Meds, Weight Gain & Metabolism
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 Q:  Meds, Weight Gain & Metabolism

 Dear Dr. Phelps,
 I was diagnosed as Bipolar II (mild) 2 years ago after a marital crisis, I was on  Depakote for almost a year and did not like what it was doing to my weight and the sedation it was causing me so I asked for Lithium, I felt it may work for me being  that it has worked miracles for my brother who is Bipolar I, and has been taking  Lithium for 30 years. My major complaint is the weight issue again, and  sluggishness, my doc 2 weeks ago had me add Topamax to my meds. to see if it will  help with the weight issue, well I came down with a "bug" or just diarrhhea so he  said I could stop the Topamax till I feel better again. Anyway I haven't, it too is sedating like Depakote, and I've grown tired of all this "sedating stuff" I bearly  get out of bed now! My life stresses are basically over and I'm hoping I can  eventually be weaned off the Lithium, just like I have been off of Celexa.

My main  question, when a patient or if a patient gets off of Lithium will their metabolism revert back t!o it's normal self?? Will this "drug induced" weight gain start to go away?? Or am I now a permanent "fatty"?  This 32lb weight increase in 11 months has caused me to become gravely depressed, nothing else is the cause this time. I see my doc in 2 weeks and will express my concern as stated here, but would like to hear another doctor's point of view. I'd appreciate your reply.

Many Thanks,
Ms. R

Dear Ms. R' -- 
You have an important question, for which there is no clear answer yet.  The hopeful answer would be "yes, off the medication you'll go back to the way you were".  However, I've had numerous patients (all women) tell me that they couldn't lose the weight they gained on Depakote with the strategies they'd used to lose weight that had been effective in the past.  This kind of thing started me wondering about "metabolic changes" that might be induced by Depakote, and that has led me to the emerging story about
Depakote and polycystic ovarian syndrome, a story summarized via that link.  Note the related or identical story about "metabolic syndrome".  

When you've read those, you'll still have this question though: will it go away?  So, while we're waiting to get more information on that here are two ideas.  First, I strongly suspect that exercise counteracts the syndrome.  Even if you have to walk twice a day to get enough exercise, I'm pretty sure this would start things in the right direction.  The more aerobic, the better, it looks like to me.  No evidence on this so far. 

Meanwhile, at least your next "mood stabilizer" could be one that doesn't cause weight gain.  Read about thyroid; look at verapamil; and trileptal.  Good luck to you with all that. 

Dr. Phelps

Published July, 2002


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