Bipolar weight gain solutions


8 Ways to Fight It

Bipolar Disorder: Holiday Survival Guide

Bipolar Disorder: Holiday Survival Guide

Susan McQuillan, MS, RDN

Medical ReviewerMarisa M. Tomasic, Ph.D.

Everyone strives to maintain a healthy weight throughout this most festive season, when food and temptation are everywhere you turn. But when you take psychotropic medication for bipolar disorder, the struggle can be even realer. That’s because weight gain is a common side effect of most antidepressants like fluoxetine (brand names Prozac, Sarafem), antipsychotics like quetiapine (Seroquel), and mood-stabilizing drugs like lithium (Lithobid, Eskalith) used to treat the disorder in its various stages. If you take multiple medications to control your symptoms, you may have a harder time controlling your weight during the holidays. Here’s what you can do.


The same genes that predispose you to a mental health condition may also put you at higher risk of developing metabolic disorders that result in weight gain. Genetics aside, the medications themselves often have the effect of increasing appetite and reward-seeking behavior (overeating for pleasure), as well as sedative effects that result in less physical activity.¹

For some people the slight weight gain that can be expected during the first month of taking a new medication may not taper off. If you gained more than 5% of your body weight during your first month on your current medication, your propensity to gain weight may be ongoing. Long story short: You may have to work harder than others to control your weight.²


Probiotics are thought to play a role in regulating metabolism;³ prebiotics and certain fibers help probiotics thrive in a balanced gut environment. Foods that are rich in fiber also help you feel full, so you’re less likely to go back for second helpings and if you do, you may be satisfied with smaller servings. A high fiber meal helps regulate your blood sugar which, in turn, helps prevent your body from storing excess fat. Fresh fruits and vegetables, legumes, whole grains, cocoa, unprocessed honey and maple syrup, and flaxseed are rich in prebiotics and fiber; yogurt, fermented cheeses such as Emmental, Parmesan and Gouda, and sourdough bread can boost the probiotic value of your holiday snacks and meals.


There is so much good nutrition in commonly served holiday foods like lean turkey, cranberries, green beans, Brussels sprouts, sweet potatoes, and winter squash that there’s no reason to eliminate them. While cutting back on added fats and sugars in your diet can help you fight weight gain on a daily basis, doing so doesn’t exactly contribute to the spirit of the holiday season.

At festive meals, don’t go overboard, but give yourself permission to eat what you like. Fill your plate with small portions of a wide variety of foods offered. And when you’ve wiped your plate clean, pause at least 20 minutes before going back for more. At that point, you may find yourself feeling full and able to resist overeating.


Beverages go down so quickly and easily, and are not recognized by your body the same way as solid food is, so it’s easy to forget that liquid calories count toward added weight. For the most part, fluid calories don’t fill you up the same way as solid foods and ultimately leave you feeling both physically and psychologically unsatisfied.

That’s why it’s fairly easy to take a pass on the sodas, juices, ciders, alcoholic beverages, sweetened coffees and teas, and water-based hot cocoa mixes that are so abundant during this season. You won’t feel hungry or deprived if you stick with calorie-free drinks like sparkling water and herbal teas, and save those beverage calories for more substantial and rewarding foods.


Depending on the type of exercise you do, physical activity can help boost your metabolism to lose weight or at least prevent further weight gain. Exercise also helps lift your mood and lower anxiety without the additional side effects of mood-lifting medications like antidepressants.

Going for a walk or a run or another outdoor exercise gives you the added opportunity of experiencing the natural healing and mood-lifting power of nature. Physical activity that includes both cardio and strength training also protects your heart and respiratory system to not only improve your mental health but your physical health as well.


At least one study found that people with bipolar disorder are more likely to overeat and indulge in emotional overeating than people who don’t have the condition.⁴ Both positive situations and emotions—feeling happy, playful, confident and even relaxed—and painful ones—sadness, boredom, anger, anxiety—can affect appetite.

Emotions can also cause sudden mood changes for no known reason. If you pay attention to your moods and mood swings, you may recognize that it is not hunger that drives you toward overeating, but emotions that need to be dealt with in ways that don’t involve food.


A recent review of related studies found that approximately 14% of patients with bipolar disorder also have an eating disorder, such as anorexia, bulimia, or binge-eating disorder. ⁵ Because it’s generally meant to be short-term, cognitive-behavioral therapy can help you get through immediate challenges and rough patches in life, including holiday stress and holiday overeating, whether you suffer from an eating disorder or not.

Not only is a therapist someone you talk to and who can help you monitor your eating, but also someone who can provide you with coping and behavioral tools that can really help.


If all else fails, you may want to speak to your health care provider about the risks and benefits of adding a medication that targets weight gain, to your existing regimen.⁶

Keep in mind, however, that such drugs have shown mixed results for this use in clinical studies. And for some people, they come with health risks and side effects of their own, ranging from headaches, gastrointestinal disorders, and dry mouth, to memory problems, insomnia, suicidal thoughts, and more. If you go this route, stay in close touch with your prescriber.


Why Do You Gain Weight With Bipolar Disorder?

Written by Alexandra McCray

In this Article

  • Drugs With Weight Gain as a Side Effect
  • Other Reasons for Weight Gain
  • What You Can Do
  • Other Ways to Manage Weight Gain

Doctors use different medicines to treat bipolar disorder. The drugs help control your symptoms, but they sometimes lead to extra pounds.

They can lower your metabolism. If you didn’t have much of an appetite before, you may feel hungrier and want to eat more. You might crave sweet and fatty foods. You could have some, all, or none of these side effects. It’s different for everyone. Here’s what you need to know.

Drugs With Weight Gain as a Side Effect

Bipolar medications that may make you gain weight include:

Anxiolytics

  • Lorazepam (Ativan)

Mood stabilizers

  • Lithium (Eskalith, Lithobid)

Anticonvulsants

  • Carbamazepine (Epitol, Equetro, Tegretol, others)
  • Divalproex sodium, valproate sodium, valproic acid, (Depacon, Depakene, Depakote, Depakote ER, Stavzor)

Antipsychotics

  • Asenapine (Saphris)
  • Chlorpromazine (Thorazine)
  • Clozapine (Clozaril, Versacloz)
  • Haloperidol (Haldol, Haldol Decanoate, Haloperidol LA, Peridol)
  • Olanzapine (Zyprexa, Zyprexa Relprevv, Zyprexa Zydis)
  • Paliperidone (Invega, Invega Sustenna, Invega Trinza)
  • Quetiapine (Seroquel, Seroquel XR)
  • Risperidone (Risperdal, Risperdal Consta, Risperdal M-Tab, Perseris)

Antidepressant-antipsychotics

  • Olanzapine and fluoxetine (Symbyax)

Antiparkinson agents

  • Pramipexole (Mirapex, Mirapex ER)

Other Reasons for Weight Gain

Symptoms of bipolar disorder can also lead to weight gain. For instance, the condition can cause periods of depression. You might eat more and not exercise as much during these times.

If you have bipolar disorder and a binge eating disorder, you’ll eat large amounts of food and feel out of control. All of this can lead to more body fat.

What You Can Do

You can’t control the side effects of medication, but you can talk to your doctor about switching to something else. They include:

Lamotrigine (Lamictal, Lamictal XR, Lamictal ODT). This anticonvulsant isn’t linked to weight gain.

Topiramate (Topamax). More research is needed to know if this anticonvulsant can treat bipolar disorder. It can lead to weight loss, but it can also cause dizziness, fatigue, and nervousness.

Certain antipsychotics. Aripiprazole,Latuda, Vraylar, and ziprasidone may not impact your weight.

Anti-obesity medication could be another option in the future. Researchers need to learn more about how they affect people with bipolar disorder. This is important since people with the condition are likely to be obese (BMI of 30 or more).

Other Ways to Manage Weight Gain

Lifestyle choices can make a big difference. Try to make small changes you can stick with over time. You can start by eating more vegetables and protein. You should also try to eat less sugar.

Make exercise a part of your day. You don’t have to work out for a long time. Aim for 30 minutes 3-5 days a week.

You can also ask your doctor about metformin. This type 2 diabetes drug may help you keep off weight while taking some bipolar disorder medications. It works best when you have a healthy lifestyle.

Medications for Bipolar Disorder and Weight Loss

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contents

introduction

Bipolar disorder can be treated with drugs from different groups. These groups include mood stabilizers, antipsychotics, and antidepressants. Medications from each of these groups affect your body in different ways, including your weight. Here's a look at how some of the most common bipolar disorder medications affect your weight, as well as other side effects.

Can medications for bipolar disorder cause weight loss?

Most bipolar drugs cause weight gain, not weight loss. For example, some of them increase blood sugar levels, which can lead to weight gain. Others affect your energy level. During manic episodes, you usually don't get enough sleep and can burn a lot of energy. Taking medication for bipolar disorder can calm your mood and help you sleep. In turn, these effects can reduce the amount of energy your body burns. This can lead to weight gain, especially if you don't adjust your diet. However, how these medications can affect your weight varies.

Mood stabilizers

Low risk of weight gain: Lamotrigine (Lamictal) is likely to cause weight loss. However, it can also lead to weight gain. Other common side effects of this medicine include:

  • headache
  • Trouble sleeping
  • Hangover
  • stomach upset
  • body aches and pains

Risk of weight gain: Valproate may cause weight gain. It can also cause chills, headache, dizziness, and nausea.

High risk of weight gain: Lithium is known to cause weight gain. Common side effects of this medication include:

  • drowsiness
  • humor
  • low blood pressure
  • slow thyroid function
  • mild nausea

antipsychotics

low risk of weight gain. Other side effects of this drug may include male breast enlargement, low blood pressure, and fainting.

Risk of weight gain: Quetiapine may cause weight gain. Common side effects may also include:

  • Changes in blood pressure
  • nausea
  • cataracts
  • male breast development
  • decreased thyroid function

High risk of weight gain: Olanzapine may cause weight gain because it may cause weight gain increases appetite. Other common side effects may include:

  • Dry mouth
  • Thirst
  • Frequent urination
  • shutter
  • Dizziness
  • Drumeness
  • Motor disorders and tremens

Councils to take

,0002 for the treatment of accessible. Most of them affect your weight, but many increase the risk of gaining weight instead of losing weight. By making healthy choices in your diet and adding in an exercise routine, you can minimize these effects.

Many people with bipolar disorder often have to try several different medications before finding one that works. Talk to your doctor and balance your concerns about weight gain with the possibility that some kind of medication will help you. Tell your doctor about your medical history, your family's medical history, and concerns about how treatment will affect your weight. This information will help your doctor figure out which medicines may help you.

Bipolar disorder in women - Bipolar.

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Symptoms of bipolar affective disorder in women

The disease occurs equally often among both men and women. However, in women bipolar disorder can have its own characteristics:

  • In women, bipolar disorder type 2 is more common
  • This means that they are more likely to have hypomania, rather than full-blown mania.
  • This also means that we see more depression in women.
  • In women, a rapid cyclic course is more common
  • Among comorbid mental disorders in women, the following disorders are more common: borderline personality disorder, anxiety disorders, eating disorders, alcohol dependence.
  • Among somatic diseases, women are more likely to suffer from migraines, diabetes, hypertension, thyroid disease, and obesity.
  • Menstruation and menopause can trigger an episode of illness.

Bipolar Disorder Survival Guide for Women

We have translated a chapter from The Bipolar Disorder Survival Guide (Second Edition, 2011). This chapter is titled "Women Only".

For women, bipolar disorder brings additional challenges. Each stage of life - puberty, pregnancy, menopause - requires you to rethink your treatment regimen. At the same time, the treatment of the disease sometimes requires drugs that can adversely affect your health and the health of your child.

Mood-stabilizing medications can affect the development of the baby in utero (teratogenic risk), but harm from untreated bipolar disorder can be even greater, so the risks should always be carefully assessed. In this chapter, we will address all of these issues.

“I've always had a lot of worries about my period, birth control pills, physical changes when taking medication — they made me feel fat and stupid. But the most difficult decision was whether to continue taking medication during pregnancy. And when I finally took it, my psychiatrist said that he did not know how to select drugs for pregnant women and advised me to turn to someone else. But not only that, my usual gynecologist said the same thing!

My husband insisted that I stop taking medication. And I didn't know what to think. When I stopped taking the pills and got pregnant, I felt worse. There was a new attack of the disease, and I ended up in the hospital. Fortunately, the baby was born healthy. But, looking back, I think that qualified help would definitely not hurt me. ”

43-year-old patient with bipolar I disorder.

“My boyfriend thinks PMS is to blame. But that's not the case at all. I'm much, much worse. It feels like bipolar disorder and PMS reinforce each other several times and plunge me into panic, aggression, deep longing, which are not typical even for me.

27-year-old female with bipolar II disorder.

“The antidepressants I was prescribed for my severe menopause caused rapid weight gain. So I came up with more truthful names for them: depa-pig, olanza-zhirin, longing-don.

52-year-old woman with bipolar II disorder.

If you are a woman, bipolar disorder is more difficult for you.

It significantly influences how the different stages in the development of the female body go. You may face the same problems as these women.

Mood-stabilizing medications can affect your baby's development in utero (teratogenic risk), but harm from untreated bipolar disorder can be even greater, so the risks should always be carefully assessed.

Every stage of your reproductive life—puberty, pregnancy, menopause—requires a review of your bipolar disorder treatment regimen.

Moreover, the treatment of the disease sometimes requires drugs that can adversely affect reproductive health. In this chapter, we will address all of these issues.

In order to find the best treatment, it is important to know the following facts:

  • Women are more likely to suffer from depression that is longer, more frequent and resistant to treatment than men.
    This means you may be misdiagnosed with recurrent depressive disorder. This means that you risk missing out on years of adequate treatment. On average, women start taking lithium several years later than men.
  • Mixed episodes, rapid cycling, and bipolar II disorder are more common in women.
    They are treated with complex combinations of drugs (usually mood stabilizers and atypical antipsychotics) that can affect your health (eg cause weight gain).
  • Women are more likely to experience episodes of mania or hypomania provoked by antidepressants.
  • Because women are more prone to depression, doctors often prescribe them only antidepressants. This may provoke mania, hypomania, or a mixed episode.
  • Women are more likely to have physical problems associated with bipolar disorder.
  • Migraines, headaches, thyroid disorders can complicate the course of bipolar disorder.
  • In women, medications are more likely to cause weight gain, as well as an increase in blood cholesterol and insulin resistance.
  • Bipolar disorder itself greatly affects a woman's health during pregnancy and after childbirth, as well as the menstrual cycle.

Might be interested: Antidepressants and pregnancy


Bipolar disorder is often associated with weight gain, diabetes, PCOS, PMS. Women with bipolar disorder have a very high risk of developing postpartum depression. These comorbid disorders often require separate medication and other care.

But the good news is that you can benefit from the latest science in researching the biological and physiological aspects of living with bipolar disorder (see Burt & Rasgon, 2004; Cohen, 2007; Kenna et al., 2009).; Marangell, 2008; Rasgon et al., 2005; and Joffe, 2007.)

Scientists have gathered enough information about which medications are safest in pregnancy and what are the risks of stopping them abruptly. We have this knowledge thanks to research not only on bipolar disorder, but also on epilepsy, which has been treated for many years with anticonvulsants: divalproex (Depakot), carbamazepine (Tegretol), lamotrigine (Lamiktal).

Today we know more than ever about the effects of mood stabilizers on reproductive functions, particularly the menstrual cycle. We also know how important family and spouse support are to a woman's recovery from an episode of bipolar disorder. We also know that different types of couples and family therapy can prevent the return of depression and alleviate it
symptoms. (Miklowitz, 2008).

So science and education are on your side. As you struggle, remember the rule emphasized in the title of this book: Successful treatment involves constant interaction with your doctor and family members. In many situations, there are no clear right answers, and this can be frustrating. You will most likely have to make different decisions at different stages of life. But knowing the advances in the treatment of bipolar disorder will help you make an informed choice. Understanding the problem will give you a sense of greater control over your health and the health of your child.

Pregnancy is probably the most difficult topic for women with bipolar disorder.


Menstrual cycle

Bipolar disorder and medications affect the course of the menstrual cycle. Typical violations are the absence of menstruation for some time (amenorrhea), cycles longer than 35 days (oligomenorrhea), irregularity of cycles. Irregular cycles (shorter than 25 days or longer than 35) occur in 15-20% of all women.

Research. Cycle disorders are more common in women with bipolar disorder (occurs in 35% of them) than with depression (25%) or healthy women (20%). (Hadine Joffe and colleagues, 2006, Massachusetts General Hospital).

Is this normal?

Your doctor should study your cycle over time, especially if you are gaining weight due to medications or have irregular cycles. The causes of violations can be natural: adolescence, breastfeeding, the onset of menopause. But there are also pathological causes: polycystic ovaries, increased prolactin levels, lack of thyroid hormones, neoplasms in the anterior pituitary gland, too much exercise, weight loss, severe stress.

Prolactin levels

High prolactin levels are dangerous because they increase the risk of breast cancer and can cause estrogen levels to drop. Low levels of estrogen can cause infertility and increase the risk of osteoporosis.

Elevated prolactin levels cause irregular cycles, galactorrhea (excretion of milk from the breast), lack of menstruation, migraines, decreased sexual desire.

Some antipsychotics can increase prolactin levels. Between 44 and 88% of people taking risperidone suffer from it. Typical antipsychotics (eg, chlorpromazine and haloperidol) can also cause a rise in prolactin.

If you have a family history of breast cancer, it is especially important to control your prolactin levels.
If you have high prolactin and cycle problems, you may want to change your medication (such as quetiapine, aripiprazole (Abilify), or ziprasidone (Geodon). If you find both high prolactin and low estrogen, a hormonal contraceptive may help to increase it.

Choice of contraceptives

Planned pregnancy will allow you to better control the disease and the health of your baby, so effective contraception is especially important for you.0005

You also need to be aware that oral contraceptives and drugs for bipolar disorder can affect each other. Certain anticonvulsants, including carbamazepine, oxcarbazepine (Trileptal), and topiramate (Topamax), increase the metabolism of sex hormones and birth control pills. This means that they reduce the effectiveness of contraceptives. If you are taking them, you should choose another method of contraception, such as condoms, a cap, or high estrogen pills.

In addition, birth control pills can make some drugs less effective, such as lowering the blood levels of lamotrigine. So you should change your method of contraception or increase the dosage of lamotrigine. If you take this mood stabilizer and suddenly stop taking contraceptives, its blood level may rise sharply, which can be dangerous. Be sure to tell your psychiatrist which contraceptives you are using.

Menopause

“The onset of menopause was hell for me. I've spent years balancing with HRT when the doctor suggests I stop taking estrogen. Doesn't he understand that my life will then turn into complete chaos?

52-year-old female patient with bipolar II disorder

There are few studies on the impact of bipolar disorder on menopause.

Menopause is known to be a risk factor for episodes. One study showed that 20% of bipolar women in menopause report an increase in mood swings. Every third person developed a fast cyclicity. (Blehar et al., 1998).

Of course, not all mood swings after menopause are caused by hormones.

There may be other reasons: divorce, illness, death of parents and other stressful events. If you are in your late 50s and are experiencing symptoms of depression or mania, check your hormone levels: FSH, estradiol, thyroid hormones, luteinizing hormone, and discuss with a psychiatrist whether treatment needs to change. Psychotherapy or a psychological group can help you cope with the changes in your life.


Study linking depression to menstrual cycles

A Harvard study of 1,000 women found that depressed women had earlier periods. In addition, their menopause occurred earlier, especially if they experienced severe depression and took antidepressants. These women also differed from healthy women in their higher levels of follicle-stimulating hormone, luteinizing hormone, and lower levels of estrogen.

Important: If your mood steadily worsens after menopause, you may need higher doses of an atypical antipsychotic.
It may also be necessary to reduce the dose of lamotrigine due to its effect on estrogen levels.

Some women decide to take hormone replacement therapy (usually take estrogen and progesterone). There is evidence that it may help stabilize mood and reduce hot flashes (Freeman et al., 2002). Such therapy has other benefits, such as increased bone strength.


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