Crossing the Threshold – Obesity and Bipolar Disorder

Today my weight crossed two boundaries. I’ve not been this heavy since right after giving birth to my son and I’ve tipped the scale just enough for my BMI to now be considered inside the ‘Obese’ range.

So, after an hour of hopeless sniveling and re-weighing myself a few times, I’ve had to take a minute to sit and contemplate my fate.

It was only two weeks ago I sat with my psychiatrist and bitterly complained about all the pounds I’ve packed on.  For whatever reason, it seems as if the process has accelerated for the last two months.  After a long discussion and a plan to begin changing my medication around – which includes the elimination of the Wellbutrin – my psyc admitted that my only choices were crappy ones.

Great.  From a size 4 to a size whatever.  Crap indeed.

What percentage of bipolars have problems with obesity? It’s impossible to tell, but in the studies I came across, every one cited  some number of over 60% of participants.  Which is ridiculously high.

The truth is many drugs used as anti-depressants, mood stabilizers, and anti-psychotics can cause weight gain.  And not just a pound or two, either.

As just one example, after Alaska attorney James Gottstein helped make public Eli Lilly’s internal documents about the drug Zyprexa, the manufacturer added to the label the information that one out of six patients will gain an average of 33 pounds in their first two years on the drug. [1] Given such cause-effect relationships between many drugs and weight gain, the usual invisibility of drugs as contributing factors is particularly puzzling.

Why do these medications cause such dramatic weight gain?  The mechanisms  are not yet fully understood.  Several theories include impairment of the central nervous system’s control over energy intake, others are thought to affect metabolic rate and leptin levels, and there are probably other mechanisms related to other medications.

Why is so little known about causes of the weight gain side effect?

One reason…is that drug manufacturers tend to focus their research, as well as their often selective reporting of research, on the effects that they hope a new drug will have rather than the whole array of effects it can have on individuals. And individual variability is known to characterize reactions to drugs of many kinds, not just psychotropic ones.

Interesting.  If one thinks about all the campaigns to combat obesity in the United States, rarely, if at all, are psychiatric medications mentioned in the equation.  Even the First Lady’s campaign to fight obesity makes absolutely no mention of psychiatric drugs when citing possible causes.

Armed with all of this knowledge, what’s a bipolar to do?  Well, I hate to sound pessimistic, but there are really two choices if you’re like me, and gain weight just looking at a bottle of Wellbutrin.  Take the med, try to keep your sanity, continue to work on the inevitable self-esteem issues weight gain causes and keep on buying bigger clothes – or, make an informed choice, go off the med and take your chances.  I will probably settle for somewhere in between for now and eliminate two out of the three meds I am on.  After the emotional roller coaster I was on today, though, I don’t even want to think about if the med change doesn’t help correct the problem.

For more, read: The Elephant in the Living Room

I feel your pain. A couple of years ago, I lost about 40lbs. Last year, I started Geodon with no apparent weight or blood sugar complications. But when I started Paxil (well, ramped up the dosage actually) I put on about 10lbs in short order. My blood sugar has gone all wacky too. I’m talking to my psych today about cutting back on the Paxil. I can’t have all this extra weight on me and the dosage is making really jittery (like caffeine without the awake part). What really gets to me is how manufacturers are advertising and doctors are prescribing anti-psychotics as sleep meds or for MDD. There’s no mention of Seroquel’s weight gain issues and yet they use it just for sleep!

It’s scary to make a med change, but your general health is important too. You may see some of those pounds just melt away once you change meds. I wish you luck. 🙂

Thanks so much. First, congrats on losing 40 lbs – that’s a remarkable accomplishment!

I was on Paxil years ago and had the same problem you’re having. Are the jitters kind of like a low-grade hypomania? (That’s what it felt like to me.) You’re really, really wise to get to the Dr now and not let it get any more out of control. Blood sugar issues are serious. What do you think the Dr will do? It’s so frustrating to do the right thing, take the med and ruin your body in the process. Doesn’t it make you want to scream, “I didn’t do anything wrong!”

There’s a lovely lady who follows my blog – her name is Candida Abramson. She’s a therapist, writes a blog and wrote a post titled, “The Bipolar Road Less Traveled: Beyond Lithium, Part II,” about BP meds that are alternatives to Lithium. (There’s a link in case you’re interested.) If this Oxcarbazepine I’m on doesn’t do the trick, then I will bring this list to my Dr. There’s just got to be a better way than having to sacrifice our health for the sake of our moods.

I hate this for you, Vivien. I gained 100 pounds on my meds. Even after being off all meds now for over a year, I’m just starting to lose weight—and I’m working hard at it.

The most important thing is to be a physically healthy as you can. What steps are you taking in that direction? Not with the goal of losing weight, but being healthy?

I’m so sorry to hear what the meds have done to you. I remember you said you have lost weight recently – keep it up! That is excellent news. What are you doing to lose? Diet and exercise?

As far as being healthy, I’m trying to eat less but eat right and get enough sleep. The increased activity is going to have to wait until I stabilize on the oxcarbazepine (Trileptal). About 30 minutes after I take it I’m no good for anything (except blogging) for about 4 hours. I know it will pass in time but it’s really frustrating.

As an aside, I’m double frustrated, because when I began this whole ‘treat the entire spectrum’ journey 1.5 years ago, my Dr told me I will gain weight. I told him that it was no problem, that I would just spend more time in the gym. He replied that increased gym time wouldn’t matter, because these drugs just make you gain no matter what. Makes me wish I’d heeded his warning and just not taken the damn things. (Hope my husband isn’t reading this! LOL)

I’m so sorry this has happened to you. I just 5 minutes ago received a comment on my post from a woman who has gained enough weight to put her at risk for diabetes, mainly as a result of the atypicals, which are the main culprits. All I can say is that you are not alone. There are even lawsuits now against some of the meds [Zyprexa stands out in my head] for the weight gain they cause, and accompanying side effects (diabetes anyone?). This is such a hard row to hoe, and I just want you to know that you are not alone, you are brave to continue to treat your condition despite the nasty side effects, and I’m impressed with your fight–and your openness and honesty. Candida

Thank you so much for the kind words, Candida. It is so ironic that the med which is supposed to ‘save’ us is our undoing in the end. I have to admit there are days (like today) I want to completely go off the medication and go back to being stick-thin. With my family at stake though, it leaves me no choice. Thank you again for your reply.

I definitely feel your pain, and it is so frustrating to have to chose between your health and, well, your health!

I gained 40 lbs in a matter of two months on Zyprexa, and though the weight is finally starting to come off, the overwhelming number of stretch marks that quick gain afforded me means even if I do get back to my original size, I will definitely never look the same again.

I do feel, however, that since you’re willing to make a change and try to address the issue you’ll be successful. It takes a long time, but every little bit helps.

I’m so sorry to hear this happened to you, but in a strange way it is comforting to know I’m not the only one. That Zyprexa is really nasty stuff. Someone must be getting relief from it but the majority if things I read and hear are pretty negative. Good for you for chucking it. How long was it before you started to see your weight change? (I’m only on week 3 and getting impatient already.)

I don’t want to discourage, but it took much longer than I expected… 6 months probably since my weight peaked before things started to recede? Maybe there were traces of it left in my body that had to dissipate, but I was really surprised that it took so long before anything happened (despite changing my diet and working out, etc.)

Zyprexa is tricky, from what people have told me (and what I experienced myself) it is one of the only drugs out there that can knock out a manic episode in a single day. Doctors have been trying to prescribe it as a continuous medication for many people, but just based on what I experienced (and several other people I know) it seems to work best as an “emergency” sort of medication. Get too high? They take a zyprexa. I know people who really swear by it! But after what I went though, I’d rather not touch the stuff.

Thanks! Of course – feel free to share. And, thanks for writing. I read the last few entries of your blog and hope you and your wife are doing better. Hang in there. Hope to see your comments again.

Urgh. Zyprexa killed me.

I never in my life had any issues with weight until I started using psychiatric medications. I was lucky, and I never thought about it. With me I can tell you the straightforward, obvious mechanism of action: these meds all made me f**king ravenous! (Sorry, but that’s the only way to capture it.)

Things are better for me now. I’m carrying around a few extra pounds from a recent medication try, but I know that I can get them off of me with a little effort and awareness. I also know that unfortunately, others are not as lucky as I am.

Hi, Ruby: I’m surprised how many people have responded to this post…most of them privately. Packing around extra weight is such a self-esteem killer. If BPs aren’t depressed from the illness, the body image issues sure rock the boat. How sad that we have to sacrifice our physical health to get our mental health in order. Personally I’m just beginning to see the weight come off, three weeks after stopping the Wellbutrin. Let’s hope the trend continues. Glad to hear you’re off whatever was making you gain – you’ll get the weight off. I hope all is well!

Thanks, Vivien. My former psychiatrist was excellent in that he recognized that weight gain really compounded my depression – I think because I had never had a problem, I didn’t handle it well in my mind (I mean, I know it can be very rough for everybody, but I think it really messed with me a little more than average). But he actually prescribed for me all sorts of things to help me lose weight, which was nice, because I don’t know that I ever would have had periods of being depression free without them.

All is well with me. All is beyond well. I only wish the same for you. 🙂

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