Appetite Stimulant and
Depressants
Dr. Kunal Gokhale
Introduction
• Appetite, a desire to eat or drink, is a complex phenomenon
influenced by several factors.
• The final outcome is achieved by the release of various hypothalamic
peptides, which are integrated with catecholaminergic,
serotoninergic, and opioid signaling pathways.
• Dopamine and 5-HT-mediated processes in the CNS and ghrelin, a
gut-brain peptide, probably play a important role in appetite control.
• Loss of appetite (anorexia) is a common complaint in clinical
practice.
• Its etiology varies from prolonged, debilitating illnesses to
purely psychological disturbances such as depression.
• It is common in patients with widespread cancer.
• It is imperative, therefore, to investigate thoroughly an
individual complaining of anorexia for the underlying cause.
• Temporary anorexia due to short illnesses usually needs no
treatment.
• Symptomatically, appetite can often be improved by varying the diet
and by using simple preparations such as lemon pickles, bitters such
as bitter orange peel, and soups.
• The aromatic bitter appetite stimulants combine the properties of
bitterness with that of aromatic volatile oils, e.g., orange, ginger, and
cardamom.
• The use of costly appetite stimulants and ‘tonics’ for this purpose is
unnecessary.
Alcohol
• In small quantities (10%), given before a meal it can augment the
gastric secretion both reflexly by stimulation of the taste buds and by
a direct action.
• It is a major constituent of popular ‘tonics’.
• Many tonics dispensed in fancy bottles contain 10-15% of alcohol.
• Repeated ingestion of alcohol, however, causes chronic gastritis and
a diminution in appetite.
• The use of alcohol-containing ‘tonics’ in children is to be condemned.
• Their prolonged use even in adults is to bediscouraged
Megestrol acetate and Glucocorticoids
• Useful in increasing the appetite but not necessarily weight in
patients with cancer-induced cachexia.
• Insulin and oral hypoglycemics augment gastric secretion by
producing hypoglycemia; however, their use is irrational and
hazardous.
• Similar claims have been advanced for vitamin B12 and anabolic
steroids, but whether appetite stimulation is their primary action or
secondary to their metabolic effects remains to be established.
Cyproheptadine
• The 5-HT antagonist.
• Some appetite stimulating property; however, used in large doses, it
inhibits the release of ACh and depresses the circulating cortisol level.
• Thus there is no safe and reliable appetite stimulant.
Anorexia nervosa
• It is a chronic disorder characterized by loss of appetite and self-
induced weight loss.
• Accompanied by psychological and physiological alterations such as
amenorrhoea.
• Hypothalamic abnormalities are believed to play a role in its
pathogenesis.
• Currently, no pharmacological agent of proven value is available for
its treatment.
• Olanzapine, an atypical antipsychotic acting on multiple receptors,
and reboxitine, an antidepressant, have been tried as adjuncts.
