Saturday July 9th 2011 - Weight gain associated with Bipolar medications

Weight gain is one of the most common and difficult side effects of many of the medications used to treat bipolar disorder and other psychiatric illness. The most common types of bipolar meds are atypical anti-psychotics, anti-depressants, anti-anxiety, anti-manics or “Mood Stabilizers” and anti-seizure medications.  

When I was initially diagnosed as Bipolar in 2001, my psychiatrist put me on a combination of anti-psychotics including Seroquel, Lithium, Depakote, and clozapine. All of these drugs are in the highest weight gain risk group. I was already obese, but these drugs made it impossible to lose weight. True to the claims, I gained weight like a sumo wrestler. 


Through the years I have adjusted my bipolar "menu" to Lamictal, Hydroxyzine, Seroquel, and Lorazepam. Lamictal is an anti-manic mood-stabilizer. Hydroxyzine and Lorazepam are anti-anxiety meds. Seroquel is an anti-psychotic. I've been on these drugs for over four years and they are very effective. I still suffer from the symptoms of being manic-depressive and I still have panic attacks, but I'm not totally incapacitated by them. I'm sure that I would be incapacitated and a puddle of useless poop without these medications. 


I have borrowed the following quick reference guide from a Candida Fink, MD's blog article at http://blogs.psychcentral.com/bipolar/2008/10/preventing-and-reversing-weight-gain-associated-with-psychiatric-medications/


Atypical Antipsychotics

Almost all of the atypical antipsychotics are notorious for causing fairly significant weight gain in most (but not all) people who take them. Here’s the list of culprits ranked from most to least risk for causing weight gain:

• High risk: Olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal), aripiprazole (Abilify), and clozapin (Clozaril)
• Little to no risk: Ziprasidone (Geodon) and older first-generation antipsychotics such as perphenazine (Trilafon)

The weight gain from antipsychotics appears to come from increased appetite (“hyperphagia”) and some changes in metabolism. This family of medicines also has varying degrees of risk of certain health risks such as diabetes and elevated cholesterol, which may be related to the medication’s effect on metabolism.

Antidepressants and Antianxiety Medications
Antidepressants and antianxiety medications all have some risk of weight gain, although not typically in the same severe range as the antipsychotics. The risk seems to be more individualized – some people notice a lot of change in appetite and weight and some notice little. Occasionally, some people actually lose weight on these meds. In addition, these medications do not carry specifically the risks of diabetes and high cholesterol.
The most common antidepressants and antianxiety medications are the SSRI’s and SNRI’s (the weight gain risk really depends on the individual):

• SSRI’s: Fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), and citalopram (Celexa) are some examples.
• SNRI’s: Venlafaxine (Effexor) and Duloxetine (Cymbalta) are the most common.

Bupropion (Wellbutrin), which is in a class of its own, is the only antidepressant without any risk of weight gain – but it is not particularly effective for anxiety.

Anti-Manics or “Mood Stabilizers” and Anti-Seizure Medications

Mood stabilizers and the anti-seizure medications often used to treat or prevent mania may also carry the risk of causing weight gain, but the risk varies depending on the medication and its effect on the person taking it:

• High risk: Valproic acid (Depakote)
• Moderate risk: Lithium
• Low risk: Lamotrigine (Lamictal) and carbemazapine (Tegretol)

Curbing Weight Gain via Medication

When medication triggers weight gain, one of the more obvious solutions is through medications – either selecting a different medication that’s less likely to cause weight gain or adding a medication that has a track record for negating the weight-gain side effect.


The most important factor here is good communication with your prescriber and regular monitoring of the medications and their effects – both good and bad. Some weight gain may be unavoidable, but try to be honest with your doctor about what you will and will not live with in this department.