The side effect with the most complaints. And I’ll try to inject a little sanity here. It’s not your fault. You’re not lazy. You’re not weak. The god damn pills are making you fatter. But what can you do about it?
It all depends on the med and the disorder.The first line of defense is always the usual weight loss program – fewer calories and increased activity. In other words, eat less and exercise. But that doesn’t always work, and can cause a shame spiral. You exercise and diet, yet you still gain weight, so you feel bad about yourself. Doesn’t that work wonders for the antidepressants you’re taking? What’s the point?
I’m not qualified to address the diet part, but as far as the exercise goes – any form of exercise is going to make the meds work better and help you with your disorder. Well, maybe it will make the meds work better. Forced exercise does so in all sorts of critters, but as far as humans go, the only study I could find online that was in English (as opposed to heavy Science) and somewhat conclusive states “Physical training did not change the serum levels of the antiepileptic drugs to a clinically important degree.” But they don’t tell us what they consider “clinically important” in the abstract, dammit! In the US that’s 20%! That could be a big deal to some of us!
However you may as well keep exercising for whatever you happen to have, because it’s going to help anyway. Depressed? Geez, how many studies do you want showing exercise helps depression? What do you like to do? Tai Chi? Aerobics? Weight training or swimming? Running? What about panic or anxiety disorders? Jogging alone is almost as effective as Anafranil (clomipramine). Just think of the two together! The study I reference above for epilepsy shows that while the serum levels of the anticonvulsants weren’t improved significantly, the incidence of seizures were reduced with regular exercise. So even if you don’t lose a pound, start exercising and keep exercising so you don’t spazz out so much. I can tell you from personal experience, we’re both more prone to seizures when we don’t exercise regularly, so as long as she tumbles and I do my Yoga, our seizure thresholds aren’t as low.
As for diet, I’m clueless. My problem is keeping weight on. You can all put away the world’s smallest violins now. Plus I have food allergies like you wouldn’t believe. I can’t tell you what to eat or what not to eat. I can tell you these things:
One size does not fit all. You’ll have to find a diet that works for you. And even that may fail, as some meds will alter your metabolism in such a way that the best you can hope for is to stop gaining any more weight. So you might do the diet-go-round just like the med-go-round and find something that is marginally effective.
You must consult with your doctor on dietary changes, especially if you take anticonvulsants as they are most sensitive to foods and changes in your diet. If you take anticonvulsants, especially Lamictal (lamotrigine) or EIAEDs like Tegretol (carbamazepine) or Trileptal (oxcarbazepine), don’t be surprised if your meds work differently if you make radical changes to what you eat.
Those high-protein, low-carb diets (Atkins, South Beach, whatever) – I don’t know if they will work for you or not. I’m forced to eat something like that because of my food allergies and they probably contribute to keeping me scrawny. There are a couple of meds that do not mix well with these diets. Topamax (topiramate) and lithium. Yes, I know, I take Topamax (topiramate). I also get kidney stones, and that’s one of the problems you can have when mixing that med and those diets. The other is an increased chance for osteoporosis. Both of these risks, and how they are increased with a high-protein diet, are spelled out in the PI sheet for Topamax (topiramate). As for lithium that’s just a guess on my part. The high-protein diet makes your kidneys work harder, and lithium makes your kidneys work hard enough. Again, talk with your doctor about it, but I don’t think it’s a good idea to mix the two. However, there are people reporting positive results mixing lithium and Atkins with no immediate side effects, so I could just be full of crap on this point. Drinking lots of water is a key point.
Just as exercise can improve the symptoms of your disorder, so can diet. No, really. All those books aren’t all a load of crap, they just aren’t a universal solution, no matter what they claim otherwise. In spite of the authors’ sincerity in believing their diet can cure everyone as it helped them. As I state above, one size does not fit all. And a change in diet is also unlikely to deal with all of your symptoms, or the full of extent of your symptoms. It’s possible, just unlikely. But a change in diet could make your symptoms better. Just remember: one size does not fit all! Sorry, I wish I could find better studies, but I couldn’t for some reason. So while a change in diet may not help you lose weight, it may be beneficial in other ways. The fact is that depression and/or mood swings are an expression of food allergies and/or sensitivities for some of the people who have some of such things.
Again, from our own personal experience, when Kassiane and I each removed the various foods to which we are allergic from our diets the frequency and severity of our mood swings diminished somewhat. We’re still bipolar as all get out, so a change in diet just helped. It was no where near a cure. Unfortunately in my case it just fueled my delusion that I could control my bipolar disorder without medication for a couple more years, thus increasing the severity of the kindling and making the meltdown I later suffered all the worse. Please don’t be like I was. Work with professionals when dealing with something as serious as bipolar disorder. You can’t deal with it yourself.
OK, now we’ve covered the usual bits, diet and exercise. But those won’t work in all cases. Some of the meds cause metabolic changes that will cause you to plump up no matter what you do. A pill caused the weight gain, so you need a pill for weight loss. It’s logical, it’s understandable and it really is the way to go if the diet and exercise don’t work.
The question is, which pill?
First up is Axid (nizatidine). Axid (nizatidine) is a histamine blocker used for ulcers and GERD. Because it blocks histamine reception it sometimes causes weight loss. Now a lot of meds that are really awful for weight gain hit your H1 histamine receptors, notably Zyprexa (olanzapine), Seroquel (quetiapine), Remeron (mirtazapine), and the TCAs, especially Sinequan (doxepin), Surmontil (trimipramine) and Elavil (amitriptyline). The thing is, Axid (nizatidine) blocks H2 histamine reception. Does it work? Sometimes. The anecdotal evidence is spotty. A study with Seroquel (quetiapine) shows it to stop weight gain, but cause no significant weight loss. One study with Zyprexa (olanzapine) shows it to be an effective weight loss medication. Another study shows that its effects wear off after time. Dr. Amen mentions using it in Healing Anxiety and Depression. Axid (nizatidine) is the preferred histamine blocker to try, because it has fewer drug-drug interactions and fewer side effects than the others. No matter what your psychiatric disorder, you can try this med, but it probably will only work for the drugs listed. If it works at all.
Next is Glucophage (metformin hydrochloride), a drug used to treat type 2 diabetes. It’s been used off-label to treat the weight gain associated with ovarian cysts and people with too much in the lipid department that results in obesity. I found one small study where it successfully countered the weight gain in bipolar children being treated with a variety of different medications. As it treats wacky glucose levels it might be just what is needed anyway if you’re taking an antipsychotic, as Zyprexa (olanzapine), Seroquel (quetiapine) and some of the older ones have been shown recently to increase the chances of diabetes. If you have a seizure disorder and have weight gain issues because of Depakote (divalproex sodium), Depakene (valproic acid) or whatever they call valproate sodium in your part of the world, this is about your only option. Everything else is either going to lower your seizure threshold or would interfere with the workings of your meds.
Another med is Symmetrel (amantadine hydrochloride). This med is also used to treat tremor. I’ve just read some anecdotal evidence supporting its use. I’ve found just one small study showing that it stopped the weight gain of a variety of unnamed antipsychotics and anticonvulsants. The data suggest longer treatment would result in weight loss. Like all the other anti-Parkinson’s medications, Symmetrel (amantadine hydrochloride) messes with your dopamine. That could be a good thing for you, or it could be a bad thing for you. If you have a seizure disorder, forget about it. If you’re bipolar, who the hell knows? It might make you manic, it might not. If you’re depressed it might help with your depression, or it might have no effect. There’s even a slight chance it could make things worse. If you have a panic/anxiety disorder it could make things worse, or it could make no difference, or it could even make things better. If you’ve had any experience with Wellbutrin (bupropion) then you’ll have an idea of how you’ll do with Symmetrel (amantadine hydrochloride). I’ll probably have to give this med a full write-up, as it’s just too interesting.
Now that I mention it, Wellbutrin (bupropion) has been undergoing trials for weight loss, even if you’re already depressed. See the page on Wellbutrin (bupropion) for more information about if this is an appropriate medication for you.
That’s it if you’re bipolar.
Maybe. It all depends on how bad that built-in ADD is. But that’s an ADD issue, which I’ll be covering later.
If you have a panic/anxiety disorder or schizophrenia, that’s also about it for the weight-loss meds. With one new exception:
Meridia (sibutramine hydrochloride monohydrate). This is basically an antidepressant that tested much better as a weight-loss medication than it did as an antidepressant. As such, you shouldn’t ordinarily mix it with antidepressants, because either your liver will get confused and you’ll wind up with too much or too little of your meds in your system, or your brain will get confused and your neurotransmitters will get thrown out of whack. Anyway, Meridia has been shown as rather successful as a weight control medication for people with schizophrenia or schizoaffective disorder who are taking Zyprexa (olanzapine). If you’re really depressed, really overweight and nothing else has worked that well, you may want to check out a potential Meridia & Zyprexa cocktail. It reads as bizarre, but stranger things have worked for people. If you’re in the bipolar spectrum, you should be extemely careful with Meridia, as it is still works on your brain like an antidepressant.
I’m probably going to write up a full page on this med as an off-label antidepressant in its own right. One of these days. But please don’t bug me to do so. Otherwise it’ll just take me longer to do it.
If it’s just pure depression, you might be able to take classic diet pills. Obviously you’ll have to work with both your psychiatrist and GP very carefully with this, and they’ll have to be talking to each other. Something like Adipex (phentermine resin) or Bontril (phendimetrazine tartrate). You’d have to be very overweight and very depressed to be mixing those meds with an antidepressant, though.
As for all those “natural herbal supplements” you see advertised everywhere – read the fine print. “Results aren’t typical.” One study I found has most of them failing actual trials. Except for ephedra, which has been pulled from the market for adverse effects. No side effects my ass, because like many of the others they do have side effects, including liver problems and even death. Also check the FDA Alerts and you’ll find that many of them are recalled by the FDA after a few months for a variety of reasons. They may promise no side effects, but they lie.
Plus you have absolutely no clue as to how the stuff in those capsules are going to interact with your meds. It’s bad enough being a lab rat with meds that have been tested for interactions with each other. When you start throwing untested stuff into the mix you’re really playing with fire. If they were just one or two herbs or amino acids it would be one thing, that’s something that could be easily figured out, but they’re not. They’re always a blend of a dozen things. If you’re going that route you may as well just do diet and exercise, because all of them come with a diet and exercise program, and that’s what usually does the trick for weight loss.