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. The team referred her to a new treatment program in the area, where she was diagnosed with — and finally treated appropriately for — bipolar disorder.
For millions living with bipolar disorder, staying on top of mood episodes is a daily challenge — one that often requires long-term treatment like medication. While medications can be life-changing, many patients face a frustrating side effect: weight gain. As medications stabilize emotional highs and lows, patients are left balancing the benefits of treatment with how it affects their bodies. While weight gain is a relatively common side effect of many medications used to treat bipolar disorders, it’s possible to manage these side effects by working with your physician to find the right medication and lifestyle habits for you.
[READ: Bipolar Disorder vs. Depression: What’s the Difference?]
Treatment for Bipolar Disorder
An estimated 2.8% of adults in the U.S. experienced bipolar disorder in the past year, according to the National Institute of Mental Health. Bipolar disorder is a chronic mental health condition that affects mood, energy levels and the ability to function.
There are a variety of treatments available to help manage bipolar disorders, including cognitive behavioral therapy, interpersonal or family-focused therapy, inpatient psychiatric care, outpatient programs and medication. Typically, medications are considered a first-line treatment.
“Broadly speaking, three classes of medications are used to treat bipolar disorder: antipsychotics, mood stabilizers and sometimes antidepressants,” says Dr. Roscoe Brady, the vice-chair of Research at the Department of Psychiatry of the Beth Israel Deaconess Medical Center.
While medications can be highly effective in managing symptoms, many people struggle with the decision to start or stay on them due to potential side effects. One of the most commonly reported concerns is weight gain.
“The unfortunate truth is that the medications that are most effective for treating bipolar disorder are often linked to substantial weight gain in a decent percentage of patients,” Brady says.
Often, weight-related concerns can cause people to stop taking their medications. A 2017 survey conducted by the Depression and Bipolar Support Alliance of people with bipolar disorder or depression found that weight gain was the side effect that most often led people to stop medication.
[READ: What’s the Difference Between Bipolar Disorder and Borderline Personality Disorder?]
Common Bipolar Medication Side Effects
While bipolar medications can be transformative in their ability to help manage symptoms and improve quality of life, they often come with side effects, which may include:
— Dry mouth and sore throat
— Sexual dysfunction
— Blurred vision
— Dizziness
— Extrapyramidal symptoms, which are neurological side effects characterized by restlessness, muscle twitching and abnormal movements in the muscles
— Nausea or vomiting
— Confusion and impaired memory
— Fatigue
— Stomach pain
— Increased urination
— Constipation or diarrhea
— Loss of appetite
— Headache
— Worsened symptoms of depression or mania
— Sedation and drowsiness
— Increased blood sugar and cholesterol levels
— Weight gain
Side effects vary from person to person, and not everyone on a certain medication will experience side effects, but it’s key to stay informed and monitor changes closely as you start medication. Additionally, some side effects are transient while others may be more long-lasting. For example, dizziness or sleepiness may be more pronounced when starting a medication but are likely to subside over time, while others — like weight gain — may persist.
Which Bipolar Medications Cause Weight Gain?
“Certainly not every medication patients try results in weight gain, but for quite a few of the mainstay medications used, weight gain is quite a prevalent side effect,” Brady explains.
Some of the bipolar medications most commonly associated with weight gain include:
— Lithium (Lithobid)
— Valproic acid (Depakene)
— Divalproex sodium (Depakote)
— Carbamazepine (Tegretol, Equetro)
— Haloperidol (Haldol, Peridol)
— Lamotrigine (Lamictal)
— Olanzapine (Zyprexa)
— Olanzapine and fluoxetine (Symbyax)
— Paliperidone (Invega)
— Risperidone (Risperdal)
— Quetiapine (Seroquel)
— Asenapine (Saphris)
[See: Top Medications for Anxiety.]
How Do Bipolar Medications Cause Weight Gain?
“The relationships between these medications and weight gain are complex,” says Dr. Jonathan Komisar, an assistant professor in medicine at the Duke University School of Medicine’s Department of Psychiatry and Behavioral Sciences.
While the biological pathways behind this side effect aren’t fully understood, metabolic and appetite changes are known to play a role.
“It’s a combination of things — increased appetite, decreased metabolism, fluid retention, among other things,” Brady says.
The likelihood of weight gain is dependent on several factors, including the specific medication, as some carry a higher risk of weight gain, and the dose taken, as some are associated with dose-dependent weight gain. For example, of the mood stabilizers, valproic acid is the most likely to induce weight gain.
“Around 50% of patients on it will experience medication-related weight gain,” Komisar says.
Managing Weight on Bipolar Medication
Weight gain is a deeply personal experience, one that affects how people feel in their bodies, their confidence and their health. While some people may not be concerned about the prospect of gaining weight, for others, it can feel deeply distressing.
It’s important to recognize that concerns about weight go beyond appearance. Iit can be a significant health issue, especially given the increased risk of cardiovascular and metabolic disorders among people with psychiatric disorders.
“We know that individuals with psychiatric illness, such as bipolar disorder, have higher rates of premature mortality,” Komisar says. “A large portion of this increased risk is due to cardiovascular and metabolic risk factors.”
Managing weight gain while on bipolar medications can feel daunting, but it’s far from impossible. With the guidance of a health care provider, weight changes can be addressed through thoughtful medication evaluation and adjustment if necessary and healthy lifestyle changes that support both physical and mental health.
[Read: Ways Stress Makes You Gain Weight.]
Finding the Right Bipolar Medication for You
Finding the right medication for bipolar disorder is a process that often requires patience, time and open communication with your health care provider. Almost all medications come with the risk of potential side effects, so it’s important to have honest conversations with your provider about what matters to you, including concerns about weight gain.
“The best advice I can give patients worried about weight gain is to bring your concerns into the room with your practitioner,” Brady says. “Talk about it openly so you can both work to achieve a balance between managing symptoms and supporting your overall well-being.”
Speaking up early can shape your treatment plan, from choosing a medication with a lower risk of weight gain to monitoring side effects closely and adjusting your dosage as needed.
In some cases, health care providers will prescribe additional weight-loss medications, like metformin or Topamax, to manage weight-related side effects. These medications carry their own risks and side effects, so it’s important to talk with your doctor about whether they’re appropriate for you.
Tracking your physical and emotional experience with a medication can also help guide treatment decisions.
“It is always possible to switch medications if side effects, such as weight gain, become too much of an issue for a patient,” Komisar says. “However, in patients in which a particular medication has been incredibly effective for them and/or alternative medications have been ineffective for them, I would first attempt to adjust the dose to see if that helps reduce weight gain, encourage lifestyle changes and consider the addition of a medication shown to help prevent or reduce weight gain prior to switching.”
If you and your physician believe that switching medications is the right step for you, there are medications available that are considered more “weight-neutral.”
According to Komisar, “Of the current medications approved for the management of bipolar disorder, certain antipsychotic medications are felt to be more weight-neutral, specifically aripiprazole, lurasidone and ziprasidone. Mood stabilizers with less significant weight gain include lamotrigine, carbamazepine and lithium.”
Lifestyle Changes
Medication is only part of the picture when it comes to weight-related concerns. Establishing healthy lifestyle habits can both support overall well-being and help manage weight gain. Your health care provider can help determine what strategies work best for you, but some common lifestyle changes include:
— Exercise regularly. “It’s often helpful to find someone in your life who is already working on managing their weight,” Brady says. “See if there’s something you can do together — a support group, calorie counting, exercise. Finding someone to join you can help because it can be hard to do on your own.”
— Practice portion control
— Limit processed foods and added sugars
— Get enough sleep
— Aim to eat plenty whole foods, fruits and vegetables
— Track your progress and concerns with your provider
When it comes to weight management while taking bipolar medications, starting early can be a helpful strategy to stay on top of concerns before they arise.
“There’s no such thing as too early to start these things,” Brady says. “People who practice portion control and exercise regularly before starting these medications are probably in the best position. Don’t wait for weight gain to happen. Start collecting data, controlling portions and exercising routinely before the first pound even goes on.”
More from U.S. News
The Best Gift Ideas for Nursing Home Residents
What Not to Say When Someone Loses Weight — Especially Now
Bipolar Medications and Weight Gain: What to Know originally appeared on usnews.com
