Other medications that are commonly used include tryicylcic antidepressants, SSRI antidepressants, Nonsteroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants. In contrast, Dr Holtorf advocates a controversial six step plan that involves the treatment of hormone imbalances, mitochondrial dysfunction, sleep disturbances, and chronic infections. The Infectious Disease Society of America states that Lyme disease is easily treated with a few weeks of antibiotics and that chronic Lyme disease does not exist. Their position is that standard blood tests are an accurate means of determining the presence of Lyme disease. Holtorf maintains a controversial stance that weight loss is not an issue of diet and exercise, citing causes for the inability to lose weight as leptin resistance, undiagnosed hypothyroidism, environmental toxins, hypometabolism and dysfunctional weight set-point. Leptin resistance is described as a condition in which overweight individuals are unable to respond to the hormone’s signals appropriately, leading to a starvation response in the body as well as hypothyroid symptoms at the cellular level where they are more difficult to detect. Holtorf treats leptin resistance in patients with a class of medications that are typically reserved for controlling blood sugar levels in diabetics. A suppressed or "wrecked" metabolism is another cause of obesity commonly cited by Holtorf. Holtorf claims the metabolism, when subjected to repeated or overzealous dieting and exercise, will regulate itself by repressing thyroid hormone levels in the body, resulting in a hypothyroid state. Even the return to normal intake of food or levels of exercise will not be substantial enough to return the metabolism to its previous state. According to his website, holtorfmed.com, this leads to a permanently or chronically suppressed metabolism and Holtorf issues metabolic testing for patients exhibiting metabolism suppression, as well as labs denoting thyroid and other hormone levels. Set-Point malfunction is another theory proposed and supported by Holtorf, which suggests that the body is programmed to return to a set weight and that this point can be altered by numerous medications, resulting in weight gain. Holtorf prescribes naltrexone, an opioid receptor blocker, used most often to treat opiate addiction, and buproprion (Wellbutrin), a common antidepressant, to reduce the body's set-point.