Is Your Bipolar Medication Making You Fat?

One of the most common barriers to recovery is non-compliance with taking medication. In fact, in working with people with manic-depressive illness, I have reached the point where every day now I hear the same story from either someone under treatment or their spouse – “Everything was fine until I/he/she stopped taking the meds”.

Now I do not for one moment believe that people with bipolar disorder are stupid, and that they do not understand the relationship between taking medication and staying well. In fact, it is well accepted that folks with bipolar disorder tend to be, if anything, smarter than the average bear.

For the most part, these people are not making naive, capricious or irresponsible decisions. I suspect that for many of us, we go off our meds because we have performed our own personal cost/benefit analysis and decided that because we are managing better we can afford to risk a mood episode in exchange for a period of relief from medication side effects. And as vain or shallow as it may sound to the uninitiated, the number one side effect of bipolar meds that many of us hate the most is weight gain.

Nearly every effective medication for bipolar disorder has weight gain as a side effect. However, it is important to remember that not everyone taking a particular drug will experience side effects. NEVER let the fear of a particular side effect prevent you from trying a medication that your doctor (ideally an experienced psychiatrist with specific expertise in bipolar disorder) believes could be helpful for you.

The fact is that we all respond differently to the various mood stabilizers and other medications, and some folks will never gain an ounce. However, weight gain is extremely common, and if you are unhappy with your current weight, it may be relevant for you to ask “Is my medication making me fat?” If the weight gain began at the same time as you started taking the meds, the answer is probably yes.

However, in the US and other developed countries, we are in the middle of an obesity epidemic. The issues around weight and bipolar disorder are complex and interrelated. Understanding what is going on in relation to your own weight gain, and turning things around, is going to take concentration and dedicated effort.

Did you start to gain weight before commencing medications? There is no shame in it if you did. In fact, it puts you in the majority. 70% of American men and over 60% of women are overweight, and approximately one third of the US population is obese – and it just gets worse every year.

Some research has been done on whether people with bipolar disorder start off being heavier than the general population, even before diagnosis and treatment, but the results have been mixed. What we do know is that after being diagnosed and treated, weight management is a huge issue for the bipolar population, with 35% of people with bipolar disorder being obese! This is the highest percentage of any psychiatric illness!

I get more questions about medication and weight gain than anything else, and I KNOW that many people quit taking their medication because they find the weight gain to be so extremely demoralizing. Much as I sympathize with this (and believe me – I do – after gaining over 40 pounds I did it myself) it is NOT the answer. Instead, learn about the weight gain/loss implications of the various meds that are used to treat bipolar disorder, and the strategies you can use to maintain your weight at a healthy level where you can feel good about yourself.

So which meds are most likely to cause weight gain?

NOTE: WE ARE ONLY GOING TO LOOK AT PROVEN MOOD STABILIZERS:
1. For risk of HEAVY, MAXIMUM weight gain, and probably diabetes, Zyprexa;
2. For risk of SUBSTANTIAL weight gain, lithium, Depakote, or Seroquel;
3. Those meds that seem to be weight neutral include Abilify, Lamictal, and Tegretol.

Don’t be afraid to discuss this with the medical professional who prescribes your drugs. If you have bipolar disorder there are a range of medication options available – it is perfectly ok for you to ask for one that has fewer side effects and that will not undermine your overall health.

For instance, Zyprexa, a drug manufactured by Eli-Lilly, has, in the last few years, been the target of multiple lawsuits across the country. In particular, it is alleged that taking Zyprexa can cause excessive weight gain and even diabetes. If your doctor recommends Zyprexa to treat your bipolar disorder, talk to him about the risks of these potential side effects and ask about the possibility of a safer alternative.

Ask your doctor politely but firmly about trying Lamictal or Abilify. Sometimes side effects such as panic attacks or the notorious “Lamictal rash” will rule these alternative meds out, but usually they are safe to try.

Some doctors offer a cocktail of drugs to help counteract the weight gain. For example Wellbutrin, especially if you are on an anti-convulsant, or Topomax.

What is important is that your doctor be proactive in helping you find medication that stabilizes moods without destroying your overall health through substantial weight gain.

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