Metformin & Weight Control
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Q:  Metformin & Weight Control

Dear Dr. Phelps,

I'm 29 years old and was diagnosed with Bipolar-I when I was 22. The illness runs in my family, but I didn't experience my first clinically significant episode until I developed an eating disorder at age 21. It felt like the eating disorder somehow "triggered" the bipolar. Since then, I have struggled with my weight and have experienced carb cravings and occassional binging. My weight has fluctuated a lot since starting medications (at my worst, I gained and then lost 70 pounds). Over the last 3-4 years, I have noticed that I am tending to gain weight with increasing ease. This is true even when I restrict calories. When I am able to lose weight, it is only with great difficulty. I saw the information on metabolic resistance that you posted and showed it to my psychiatrist. With some reluctance, he agreed to try metformin both to help me lose weight (I am 5'3'' and currently weigh 147 lbs.) and to help prevent me from gaining any more. But he requested that I ask you a few questions:

1) What have your results with metformin looked like in the 5 months since you last wrote on the topic?
2) Have you noticed any effect on mood from metformin in patients with bipolar?
3) Roughly what percentage of your patients started on metformin have achieved significant weight loss or have avoided further weight gain?

I am happy to follow up by reporting to you the results of my "metformin trial" if you would like to increase your "n". I keep a very detailed chart of my moods, weight, and medications, which should help me determine whether the metformin is working. BTW, I now take seroquel (400 mg), lithium (900 mg), parnate (20 mg), synthroid (88 mcg), and lamictal (300 mg).



Dear Liz --
You have a smart psychiatrist: those are good questions I'd hope a doctor would ask. My sample size remains small, so I'd be interested in your results if you try this. Frankly, after about 10 patients, only two of whom have lost a significant amount of weight, and one or two who appear to perhaps have ceased gaining, I've started using amantadine more often. There too we have only one open study with less than 20 people to go by. And I'd held off using it because it affects the neurotransmitter dopamine, which in some versions of bipolar disorder would seem like working against one's own medications, some of which affect dopamine in somewhat opposite way. But darn if the first 4 people I tried it on didn't start losing weight. On the other hand, all four also got a tremor and had to reduce the dose from 300 to 200 mg, and the long term consequences of using amantadine this way are basically completely unknown (as well as amantidine's somewhat higher risk profile in first place).

However, I haven't changed the metformin story to match what you're reading here; in part because my sample is also too small to say "it doesn't work"; and in part because of the case report from Dr. Rasgon I posted as part of the metabolic syndrome story, in which metformin was used effectively to treat depression. There's still something more appealing to me to try to treat the problem, which it seems metformin has the capacity to do, though admittedly not every time; as opposed to amantadine, which as far as we know is just adding another medication with some sort of funny side effect of weight control (rather like the Topiramate strategy).

Another similar "report from the fringe" would be to look at using T3/T4 thyroid, which has no clear data supporting its use (not even the less-than-20 open trial data), but again some metabolic rationale as discussed in Thyroid and Bipolar. Careful not to freak out your doc' with too many of these reports! Good luck to you.

Dr. Phelps

Published December, 2003


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