Q: Weight Gain & Diabetes & Bipolar Disorder
Dear Dr. Phelps,
I have had a diagnosis of Bipolar II for over 25 years, and was recently
diagnosed with diabetes. Weight gain over the years (some due to different
medications) and a genetic predisposition to both disorders have played a part.
I question though whether bipolar medications also share the responsibility.
My pdoc is telling me that a concurrent diagnosis of these two is generally bad
news, for the management of either. Diabetes affects the brain and creates a
different playing field, and stress is a factor in the management of both.
Have you found this to be true, and what is your best advice to bipolars who
also have diabetes?
Dear Colleen --
Tough problem. Sorry to hear it got you too. I'm not sure I'd go so far as to
worry about how diabetes might make bipolar disorder worse, particularly since
the whole idea of diabetes treatment is to control blood sugars to the point
where any such effect is moot. I've never found myself thinking that someone's
bipolar disorder was proving hard to control because of their diabetes, never.
However, the rest of his assertion, about how stress
makes both the diabetes and the bipolarity harder to control, I agree there. And
bipolar disorder symptoms can probably be blamed for inducing some stress.
Diabetes too, perhaps, but not if the treatment is going right. Same for bipolar
disorder, I suppose. So, overall I'd say the two are not really commonly making
each other worse; rather, the same factors that cause both can continue to
worsen both, namely uncontrolled stresses.
BUT, the controllable factor affecting both is
medication choices. I could go off on a diatribe about how we've used the
atypical antipsychotics too much because for the doctor they're easy to use,
compared to high maintenance medications like lithium and carbamazepine and to a
lesser extent valproate (Depakote, Epilim)..Or because olanzapine (Zyprexa) is
such a superb mood stabilizer that we have forgotten to properly weigh the
risks, as well as the benefits, in part because it is so seductively effective
(from a doctor's side of the equation) as well as in part because the
manufacturer has not helped bring the weight and diabetes problem to light very
well (a possible understatement).
But to stay positive, as you yourself have done in your
question, my "best advice": I recently had to think about that and write it
down, for that book you've heard I'm writing. Here's a chunk of that:
Handle Weight Gain
we will look at several strategies here, there are a few which so far exceed
the value of the rest that they merit special attention:
Using medications that
are not associated with weight gain; and
Avoiding simple sugars.
Unfortunately, these most important strategies are also so unrealistic that
the list should really read more like this:
Exercise: you canít beat
it -- but you canít do it either, right?
Use medications that are
not associated with weight gain: (great idea, docí -- got any?)
Avoid simple sugars:
like, donít eat what everything around you tells you to?
After examining the alternatives to these basic
strategies (e.g. "antidote" medications like amantadine, acid production
blockers, sibutramine), I come back to these apparently unrealistic strategies
because despite being difficult to do and stick to, they are by far the
best options. Note this ends up including the mood stabilizer options that are
not associated with weight gain, including carbamazepine (though it clearly has
other risks) and lamotrigine (ditto, in this case the rash risk and lack of
effectiveness against manic-side symptoms) -- and avoiding Zyprexa. How many of
your readers have had good luck with Geodon, I wonder (as it is apparently the
most "weight neutral" of the atypicals; maybe we should figure out some way to
take a "reader poll"? )
Sorry there isn't a better answer. I'm keeping my
Gain page on my website up to date as well (there are a few
My best wishes to you.