BipolarII, Meds and Weight
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BipolarII - Weight and Mood Stabilizer (DEB)

I've been diagnosed with BPII, with mostly depression, but lots of anxiety also. I feel mixed most of the time, with very few days of normal.... My question is I've read that untreated BP only escalates and becomes more severe if it goes untreated. My pdoc has informed me he thinks a mood stabilizer would help calm the mood swings, and depression, now that we've figured out the correct diagnosis. The first diagnosis was depression causing anxiety. I knew all along the anxiety was not being treated with the SSRIs. Buspar did nothing. Xanax did nothing. I've read your articles and realize you go for the MSs. I am so afraid of gaining another 50 lbs. on an already 80 lbs too much, say on lithium. Depakote can cause blood problems. I am currently taking Serzone that helped until recently....and I think it is still but not with sedation, so klonopin was added (and I understand that is used sometimes for BP swings.) Can you give me some advice on the weight issue. I'm 216 and 5'1", just started the protein power plan, and am walking one mile per day. Will you also address how you would treat a patient presenting what I am? Thank you in advance for you answers. DEB

Dear Deb --
You are right, there are weight gain risks to lithium; and Depakote, even more so.  In my practice I use low doses and lower them immediately if a person sees weight gain: there are now quite a few alternatives that don't cause weight gain.  However, I still think that lithium and Depakote have the most obvious, well-established "track record", including on what to watch out for.  So generally for someone who looks bipolar II, as you saw on my site, I start lithium or Depakote and add the other one if a fully tolerable dose of the first, (i.e. low enough to avoid any significant side effects at all, including weight and especially the appetite increase from Depakote that is the harbinger of weight gain), isn't enough to control symptoms.  Later I taper off the antidepressant.

Check out topiramate.  It's still pretty new.   Dr. Ivan has a great list of basic Q/A.  It's the one you may have heard about that lowers appetite: most people seem to lose a few pounds, but some can lose as much as 5% of their weight (uh, that comes to 10+ lbs.for you).

Dr. Phelps

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