Contrave Review: Can The Obesity Drug Cause Suicidal Thoughts?

Contrave Review: Can The Obesity Drug Cause Suicidal Thoughts?

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Disclaimer: None of the information in this article constitutes medical advice, and is just the opinion of the writer(s). We recommend that patients follow their doctor’s guidance in regard to prescription medication.

Contrave is a prescription weight loss pill that's approved for use in the U.S. by the Food and Drug Administration (FDA) for overweight and obese adults above a Body Mass Index (BMI) level of 27.

The generic name for the drug is naltrexone HCL/bupropion HCL and we'll use these terms interchangeably throughout this article as they refer to the same active drug ingredient(s).

In this article we’ll review medical studies on Contrave to determine if the drug is effective for weight loss. We'll also highlight side effects of the drug, and share before-and-after images from a real user.

Does Contrave Work for Weight Loss?

Contrave has been studied in several clinical trials, four of which were summarized in this meta-review published in the Pharmacy & Therapeutics journal. Researchers found that in all four trials, Contrave caused weight loss on average.

36% of patients lost greater than 5% of their body weight in 56 weeks in the worst-performing trial, while 57% of patients lost greater than 5% of their body weight in 56 weeks in the best-performing trial.

A more recent medical review examined whether Contrave was effective for weight loss in a patient population with type-2 diabetes. Data from over 4,500 patients was analyzed, and the researchers found that Contrave was effective for this patient population, resulting in average weight loss of 11-22 pounds (lbs) over the course of the 56 week studies. 

Based on the available medical research, we will conclude that Contrave is effective for weight loss.

Contrave Side Effects

Contrave does cause side effects in some patients, and the side effects may be more severe than other weight loss drugs such as Plenity because Contrave works neurochemically while Plenity simply takes up space in the stomach. 

A medical review published in the Hormones journal detailed the most common side effects of Contrave: nausea (experienced by 29-42% of patients), constipation (16-24%) and headache (14-24%). These are relatively minor side effects.

The more concerning side effects, which are significantly more rare, involve suicidality. 

Contrave's FDA label contains a "black box" warning, which is the most severe type of warning required by the FDA. It indicates a side effect which may be life-threatening. The label states that Contrave may increase risk of suicidal thinking and actions in children, adolescents and young adults.

The risk of suicidal thoughts or actions likely affects a very small percentage of Contrave users, but this side effect suggests that patients with a personal or family history of suicide may benefit from speaking with their doctor about alternative weight loss medications that don't carry this risk.

Contrave Before-and-After Images

Patients are often curious about before-and-after images of weight loss drug patients, given that the manufacturers rarely share such images of real patients on their websites.

A popular YouTube video published by a channel called "B Runewicz" shares before-and-after images of their weight loss while using Contrave:

Questionable Inactive Ingredients

Contrave ingredients

Contrave contains two active ingredients as we referenced in the intro to this article.

Like many prescription medications, Contrave also contains several inactive ingredients we consider questionable from a health perspective, like Opadry II Blue and FD&C Blue #2 aluminum lake. These are artificial dyes.

A medical review on the toxicology of artificial food dyes found all of them to be potentially harmful, and the study authors suggested that all be removed and replaced with safer alternatives.

We generally recommend avoiding artificial dyes wherever possible, and we hope that Contrave's manufacturer phases out their use. There are no medical or nutritive benefits to artificial dye consumption, and it seems questionable to add these ingredients for branding purposes to products that are prescribed to people in an already-compromised health state.

OTC Weight Loss Options

SuperGut product shot

There exist several over-the-counter (OTC) weight loss products that don't require a prescription, and have medical research backing. We are not suggesting that these products are as effective as Contrave; just that it may be worthwhile for an overweight patient to discuss these options with their doctor given their documented efficacy and lack of significant adverse effects.

We recommend dietary fiber as a safe and effective weight loss supplement.

An extensive medical review published in The Journal of Nutrition found that dietary fiber intake directly predicts weight loss when consumed at a high enough dose. It's zero-calorie plant matter that makes you feel full faster, and consume fewer calories overall.

The fiber supplement we recommend is SuperGut Fiber Mix. It contains a clean and effective formulation: a blend of three different types of unflavored dietary fiber and zero additive ingredients. It can be mixed into liquids or foods. Interested consumers can buy SuperGut fiber at this link.

We recommend using two fiber mixes per day, which provides 16 g of total fiber. This is within the effective fiber dosing range associated with the greatest weight loss outcomes in the above-linked study (8-29 additional grams per day).

Medium-chain triglyceride (MCT) oil is another dietary supplement which has been shown in clinical trials to cause weight loss.

MCT oil is quickly absorbed by the body and increases metabolic rate, which causes fat loss. A meta-study on MCT oil documented weight loss of 0.51 kilograms (kg), which equates to 1.12 pounds (lbs). The trials lasted 10 weeks on average. This equates to a potential annualized weight loss of 5.84 pounds with MCT oil supplementation.

We recommend Bulletproof MCT Oil as our top MCT oil product, because it has a clean and effective formulation. The only ingredient is MCT oil derived from coconuts, and the product has no questionable additives. Interested consumers can buy Bulletproof MCT Oil at this link.

The effective dose range of MCT oil for weight loss (based on the medical review) is 1.7 g to 10 g per day. Bulletproof's MCT oil provides 14 g in one tablespoon, so around two-thirds of one tablespoon should be a maximally-effective dosage.

Contrave User Reviews

Contrave has been reviewed over 1,000 times on for treating obesity. Its average rating is 6.9/10. allows prescription medication users to publish reviews of their personal experience using a drug.

We cannot verify the accuracy or authenticity of any reviews on this site, but we find it to be a more objective resource for user drug reviews than a manufacturer's website.

The top positive review for Contrave is written by a user named "Court98" who claims the drug caused a significant amount of weight loss:

"When I started I was 275lb and was just not happy with where I was with my body and health...As of now (3 months in) I am 45 pounds down weighing in at 230. It is such a simple medication and works so quickly when paired with a good diet."

The top negative review comes from a user named "Dee Dee" who claims that Contrave is less cost-effective than taking the generic versions of the drug separately:

"Contrave is costly. To avoid paying unnecessary money, just have your MD prescribe the two medical ingredients separately ie bupropion as one med and the naltrexone as the other. I only pay $20/month. By having them prescribed separately, my insurance covers almost ALL the cost."

Contrave Dosage

According to the research review published in the Pharmacy & Therapeutics journal linked above, Contrave is typically dosed at one capsule for the first week, which contains 8 milligrams (mg) of naltrexone HCL and 90 mg of bupropion HCL. Another tablet is added to the daily regimen on week two, and by week four the maximally-effective dose of four daily tablets should be achieved.

This final dose contains 32 mg of naltrexone and 360 mg of bupropion.

Doctors will typically prescribe patients a dose at the lower end of the therapeutic range to assess efficacy. If the patient experiences beneficial results at that low dose, their doctor may keep them at this dose because it will minimize the risk of side effects.

Stay up-to-date on our research reviews


Contrave is effective for treating obesity in both healthy and type-2 diabetic patient populations. Over the course of a year, the drug causes weight loss of greater than 5% of body weight in nearly 50% of patients, based on medical research.

However, Contrave does carry the risk of side effects, such as nausea, constipation and headache. The drug may also increase the risk of suicidal thoughts and actions in a small subset of the population.

We find two of the additive ingredients in Contrave to be questionable from a health perspective, and we hope that the manufacturer phases out use of artificial dye in their manufacturing process.

Supplemental dietary fiber and MCT oil are two research-backed OTC weight loss options that patients may wish to speak with their doctor about because of their considerable research backing and favorable side effect profile.

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