Medications and Weight
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Medications and Weight

Q:  Dear Dr. Phelps,

I have tried several different medication combinations to treat my manic-depression. Like others on these drugs, I
have gained extra weight. My doctor put me on Neurontin (1200mg) and Topamax(45mg). She told me that I would lose weight as I increased my dosage on the Topamax. I tried increasing my dosage of the Topamax, but I became extremely irritable and full of violent thoughts! It was very scary! Do you have any other suggestions, like switching medications, or going on Tenuate? No matter how much I exercise, the weight doesn't seem to come off. Here's the list of my meds:
Xanax-.25mg (as needed)
Paxil-20mg...this is a new one
Any suggestions would be helpful!


Dear Ms. D. Ė 

Unfortunately your experience is very common. Your docí was right, a lot of people get appetite suppression on Topomax and lose weight (we donít know yet if that weight loss will "stick").  But I have seen several people become quite agitated on Topomax. Itís almost like they were given an antidepressant (causes agitation in quite a few folks with mixed states of bipolar disorder). There are just a few hints to suggest that Topomax can have some antidepressant-like properties, as does

Of course Iíd suggest sharing your concern with your docí; but Topomax is one of the few options to treat weight gain thatís used at all routinely (and Iím not aware of anything thatís used even non-routinely that shows much promise Ė sorry). Of the medís you are taking, Neurontin is probably the most associated with weight gain. Paxil is also associated, but usually it takes a while and you just started that one; the rest of what youíre taking is not generally a problem. You have a lot of options, but that means giving up what youíve got, which can be scary and risky. Educate yourself about those options (other mood stabilizers, especially in combinations if routine doses have caused problems for you in the past Ė combine low doses) and discuss them with your doctor. 

Itís not impossible to solve the problem you describe, but itís tricky and takes a lot of tinkering with meds. Youíll hear "diet and exercise" over and over: thatís a hard route but for some people it really does work. For some women in particular it seems not to work, which can be extremely discouraging. Finally, there is always asking yourself the question as to how much it really matters what you weigh, in the big picture of things (I know, tricky territory there too). 

Mood stabilizers which only extremely rarely are associated with weight gain, in my experience: carbamazepine (Tegretol, Carbatrol) and lamotrigine (Lamictal). 

Long answer Ė because itís an extremely common problem.

Dr. Phelps

Published September, 2000


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