) 50 mg in 5 percent of patients.
- Celexa (citalopram) 20 mg in 4 percent of patients.
- Effexor XR (venlafaxine) 75 mg 2 percent of patients.
- Luvox (fluvoxamine) 50 mgin 1 percent of patients.
- Paxil (paroxetine)—Never. Paxil can cause weight gain.
- Wellbutrin (bupropion) —Never. Wellbutrin did not work for me.
- Serzone (nefazodone)—Never. Serzone did not work for me.
Hobbs: How do you decide which drug to use?
Anchors: I use Prozac first unless the patient is already on one of the five other effective SSRIs, in which case I leave the patient on their current SSRIs although I sometimes adjusting the dose downward since higher doses of SSRIs block the effect of phentermine (see Padla in NAASO abstracts November 1997). Prozac works fine for two-thirds of patients. In the other one-third I have to switch to another SSRI such as Celexa, Luvox or Effexor when a patient reports anorgasmia, that is inability to orgasm, or switch them to Trazodone if they report having insomnia.
Hobbs: What side effects are most common with each drug?
Anchors: The only side-effect specifically traceable to the SSRI is anorgasmia, that is inability to orgasm. It occurs more often in women than men. In those cases I switch them to Celexa or Effexor which are less likely to cause this problem. The SSRI’s seldom have side-effects with the small doses that I use. The side effects that patients report most often—dry mouth, insomnia, fast heartbeat, sweating, etc.—are caused by the phentermine, but they are not a problem for most people. Most of these side-effects, if they occur at all, occur to a mild degree during the first ten days as the patient is adjusting to the medication and then go away. That is why it is so important for physicians to start phentermine at a dose of 15 mg per day, and then only after the patients gets used to the medicine to increase it to 30 mg.
Hobbs: Do you ever add 5-hydroxytryptophan (5-HTP) to Phen-Pro (Phentermine-Prozac or other SSRI)?
Hobbs: In what percent of patients?
Hobbs: When do you add 5-HTP?
Anchors: Whenever a patient’s rate of weight-loss slows down and their hunger increases.
Hobbs: Does it help to break plateaus?
Anchors: Yes. That’s exactly what it does.
Hobbs: How often does it work?
Anchors: About half the time.
Hobbs: Does it reduce cravings?
Anchors: It’s difficult to say. The idea of “cravings” means different things to different people.
Hobbs: Does 5-HTP help reduce the symptoms of PMS?
Anchors: I don’t know. Many patients have reported a reduction in PMS with the initial use of an SSRI and since I don’t add the 5-HTP until later I don’t have a way of separating out the two.
Hobbs: Do you know why it is that sometimes 5-HTP doesn’t help?
Anchors: I don’t know for sure. Maybe their renewed hunger wasn’t caused by a reduction in serotonin. Or maybe the patient didn’t really have renewed hunger, but instead only claimed renewed hunger to cover for their behavior of eating when they weren’t hungry. I don’t really know.
Hobbs: Do patients notice any subjective differences when 5-HTP is added to Phen-Pro?
Anchors: A few patients have reported having nausea with the addition of 5-HTP, otherwise they have not reported any other differences.
Hobbs: Does it provide better appetite suppression?
Anchors: Yes, it definitely does in people who respond.
Hobbs: Does it help to reduce night time eating?
Anchors: I don’t know. I haven’t asked.
Hobbs: Have patients reported any effect improvement in insomnia, headaches, PMS, fibromyalgia?
Anchors: No, not that I have been told.
Hobbs: What is the average weight loss with Phen-Prozac vs Phen-Prozac-5HTP?
Anchors: I don’t know as far as total weight loss because everyone is started on Phen-Prozac and then 5-HTP is added later. The initial weight loss with phen-Prozac ranges from zero to 5.8 pounds per week with the average being about two pounds per week. After six weeks the rate usually settles down to somewhere between zero and three pounds per week with an average of about 1 pound per week. When a person plateaus and has stopped losing weight and I add 5-HTP weight loss returns to about one pound per week.
Hobbs: Do patients report any effect on mood with the addition of 5-HTP?
Anchors: No. I haven’t had anyone tell me that it has affected their mood.
Hobbs: Do patients report any effect on energy or fatigue?
Hobbs: Have you had any reports of daytime sleepiness?
Hobbs: What time of the day do you give it??Ωbefore meals or before bedtime?
Anchors: I found and patients have reported less nausea when 5-HTP is taken with food.
Hobbs: Is 5-HTP any less effective when taken with food?
Anchors: No. I’ve found weight loss to be the same whether they take it with food or on an empty stomach.
Hobbs: Do you ever vary the dose depending on the response, that is increase the dose if it doesn’t seem to be working?
Anchors: I would if it was necessary but the response seems pretty consistent in people who respond. I’ve had only one patient out of more than a hundred say that they found that 100 mg per day had no effect on their appetite, but increasing it to 200 mg was effective.
Hobbs: What is the smallest dose that you have found effective?
Anchors: 100 mg. 50 mg is simply not enough. This is one reason I am confident that the effect from 5-HTP effect is not a placebo effect.
Hobbs: What is the largest dose that you have found necessary?
Anchors: 200 mg.
Hobbs: Do you ever vary the dose depending on a woman’s cycle or if a person is under additional stress?
Hobbs: Do you keep patients on 5-HTP continuously?
Anchors: Yes, generally I have patient continue to take it, but I also tell them they can stop if they want to and see if their hunger returns at which time they can begin taking it again. However most of my patients have wanted to continue taking it for fear of gaining the weight back.
Hobbs: Do you have any patients taking it intermittently only when they feel it is necessary?
Anchors: A few, but not many.
Hobbs: Have you noticed any difference in response between men and women?
Anchors: Yes. Women are much more likely than men to respond to 5-HTP. But this may be because women are more honest with me about the return of hunger. Men are better at denial and rationalizing, and worse at following instructions or deferring to authority.
Hobbs: Have you found any difference in the response to 5-HTP depending on which SSRI you used?
Anchors: I don’t know. I haven’t looked at this.
Hobbs: With the addition of 5-HTP how much more common are: Nausea? Headaches? Sexual dysfunction?
Anchors: Nausea is the only problem. I have not had any reports of headaches or sexual dysfunction with 5-HTP.
Hobbs: Have you had any suspected cases of serotonin syndrome with the addition of 5-HTP?
Anchors: No. And I have carefully watched for this.
Hobbs: Have you tried adding carbidopa with 5-HTP as Richard Rothman suggests? If so, was it helpful? And did it cause any additional side effects?
Anchors: Initially I only gave 5-HTP with carbidopa. But later I found that 5-HTP alone was more effective, much better tolerated, and much cheaper. Theoretically it seems that 5-HTP-plus-carbidopa should work better, but this was not my experience.
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