For a short time several years ago, Kelsey Maggi of Salem, Oregon, felt so full of life and energy that she went for hikes at 3 a.m., took up drinking and doing drugs with friends and called in sick to work during the day because there was too much else to do and see. She didn’t sleep or eat — and didn’t mind. “It was probably one of the best weeks of my life,” says Maggi, who was 19 years old at the time.
But what followed was one of the worst periods of her life. Maggi felt so low that she attempted to overdose before checking herself into the hospital, where the episode was attributed to her depression, for which she’d been taking antidepressants for several years.
But when she went off to college and visited her college counseling center with complaints of hallucinations — other people, she realized, weren’t reacting to the person that kept following her — she learned her depression was probably bipolar disorder, a brain disorder that causes unusual shifts in mood, energy, activity levels and the ability to carry out everyday tasks, according to the National Institutes of Mental Health. The team referred her to a new treatment program in the area, where she was diagnosed with — and finally treated appropriately for — bipolar disorder.
Treatment for Bipolar Disorder
Maggi found that medications and therapy greatly improved her symptoms, but over the next several years, one of the medications that worked, Zyprexa, had a noticeable side effect: weight gain.
Although Maggi had always been very underweight and intentionally chose the drug with her doctors to help her put on pounds, it worked a little too well. In one year, she gained 90 pounds — nearly doubling her weight.
This took another toll on her mental health. “I was more exhausted all the time. I was having people point out to me that I was gaining weight, and I should go on a diet and lose the weight gain,” Maggi says. “That really impacted my self-esteem, and my depression started acting up again.”
There are two primary types of bipolar disorders — bipolar 1 and bipolar 2. The National Institute of Mental Health reports that an estimated 4.4% of U.S. adults experience bipolar disorder at some time in their lives. The disorder can cause serious symptoms that can damage relationships, cause problems at work and school and raise the risk of suicide.
And yet, people with it are sometimes reluctant to seek or stay on treatment, not only because manic episodes can feel so good — “when I was first diagnosed, it was hard to get treatment because, at the time, my manic episodes were happy,” Maggi says — but also because many of the medications used to treat bipolar disorder are associated with weight gain.
Indeed, a 2018 survey conducted by the Depression and Bipolar Support Alliance of nearly 900 people with bipolar disorder or depression found that weight gain was the side effect that most often led people to stop taking a medication.
[Read: Psychedelics for Mental Health.]
Coping with Side Effects
“You can say it’s petty, but when you gain weight, it’s not petty to you,” says Dr. Philip Muskin, a professor of psychiatry who studies mood disorders and treats people with such conditions at Columbia University Irving Medical Center in New York City.
And while in some cases weight worries aren’t tied to any real medical risk, in others, they’re legitimate to consider. Over the long term, excess weight can contribute to cardiovascular problems, a top reason people with bipolar disorder on the whole have shortened lifespans, says Dr. Gary Sachs, a psychiatrist whose research focus includes bipolar disorder and psychopharmacology at Massachusetts General Hospital.
But getting effective treatment for bipolar disorder — typically a combination of medication, psychotherapy and lifestyle modifications — is nonnegotiable if people with the condition are going to live full and productive lives, let alone survive, since a more immediate risk for people with bipolar disorder is suicide.
“The first thing is finding something that gives you relief from your symptoms,” which makes the disease very manageable in most cases, Sachs says. “We’re not choosing between mental health and obesity.”
Side Effects of Bipolar Medications
Dr. Roger McIntyre, professor of psychiatry and pharmacology at the University of Toronto, Canada, and director of the Depression and Bipolar Support Alliance in Chicago, says that when talking about side effects of medications used to treat bipolar 1 and bipolar 2 disorder, it’s important to underscore right from the start that these treatments are necessary and life-altering.
Over his more than 20 years treating thousands of people with bipolar disorders, “what I’ve seen is lives have been saved. People’s livelihoods have been saved. In many cases, thank goodness, it’s because of the treatments we have. And that’s a fact for a significant percentage of people.”
He goes a step further to say that “without the medications, there’s no doubt about it — life would be horrible for most people with bipolar disorder.”
That said, these “medications aren’t perfect, and not everyone responds to them. And some people have side effects.”
The side effects can vary depending on the specific medication and dose, but common side effects for medications used to treat bipolar disorder can include:
— Weight gain.
— Sedation and sleepiness.
— Worsened symptoms of depression or mania.
— Extrapyramidal symptoms, which are neurological side effects characterized by restlessness, muscle twitching and abnormal movements in the muscles.
— Dry mouth and sore throat.
— Increased blood sugar and cholesterol levels.
— Loss of appetite.
— Diarrhea or vomiting.
— Increased urination.
To be clear, “not everybody gets those side effects,” McIntyre says. “If one person gets it, that’s one person too many. But most people don’t get the side effects.”
In addition, side effects typically don’t last forever, McIntyre explains. “For many people who do get the side effect, it’s transient. It goes away after a week or two,” when we’re talking about things like sedation or dizziness. Weight gain naturally won’t be as transient, he says.”But as a general statement about side effects, not all medications cause them,” and they may not last a long time. There’s a lot of variability in how each person responds to different medications.
Which Bipolar Medications Have an Increased Risk of Weight Gain?
Though weight gain is among the most common side effects of treatment for bipolar disorder, it doesn’t impact everyone. Still, some medications used to treat bipolar seem to be more likely to tip the scale than others, including:
— Lithium (Lithobid).
— Valproic acid (Depakene).
— Divalproex sodium (Depakote).
— Carbamazepine (Tegretol, Equetro).
— Lamotrigine (Lamictal).
— Olanzapine (Zyprexa).
— Risperidone (Risperdal).
— Quetiapine (Seroquel).
— Asenapine (Saphris).
Exactly why these medications can lead to weight gain in some people isn’t fully understood. In some cases, the medications appear to:
— Increase appetite.
— Trigger cravings for carbohydrates or sugar.
— Reduce satiety after eating, so you want to eat more.
— Cause metabolic problems leading to higher blood sugars and cholesterol levels.
Finding the Right Medications for You
If you’re concerned about these or other meds leading to weight gain, keep in mind that you won’t put on pounds overnight. You can work with your doctor to tweak medication types and doses, as well as lifestyle choices, to best balance the benefits of treatment with its downsides.
Plus, “there are some psychiatric medications that may be less likely to cause weight gain than others, and you should consult with your doctor if you have questions about your options,” says Dr. Samar McCutcheon, a psychiatrist with the department of psychiatry and behavioral health at the Ohio State University Wexner Medical Center in Columbus.
McIntyre agrees that patients don’t always realize that “there are alternatives that are less susceptible to these types of side effects,” so have a conversation with your doctor. For his part, McIntyre says “we try to prioritize those medications that don’t cause weight gain, metabolic problems and some of these things.”
Dr. Douglas Misquitta, a psychiatrist at Ohio State University’s Harding Hospital in Columbus, notes that adding another medication, such as metformin, a drug used primarily for diabetes, or Topamax (topiramate), an anticonvulsant, “may be appropriate additions to counter or minimize weight gain.” But these medications can have side effects, too, and aren’t indicated for all patients.
Make Lifestyle Changes
In addition to medications, treatment for bipolar disorder typically involves therapy and making some changes to your lifestyle to support your overall health and well-being. For many patients, this includes adopting common weight management strategies, such as:
— Aiming to eat plenty of fruits and vegetables.
— Limiting highly caloric, nutrient-poor foods.
— Practicing portion control.
— Exercising regularly.
— Recruiting the support of family and friends.
“Those lifestyle changes have tremendous impacts on people’s lives,” Muskin says.
Lastly, Misquitta underscores that “there are options and different approaches to treatment if one particular medication causes unwanted or intolerable side effects.”
If you’re experiencing side effects, be sure to talk with your health care provider about alternative medications and other changes you can make. “Please do discuss with your provider how you feel on your medications and don’t assume that nothing can be done or that you’re stuck with side effects. The goal is for positive quality of life,” he says.
McCutcheon agrees it may take some fine tuning to get the right protocol for your situation. “There’s a balance between treating bipolar disorder and managing side effects such as weight gain. Your doctor should work with you to ensure you’re comfortable with your treatment regimen.”
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Update 05/10/21: This story was published at an earlier date and has been updated with new information.