A 3-Part Question - BipolarII, PCOS, Weight & Treatment
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 A 3-part question about BPII treatment and weight

Q: Dr. Phelps, First of all, thank you for your wonderful site (psycheducation.org). I was diagnosed with BiPolar II just 4 days ago, and I have found your site to be one of the most well-written, helpful sites in giving me the information I need. So thank you! Second of all, I have a few questions which I have been unable to find answers to. I have had a weight problem since I was in my early teens, about the same time I can remember my first episode of depression. I have read lots of articles about how the meds prescribed for BP II cause weight gain, and how there is some indication that low thyroid or high thyroid activity can contribute to Bipolar, but I have found nothing that can help me understand if the bipolar illness has been a significant contributor in the obesity I have had for 18 years. I look in the Pub Med section you mentioned in one of your other emails, but I have seen no articles written about obesity and unmedicated bipolar. Have you seen this before?

Dear Kathryn -- Let's stop there and try to answer that part, then continue.  I think you are almost certain to be right about the connection: weight problem associated with mood change, thyroid involved in there commonly, and then continued weight gain/mood symptoms.  There is a condition called polycystic ovarian syndrome (PCOS) that may link these (if you don't mind some seriously technical stuff, check out this article which tries to link a weight control hormone leptin with PCOS, which has mood symptoms in some women).  Next question...

Q #2: Following that idea, I have an appointment with a psychiatrist next week to get medication, and I am concerned about taking one that will cause me to gain any more weight. My hope is that by dealing with the manic-depression, I will be able to have the energy and desire to work on my weight - as opposed to gaining more with medication. I have read that Topamax is the one that seems to help with weight loss. What are your thoughts about using that as my first medication, and if not that one, can I take a weight-loss medication combined with the other bipolar recommended medications?

Topomax is not unreasonable in this scenario, as a starting place -- though generally I strongly rely on lithium and Depakote, and use Topomax to "salvage" those if they cause a weight problem.  You might have your doc(s) consider a fasting insulin level; some experts think that may mark those women whose PCOS will respond (including with weight loss, as well as mood improvement) to metformin (Glucophage).  If you do have PCOS, that is.

Q #3: Finally, I first went to my therapist 3 years ago for depression. Since then, I have had at least 1 defined hypomanic episode and 1-2 defined severe depressions each year. These cycles were classic bipolar II cycles and I had all the symptoms. She really only remotely mentioned the possibility of Bipolar in the last couple months (following a manic episode and then the crash with this last serious depression) and that we should "watch it" but I am honestly feeling disappointed and angry that I have been asking for help for 3 years and that it has taken this long(only once did she recommend medication...Paxil.. I took it a short time and became suicidal). She never gave me information about manic-depression - not even seriously discussing it, educating me or making any recommendations. I know each case is different, but should a therapist be able to identify manic-depression sooner? I read your section about finding a therapist, and I had thought I trusted her and opened up to her.. but now I feel let down, angry (these last 3 years have been very destructive) and I don't know if I am in good hands now or even if I should throw away 3 years invested with her. Any thoughts?

Yep: this "new" thinking about bipolar II really emerged in the last 2-3 years for those of us without some really good specialty training in mood disorders (in that camp, it was under discussion for about 15 years, if you can believe that).  So, give her a little room to get educated, and you can help that process.  If you get a good response to a mood stabilizer, that is one of the best "educations" you can offer her!  You can gently and supportively mention my site as a resource for providers also.  Thanks for your encouragement about my efforts; good luck with yours.

Dr. Phelps

Published October, 2000

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