Understanding and Managing Weight Gain from Psychiatric Medications
Many individuals living with a bipolar diagnosis often struggle with an unwanted side effect: weight gain, often due to the medications used for treating mania or depression. Medications such as Zyprexa, Seroquel, lithium, and Depakote are known to contribute to this issue. Doctors and therapists may not address this issue with the sensitivity it deserves, suggesting that proper dieting and exercise can solve the problem, ignoring the fact that depression might affect a person's motivation to engage in those activities.
Weight gain can lead to significant problems, including poor self-esteem, medication noncompliance, and physiological issues such as high cholesterol, diabetes, and heart disease. Addressing medication-induced weight gain is crucial, especially since it's one of the most prevalent and difficult side effects influencing bipolar treatment choices.
Let's dive into the most common medication culprits for weight gain and learn how you can combat this issue with a proactive approach.
Atypical Antipsychotics
Atypical antipsychotics once again emerge as the leading cause of considerable weight gain in many patients. Depending on the medication, their risk level can vary from high to little to none.
- High risk: Olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal), aripiprazole (Abilify), and clozapin (Clozaril)
- Little to no risk: Ziprasidone (Geodon) and older first-generation antipsychotics such as perphenazine (Trilafon)
The weight gain associated with these medications is believed to result from increased appetite and certain changes in metabolism. The family of medicines also carries a varying degree of risk for diabetes and elevated cholesterol.
Antidepressants and Antianxiety Medications
Several antidepressants and antianxiety medications have some risk of causing weight gain, although not necessarily in the severe range seen with atypical antipsychotics. The risk often depends on the individual, with some people experiencing significant changes in appetite and weight, while others see little to no effect.
The most common antidepressants and antianxiety medications include:
- SSRI’s: Fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), and citalopram (Celexa)
- SNRI’s: Venlafaxine (Effexor) and Duloxetine (Cymbalta)
One antidepressant, Bupropion (Wellbutrin), stands out as the only medication without any risk of weight gain, although it may not be particularly effective for anxiety.
Anti-Manics or “Mood Stabilizers” and Anti-Seizure Medications
Medications used to prevent or treat mania can also lead to weight gain, although the risk greatly depends on the medication and its impact on the individual.
- High risk: Valproic acid (Depakote)
- Moderate risk: Lithium
- Low risk: Lamotrigine (Lamictal) and carbemazapine (Tegretol)
Curbing Weight Gain via Medication
If you find that your medication is causing weight gain, some strategies can help you manage or even reverse the situation:
- Switching medications: If a particular medication is causing severe weight gain, your doctor may suggest an alternative with a lower risk of causing weight gain.
- Changing medication form: For example, Zyprexa comes in a dissolvable tablet that melts in your mouth to minimize its impact on appetite.
- Adding medications: Topiramate (Topamax) and metformin (Glucophage) can help reduce appetite and limit weight gain, reducing diabetes or high cholesterol risk.
- Combining older antibiotics: Replacing atypical antipsychotics with older, less expensive antipsychotics might be a viable option for some people.
By discussing these options with your doctor, you can improve your chances of managing weight gain associated with your medications.
A Proactive Approach to Curbing Weight Gain
In my practice, I encourage patients to take a proactive approach to managing medication-induced weight gain. We work together to monitor your weight and hunger, periodically conducting lab tests to ensure that your glucose and cholesterol levels remain within a healthy range. We also develop a custom exercise and diet plan to offset any weight gain and promote overall well-being.
The Final Word
Managing medication-induced weight gain is a joint effort between patients and healthcare providers. By being proactive, communicating openly, and monitoring your body's response to your medication, you can minimize the impact on your weight and overall health.
The increased calorie intake and changes in metabolism caused by atypical antipsychotics like Zyprexa and Seroquel can lead to weight gain, which might exacerbate symptoms of depression, such as low motivation and self-esteem. Addressing medication-induced weight gain is essential, as it can lead to complications like diabetes and heart disease.
