Bipolar Medications and Obesity
Bipolar Medications have been suspected for a long time to cause excessive weight gain and obesity. Indeed, recent research and studies prove that the link between Bipolar Disorder and Obesity exists, making it possible for pharmaceutical companies to focus on developing proper medications which would reduce weight gain.
When I was diagnosed as a bipolar at the age of 14, I started to use some common medications like antipsychotics, mood stabilizers, antidepressant-antipsychotic, anti-anxiety meds etc. I started to experience a hike in my weight and things started to spiral out of control. This meds create an insatiable hunger. Read Katie’s story here.
Over the last two decades, I have spent time looking for new studies and developments which could provide more information on how obesity and bipolar medications are linked, and I always consulted my psychiatrist before I decided to take new drugs that promised less weight gain. I know that obesity hardly seems like a big deal to a lot of people. I have heard from some bipolar patients that they didn’t care much about their weight increase because they think that with 2 out 3 people in the US classified as overweight, becoming fat is a common thing even for non-mentally ill people, and thus it should not be considered a special problem for us bipolars. But this argument doesn’t make sense, because research has shown (read further down) that obesity is substantially more common among mentally ill people than among mentally healthy people, and so is the rate of death.
Rate and Healthy Risk of Obesity
The Third National Health and Nutrition Examination Survey shows that in the Western world the frequency of overweight and obesity is 63% and for women it is 55%. Further studies prove that 68% of the population affected by Bipolar Disorder are likely to become overweight or obese and face physical and mental challenges that make treatment less successful. Amongst the obvious comorbidities of obesity, a lot of them could severely shorten one’s lifespan:
- Coronary heart diseases
- Type 1 and Type 2 Diabetes
- Gall bladder disease
In most of these cases, death is quite likely. This is why people should be more concerned about obesity and try all treatments necessary to lower the chance of weight gain. For Bipolar patients, I deem it highly important that we understand the different medications we are on and figure out whether they pose a threat to our weight condition or not.
Connection between Bipolar Disorder and Obesity
Recently, several studies were conducted to see if there was any direct connection between weight gain and Bipolar Disorder. Elmslie and her colleagues compared bipolar females with controls (mentally healthy individuals) and figured out that 44% of bipolar females were overweight compared to only 25% of controls. Also, of all the subjects involved in the sample, 20% of females suffering from Bipolar Disorder were obese compared to 13% of subjects who were non-bipolar. For males, about 19% of them were associated with Bipolar Disorder and obesity, while only 10% of the controls in the sample were obese and not Bipolar.
Even the waist-to-hip ratio was studied and it was concluded that the BMI of bipolar patients correlated with the severity and frequency of depressive moments. Out of the total sample representing bipolar patients, 58% were overweight, 21% were simply obese and 5% were extremely obese.
Most of these bipolar patients were suffering from additional conditions like diabetes, arthritis and hypertension. But the biggest revelation was that the frequency of exercise correlated in a negative way with their current BMI, while the correlation between high BMI and exposure to psychotropic medicines for Bipolar Disorder was certainly positive. This proved that consumption of bipolar medications was definitely causing weight gain and obesity in patients.
Bipolar Disorder Medications
The common medicines that are recommended for Bipolar patients are mood stabilizers like antipsychotics, antiepileptic drugs and lithium.
Several antipsychotics like Olanzapine, Clozapine, Risperidone, Quetiapine, Ziprasidone and Aripiprazole are usually used as a part of the bipolar treatment. Out of these, Aripiprazole, Quetiapine, Risperidone have shown a moderate increase in weight gain. For Apiprazole, patients put on 0.7kg in 4-6 weeks; patients taking Quetiapine reported more weight gain which is about 2 kg in 5-6 weeks and Risperidone showed an increase of 2 kgs after 10 weeks into treatment. Clozapine brought about an increase of 1 lb per month but Olanzapine was the one that affected the most. This medicine caused an average increase of 0.76 kg per week, which is significantly higher than other medicines. Ziprasidone on the other hand, has shown zero or very little increase in weight gain, thus making it an effective choice for treatment.
Valproate is one such drug that is responsible for massive weight gain. Its effects have been compared to Olanzapine. While the research on valproate in relation to Bipolar Disorder is quite less, the effect of this drug on epileptic patients is well known. Patients during a study had shown a rise of 4 kg in body weight during treatment. Carbamazepine, on the other hand, is a very handy drug when it effectively manages elevated moods in Bipolars. This medicine is responsible for very little weight gain. And then we have Lamotrigine, a popular Antiepileptic drug which is much better option than others. Not only is it effective in handling Bipolar depression, but a study conducted by Devinsky and his colleagues on 463 subjects who were on this drug showed a median gain in weight by only 0.1kg after a treatment of 318 days. You can gain that weight just by taking a deep breath! Topiratmate on the other hand caused loss in appetite. Patients using this medication reported a weight loss of 9% of their initial body weight after using this drug for 2 years.
This drug is quite common, and its effect on weight gain is well noted. Lithium often causes an increase of 4-6 kgs over a few months, making it single-handedly responsible for obesity in bipolar patients.
Doctors today try to prescribe medicines which would have less effect on weight gain, since obesity caused by these medications not only may lead to medical noncompliance, it also makes the patient even more depressed.
Practical treatment for Weight Gain from medications
While doctors try to recommend healthier medicines for their patients, sometimes they need to inevitably prescribe lithium, and other medications that cause weight gain, because their patients are not responding to other treatments. In such a case, doctors need to tell their patients about the risk regarding weight gain, and patients should be monitored as frequently as possible. Weight measurement should become their second nature. Also, in case doctors are forced to prescribe medicines that are known to cause obesity, they should recommend that their patient follows a healthy dietary structure. Sound nutritional strategies and an exercising regimen that patients can actively implement will minimize or even prevent weight gain.
Close monitoring is absolutely essential for patients to see if they are gaining weight. They need to be physically active and keep a positive demeanor that can help them to bring about a positive change, thus making the treatment successful.