This Regimen for Rest of My Life? Meds-Weight Gain
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Q:  This Regimen for the Rest of My Life?  Meds-Weight Gain

I was diagnosed with bipolar disorder in 1991 at the age of 46. At the time my beloved daughter-in-law had been diagnosed with breast cancer and the prognosis was not good. (She had cancer cells in the lymph nodes which they removed). I ended up in the hospital for 12 days and put on Lithium and Zoloft. Over the next several years, Shannon went through various chemo sessions and a autogolous stem cell replacement after high dose chemo.

As Shannon was dying my husband of 33 years-my childhood sweetheart-announced that he was moving from Nashville to Fl and I was not going along. When Shannon died six weeks later, I ended up in the hospital again six weeks later. I really don't remember but I don't believe I was taking Lithium at that point, only Zoloft. I was seeing a Psychiatrist on a regular basis.

Since 1991, I have been hospitalized 7 times, once for as long as 23 days. During that time I was put on everything from Zyprexa to Depacot to Neurontin. I have been on 800 mg. of Neurontin, 100 mg of Zoloft, and 400 mg of Lithium for about 3 1/2 years now.  No more hospital and I work as a real estate agent.

My question: Will I more than like be on this regime for the rest of my life?  Do any of those 3 drugs contribute to weight gain?

I appreciate your time. Sorry for the wordiness!


Dear Ms. K' -- 
Not wordy, but very unfortunate and sad.  However, there is evidence here to suggest that things will be different.  First, you're working now, good sign.  Second, if you really have bipolar disorder, and things do not go well at some point, there are options to be explored (not until you and your doc' decide together, and hopefully not at all if things continue to go okay).  The regimen you are on is a little unusual if you really have bipolar disorder (you could have a variant for which this is just the right mix).  In bipolar disorder the usual strategy is to combine mood stabilizers.  As you know, Zoloft is an antidepressant and Neurontin is a well, not clear exactly: it is not really a mood stabilizer but works well for anxiety and depression. 

So, this is my wordy way of saying, regarding your question about "the rest of my life", that unless it was working really well, "I doubt it".  Will you be on some regimen?  Probably, after all those hospitalizations.  Bipolar disorder often starts showing episodes under severe stress but then goes on to have episodes show up with no stressor at all (this is the so-called "kindling" phenomenon).  When that has happened, following the model of epilepsy from which the kindling idea has been borrowed, it seems that most people then require medications to prevent subsequent recurrences.  

Weight gain: Zoloft maybe, not really common; lithium at 400, maybe, not so common at that dose; Neurontin maybe, though usually that too requires a higher dose than you're taking to cause weight gain.  There's some scant evidence to suggest that the mood condition itself can cause weight gain through a mechanism called "metabolic syndrome" that stress may also trigger.  In that case, rigorous efforts at weight loss might not only lead to weight loss but mood improvement as well.  But that's hard for people who feel fine to pull off, so if you still have some mood symptoms it could be really hard.  

I hope life's path from here goes smoother for you. 

Dr. Phelps

Published March, 2002


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