Weight gain is a very real concern for most patients. Unfortunately , the majority of medications used to treat bipolar disorder have some degree of weight gain associated with them. Both lithium and depakote (valproate) are associated with weight gain, the mechanism of which is not understood.
The weight gain from depakote may be associated with polycystic ovarian syndrome, but mostly it occurs independently of the condition. Weight gain from the anti-convulstants may not occur in everyone, so it need not immediately rule out a potentially effective treatment. It is important to maintain good nutrition and healthy eating habits,as well as partake in regular exercise, to help offset the weight gain risks. Being cognizant of any appetite- including effects of the medicine can help you resist urges to eat more as well.
Of the atypical antipsychotics, Geodon (ziprasidone) and Abilfy (aripiprazole) appear to have the least overall risk for weight gain, while clozaril (clozapine) and zyperxa (olanzapine) appear to have the higher risk.
Aside from the obesity, there is the associated risk of metabolic syndrome atypical antipsychotics as well. Anitconvulsants with lower risk of weight gain include lamictal (lamical weight loss, lamotrigine) and topamax (topiramate), although topiramate does not have FDA approval for bipolar disorder. At the same time Lamictal side effects is famous. Topamax (topiramete) has been studied independently as a potential weight loss agent and has been reported to reverse the weight gain cause by other agents.
In terms of the antidepressants, the older antidepressants have been classically associated with weight gain (tricyclics, monoamine oxidase inhibitors). When the SSRIs first entered the market, they were believed to have no associated weight gain as a group, and some even were found to cause weight loss (e.g., Sarafem (fluoxetine). Keep in mind that side effect profiles are typically developed from the early studies of medications, which are conducted over the short term (I.e, several weeks). In clinical practice, however, many physicians have found that SSRQs can be associated with weight gain over the long term.
Although clinical trials have typically found that weight gain does not differ significantly from placebo, uncontrolled studies have noted weight gain over the long term. Paxil appears to be more associated with weight gain clinically than the other SSRI s. Celxa has been reported to have early weight gain. There may be an increase in carbohydrate craving associated with SSRIs as a possible mechanism. Bupropion is one antidepressant that does not have weight gain associated with it and can be considered as one treatment option. More long term controlled studies are need to compare weight gain over time between antidepressant users and those who are not. Keeping in mind the potential for weight gain, good nutrition and exercise should be part of the treatment with antidepressant as well.
Ultimately, the risk for weight gain needs to be balanced against the risk for untreated bipolar disorder. Close monitoring of weight and vigilant efforts to prevent the initial weight gain can be very effective in limiting the amount that is gained. Weight gain on one agent does not necessitate the same on another agent, so different trials may be needed as well.