Weight Gain, Exercise & Glucophage
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Q:  Weight Gain, Exercise & Glucophage

Dear Dr. Phelps,
Before I ask my question, I personally want to thank you for this website.  Its  content and personal touch are exceptional.  It is abundantly apparent that the treatment and education of the bipolar condition is your God's calling.  I was diagnosed with Bipolar type 2 approximately 6 months ago.  To date, I do not know if I am in complete acceptance of the diagnosis, but I cannot deny that the treatment protocol for the bipolar condition has been effective.  I thought that I was suffering from a panic disorder that would cycle in every 5-7 years, worsening to the point of agoraphobia and being essentially home bound.  Despite my ability to hold down steady job in a highly stressful environment, the condition was devastating to my personal and family life.  My question is in regards to the weight control issues associated with medications used to treat bipolar disorder.  I may be an exception, but I truly love exercise.  The loss of exercise in my personal life due to irration  al fears associated with sudden death  was very depressing.  One of the benefits of my pharmacological therapy is a gradual return to my previous exercise habits.  I think that it is worth noting that I voluntarily quit the 1980 US  Olympic Swim Team because I couldn't manage the panic associated symptoms.  While the medications have allowed me to gradually return to my exercise routine, I have experienced a profound increase in body weight.  Ihave gained approximately 50 pounds and increased waist size 6 inches.  I currently take Zyprexa (5 mg QD), Trileptal (900 mg QD) Lamictal (200 mg QD) and Zoloft (100 mg QD).  I have read with interest your postings on Glucophage.  My question is would one have to wory about a hypoglycemic effect with training volumes in the 4,000 - 5,000 yard range @ 80-85% of max heart range (~90 minutes total duration)?  I would appreciate your thoughts on this or any other advice on how to manage this issue.

God Bless,

Dear Mr. Weight Gain (as with your history, even initials might be identifying.  Sorry to hear that story re: making the team then having to leave it) -- 

Sorry to say I do not have enough experience with Glucophage to answer that.  It's a very common medication in the treatment of diabetes, perhaps the most common.  So you could ask that question on a diabetes site, if you don't have a good internal medicine doc' you can ask.  My understanding is that because of the way that it works, it does not cause hypoglycemia -- but that might not apply in your circumstance so I agree it's worth checking out.  

I will wonder out loud, on looking at that med' list:  are you sure Zoloft has to stay in there?  It is associated with weight gain itself, though not this much (that was surely Zyprexa, right?  or maybe some also with Depakote, before this regimen, or lithium).  But is it possible that the Zoloft might cause agitation that makes the Zyprexa necessary?  Perhaps someone has told you that the Zoloft is needed for an "OCD"-like aspect of your bipolar disorder, or perhaps you've learned by trying to taper it that it just has to be in there.  But if you're not certain about all this, ask your doc' what she/he thinks about a trial of gradually tapering the Zoloft.  If that works out okay, then perhaps gradually tapering the Zyprexa?  (But only with your doc's direct agreement/collaboration/consent, of course).  Fairly often this strategy works for one of my patients. 

Swim on.  

Dr. Phelps

Published May, 2004


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