An Approach to the Development of Drugs for Appetite Disorders

Abstract

This review covers some modern concepts in the development of drugs to treat appetite disorders. Specific attention is paid to the peripheral satiety system and the role of gastrointestinal peptides such as cholecystokinin in the pathogenesis of satiety. Alterations in neuropeptide Y and/or peptide YY are suggested to play a role in the pathophysiology of bulimia. Corticotropin-releasing factor is a putative candidate peptide involved in anorexia nervosa. The serotonin reuptake inhibitors fenfluramine and fluoxetene decrease weight in obese subjects. Endogenous opioids modulate the choice of palatable foods. Anorexia in the old appears to be related to a decrease in opioid feeding drive and an excess of the satiety action of cholecystokinin. Other agents involved in weight regulation include those which alter gastric emptying, increase thermogenesis, or modulate fat cell metabolism. It should be stressed that many neurotransmitters that modulate appetite also alter other behaviors, increasing their propensity to produce side effects.

Anorexia in the elderly—an annotation

“…The earliest reports of anorexia nervosa in the elderly were probably by Kellett, Trimble, & Thorley (1976) in a 52-year-old female and by Launder (1978) in a female aged 70 years. There have been other single case reports by Gowers and Crisp (1990) in an 80-year-old, by Cosford and Arnold (1991) in a 73-year-old woman, by White and Harries (1990) in an 82-year-old, and by Ramell and Brown (1988) in a 67-year-old.…”

“…There have been other single case reports by Gowers and Crisp (1990) in an 80-year-old, by Cosford and Arnold (1991) in a 73-year-old woman, by White and Harries (1990) in an 82-year-old, and by Ramell and Brown (1988) in a 67-year-old.…”

“…Anorexia nervosa may not only be increasing in incidence (Hsu, 1990) but may be beginning to occur in new groups of patients. Morley (1989) has comprehensively reviewed the theoretical aspects of anorexia in the elderly suggesting that loss of opioddriven feeding may be responsible for anorexia nervosa in the elderly. In our experience, however, patients suffering from anorexia nervosa remain hungry, and resist this hunger for psychopathological reasons.…”

Current attitudes to anorexia and bulimia nervosa: The needs, benefits and ways of changing

“…Areas with potential include the peripheral satiety system, the role of gastrointestinal peptides, corticotrophin releasing factor, serotonin uptake and endogenous opioids (Morley, 1989).…”

“…Similarly, research into the mechanisms behind hunger and satiety may expose opportunities for the use of new drugs for the treatment of both anorexia and bulimia nervosa. Areas with potential include the peripheral satiety system, the role of gastrointestinal peptides, corticotrophin releasing factor, serotonin uptake and endogenous opioids (Morley, 1989).…”