Q: Lithium & Weight Gain|
Hi Dr. Phelps,
I have been put on Lithium and worry excessively about weight gain.... Is it
true that lipolysis is decreased under Li therapy, thus weight gain happens?
When I read about the research papers on weight gain in bipolar depression, most
patients are classified as overweight or even obese.
I am really worried about weight gain because of diabetes (my Dad has it) and I
exercise a lot. Lately, I feel so dizzy and tired that the sticking to exercise
has become a problem.
How fast does the weight gain happen ? I am pretty suicidal these days with
lot's of agitation and anxiety. The anticonvulsants did not help, thus I have
to try the Li.....
Please, respond. Most doctors only seem to care about me becoming less suicidal
not of the way I will look in a year..
Dear Ms. M' --
Believe me, you're not alone in your concern. Even us doctors, most of us
anyway, are aware of the problem of weight gain. You can imagine the dilemma we
face, when so many of the medications we use are associated with weight gain:
the patient has symptoms; she/he wants the symptoms controlled; she/he faces
substantial risks if the symptoms are not controlled -- and yet the treatment
poses risks as well. It's a delicate balancing act sometimes.
However, there are ways to work around the weight
issue. I tell my patients that if we use lithium, they can watch their weight,
and if they start to gain, we'll change the medication approach. Also, watching
thyroid function very closely may help -- I just found an article, searching
"lithium weight" on Pub Med to see if there's anything new and smart to bring to
bear on your situation, which suggests that women whose thyroid function changes
(and I know from experience it can happen fast, like within a few weeks) are at
much greater risk of getting the weight gain problem:
Lithium side-effects and
predictors of hypothyroidism in patients with bipolar disorder: sex
J Psychiatry Neurosci 2002 Mar;27(2):104-7
OBJECTIVE: To determine the prevalence of the side effects of lithium therapy
and possible predictors of hypothyroidism in women and men with bipolar
disorder. METHOD: Twenty-two men and 38 women with bipolar disorder and taking
lithium for at least 1 year, were interviewed about lithium side effects using
a list of the most commonly reported symptoms. RESULTS: The complaint most
frequently reported was polyuria-polydipsia syndrome, which affected 36 (60%)
of 60 patients. More men than women reported tremor (54% v. 26%, p < 0.05),
but weight gain during the first year of treatment was more frequent in women
than men (47% v. 18%, p < 0.05), as was the development of clinical
hypothyroidism (37% v. 9%, p < 0.05). Weight gain during the first year of
treatment (and not sex) was the only significant predictor of hypothyroidism.
CONCLUSION: Weight gain during the first year of lithium treatment, in the
absence of biological evidence of subclinical hypothyroidism, was the most
predictive and, possibly, the first sign of hypothyroidism.
So watch your thyroid status closely; you might have to
thyroid hormone to
counteract this effect of lithium, but since thyroid hormone itself has mood
stabilizing properties, that's not all bad. Granted, you could say "what,
another medication to counteract the effects the first?" But controlling
thyroid might give you some protection against the weight problem.
Overall, I tell my patients we can watch the weight
issue closely and move on to other alternatives if weight is going up; and, that
there are quite a few but not a great many
to choose from. There's also some interesting and moderately hopeful work being
done with "Glucophage" you'll be hearing a lot about soon: treating people to
prevent weight gain using a medication for diabetes before the weight
Again, you are one of many when you voice these
concerns. There is no magic to avoid this problem, but there are things that
can be done, and your concern must be taken very seriously.
Published October, 2002