One of the significant problems people with bipolar disorder grapple with is weight gain. Many online commentators have suggested that this is due largely to the impact of certain types of medications commonly being prescribed for bipolar disorder (a class of medications called atypical antipsychotics).
However, recently published research suggests that the whole picture is a bit more complicated than laying blame on the medications alone.
First, it helps to start off by understanding America’s overall weight problem. Nearly two-thirds of all Americans are overweight (over 70% of all men and over 61% of all women), and one-third of us are considered obese (National Health and Nutrition Examination Survey). America is fat, there’s simply no easy or other way to say it. So if you’re packing a few extra pounds, you’re in the norm for America today.
Susan Simmons-Alling and Sandra Talley (2008) examined the research into the factors surrounding weight gain and bipolar disorder. They note that 35% of people with bipolar disorder are obese, the highest percentage of any psychiatric illness. They also reviewed previous research which suggested factors that may be contributing to this problem: gender, geographical location, co-existing binge-eating disorder (up to 18%), co-existing bulimia nervosa (up to 10%), higher numbers of depressive episodes, treatment with medications that cause weight gain, high carbohydrate consumption, and physical inactivity.
But research results to-date have been decidedly mixed about whether bipolar disorder (and its treatment) causes significant weight gain, or whether weight is more of a general population issue that can be magnified by the presence of bipolar disorder (and its treatment). The researchers note one study that found that 68% of people seeking treatment for bipolar disorder presented as overweight or obese (a statistic that mirrors the general population). But another study found that newly-diagnosed bipolar patients were within normal weight range, finding weight gain only occurred after diagnosis and treatment.
The researchers look at a number of possible contributing factors, including genetic and biological processes and neurotransmitter activity. Research into these areas that specifically examine weight gain in bipolar disorder simple don’t yet exist, but the authors suggested there are “similar patterns if neurochemical dysregulation between the two disorders [bipolar disorder and eating disorders] that might account for weight changes.” They also point to research that suggests that eating disorders and mood disorders may “coaggregate” in families. This begs the question, however, that if that were true, why are we not seeing a huge rise in obesity or weight problems in people taking more typical antidepressants. (While certainly weight gain may be a side effect of some antidepressants, it hasn’t garnered nearly as much attention as the weight gain experienced by people taking the newer atypical antipsychotic medications.)
When the researchers look at psychopharmalogical influences, they get to the kicker — “the pharmacological mechanisms underlying weight gain are poorly understood.” In other words, we don’t know exactly how or why these drugs may be causing weight gain in people. What they do note are possible predictors of weight gain while on the medications — gaining 4 or more pounds in the first 3 weeks of taking the medication, being younger, non-White ethnicity, having lower weight at the outset of treatment, and nonrapid cycling. Sadly, the researchers say very little else to say about the weight gain problems of many atypical antipsychotics. Given what has been published about the Zyprexa research trials in the past 2 years, I’d say this was an unfortunate choice by the authors.
They do note that metabolic syndrome has been shown to be present in up to 30% of people with bipolar disorder (metabolic syndrome is a set of health factors that increase the risk of heart disease and diabetes). What they don’t say anything about is whether this is significantly higher than the general population (it’s about 25% in the general population) and whether bipolar disorder may cause this increased risk.
Additional theories about the increased weight risk associated with bipolar disorder include a childhood history of neglect or abuse, which is reported in 36% to 49% of people with bipolar disorder. Such abuse or neglect is also highly associated with eating concerns, according to the researchers. Alcohol abuse and smoking are also singled out as possible factors, both occurring with increased prevalence within people who have bipolar disorder than those without (and both contributing to additional health concerns, such as metabolic syndrome).
Last, the authors point out that people with bipolar disorder often have lower income levels, fewer years of education and may be in poor social support situation (e.g., lack of a stable relationship). These factors may also contribute to making poorer diet choices and have worse eating habits.
The assessment the authors provided was a basic review of the literature, and as such, couldn’t come to any smoking-gun conclusions. What they found was a pretty complex picture with no obvious answers to the problem of increased weight gain in people with bipolar disorder. They do suggest strategies, however, to try and address the issue head-on, by having the physician carefully monitor the person’s health and weight, and provide dietary education as needed. The lack of a more in-depth look of the issue of the atypical antipsychotics and weight gain was disappointing. But what they did find points to the need for far more refined and focused research into this area.
Interested in keeping up with the latest advances in bipolar disorder research and treatments? Consider subscribing to our bipolar blog, Bipolar Beat, hosted by Candida Fink, M.D. and Joe Kraynak.
Reference:
Simmons-Alling, S. & Talley, S. (2008). Bipolar Disorder and Weight Gain: A Multifactorial Assessment. J Am Psychiatr Nurses Assoc., 13, 345.
The researchers made no disclosures of any conflicts of interest in the publication of this article.
33 comments
I am 5’10” and I used to weigh 125 lbs. I work out regularly. I was a size 6 until I took Abilify and within two months I gained 25 pounds and am now a size 12. My doctor put me on Geodon instead and I haven’t taken it yet because I am afraid of gaining more weight. Not everyone with bipolar disorder is overweight to begin with. Gaining this weight has caused me to become more depressed…what’s the point of taking this garbage medicine? I’m sticking to my zoloft and lamictal for now, thank you very much.
I am afraid Lamactil is starting to cause me weight gain. It’s a shame because I felt it was really working. But I refuse to be fat for any reason. I am at a 5″4 and was 135.5. Now rapidly gaining with these meds. Not worth it.
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Olanzipene seems to cause weight gain – probably because for better or worse I do not care about anything when I am on it.
Who is paying for this ‘new research’ – follow the money….
Gained 50 lbs. on Abilify in 10 yrs. Normal weight to begin with. Now have high blood pressure, high cholesterol & am now in the range of high blood sugar for diabetes.
I was thin my whole life until I attempted suicide in 1999, the doctors put me on 6 different medications. I can’t remember all of them but Neurontin, Risperidal, Tegretol, and Remeron were some of them. I gained 60lbs in 3 months! Since then I lost 45lbs of it, kept it off for a year then in 2005, with no change in medication, eating habits, or lifestyle I gained the 45lbs back. Have not been able to lose it, no matter how much exercise I get or what I eat. Also, I stopped taking those initial 6 meds years ago and have only been on Cymbalta for 3 years.
I agree with Michelle, not everyone with Bipolar Disorder is overweight to begin with. I was 25 when this happened, I used to be a ballet dancer!
I agree-follow the money! For YEARS patients have said their meds are making them gain weight. They doctors and pharma companies continue to claim we’re just eating more. The associations they are making with poverty, family abuse, etc are flawed,. If us bipoars are infact from crazy families, too poor to eat right, etc then WE WERE THAT WAY BEFORE THE MEDS. I too was thin before the meds. I
Went from 140 to 200, thanks to many bipolar drugs over the years. I am so sad that normals are clueless about our lifelong struggles. I was treated poorly just because of my weight. Some of it is due to poor diet, but much is from lithium, which decreases lipolysis.
I agree-follow the money! For YEARS patients have said their meds are making them gain weight. They doctors and pharma companies continue to claim we’re just eating more. The associations they are making with poverty, family abuse, etc are flawed,. If us bipoars are infact from crazy families, too poor to eat right, etc then WE WERE THAT WAY BEFORE THE MEDS. I too was thin before the meds. I
Recently diagnosed. My weight has fluctuated throughout my life. Manic – I was thin. Depressed – I was heavy. This is generally a 60 lb. swing to match my mood. On Trileptal now and it seems to be weight neutral as I’m losing the weight I gained during a recent depressed cycle.
I think the researchers might reach more definitive conclusions if they went on these meds, themselves and monitored their own weight.
I’m so sick of these “experts” putting the weight gain blame on the patients! I never had a weight problem until I started with the meds.
I Finally got the weight off when I was switched to Lamictal and Wellbutrin.
Im worried that my sister has bipolar, because my dad was diagnosed with it three years ago. In fact im surly definate that she does because she has a sporadic mood all the time. Then second of all she use to be fit and average, now she is pushing (i want to say over 200 pds). I love my sister and I dont want to see her in bad health. What or how do i aproach her without offending her and getting on her bad side about seeing a doctor?
Nobody will understand why I refuse meds. I’m bipolar. I get no therapy, no one who wants to hear me whinge about being manic depressive and I’m not on any meds. I choose that option over taking meds and the weight gain, possible health complications, hair loss etc because even lonely at least physically I am extrmely fit.
If I can’t keep my mind in good health…at least let me keep my body.
I want to respond to whitney.
I can surely understand that you do not want to go for the ‘weight gain’ when you first approach your sister. Not only may this hurt her feelings very much, but she would be more likely to ‘shut down’ even further.
If I were you, I would not even mention either weight, or what you think may be your sister’s diagnosis. What help would that be?
I would start out, and also continue, (as in not stopping after one attempt), to ask her in a manner that tells her you are really interested and concerned, about her internal life.
Don’t go for the answer, or diagnosis, but rather more for ‘the process’. Just by showing your interest, she is most likely to confide in you about her internal life when she is ready, and just tell you. Sometimes, it helps to take a walk, or do an activity together, rather than making the occasion too formal?
It is of course always so much easier to give advice to others, but I am telling you here what I think would work for me if I was your sister.
PS: Another good way top go would be to start talking about yourself first. (i.e. you may want to talk about how your dad’s illness has affected you, and thereby set the stage for the conversation) Or anything else that you are struggling with, or just want to share with her.
Cara, why do you think that nobody would understand? I mean, you may be right, and I am sure you feel the way you do based on past experiences. I just wanted you to know that I understand why you feel the way you do. You don’t want to lose one of the things you like best about you, and that you have some control over? Even other reasons I would be likely to understand, because usually when you listen to someone carefully, what they say and feel makes a lot of sense in the context? (just wanted to say this much for today?) take care, kat
I AM BIPOLAR AND I AM DEPAKOTE AND I PUT ON ALMOST 100 POUNDS AND THE DOCTOR I SEE ONLY SAYS…..YOUR ONLY GONNA GAIN AS MUCH AS YOU EAT,THAT IS BS IF YOU ASK ME.WHAT’S YOUR OPINION?
that is bs my daughter is 5 ad takes depakote and gained weight.i took it in the past and got up to 187
i lost weight after weight after i got off it thank god!bless your heart!
Doctors are delusional if they think the meds aren’t responsible for weight gain. I, too, was thin and fit before Depakote and gained 60 pounds. These drugs are meant to slow us down- surprise! It works! That, plus, an increades appetite… It isn’t that we’re poor and stupid and just buy Hostess and Pepsi with our foodstamps. It’s amazing that those who are supposed to help us still have a mentality of “Those stupid people can’t remember to take their meds… How hard can it be? Just eat more carrots and walk more.” Why don’t they take Depakote for 3 months and see what happens?
Love your post. You tell it exactly like it is! Amen,sister!
Cara, I understand. I refused any psych med that was known to cause weight gain. That left out a lot of drugs, and really I’m glad I did refuse them.
With me weight and depression are intertwined and I knew that if I took a drug that made me gain weight, it would increase my anxiety and depression. I told my shrink that I would rather be thin and depressed than fat and depressed. You do what’s right for you. You’re the one who has to weigh, pardon the pun, the risks.
My psychiatrist gave me a very hard time for my decision. For some reason he thought I should be willing to gain a bunch of weight. I’m glad I did what was right for me, even if I was given a really hard time about it.
Cara,
I definitelly understand you. I am not not superthin, but I have quite nice body. Gaining weight and hairloss are definitelly scary for me. And no, I could not be happy fat with patches of my hair coming out (I pride my hair). Along with possible memory problems and loss of creativity? I am may as well be dead that losing the important traits of myself.
Unlike most of you, I have had a weight problem most of my life. But then I’ve been Bipolar most of my life and on meds. Currently on Lamictal, Zoloft and Risperidal. Am over 200 lbs and have a very small frame. When the meds are working well, I feel great, don’t crave the sugar and feel like walking. Lately the meds havent been working well, I’m craving sugar and of course couldnt be motivated to walk if my house was on fire and I had to get out. For a while there I was fat and happy, but not happy to be fat. Now I’m just fat and miserable. I just want the option to feel good and be a normal weight. If it’s about money why can’t they come up with a med that works for both scenarios, I’m sure we’d all pay for that.
I too am on the same meds as Shawna. I’m on risperidone and sertraline (generic for Zoloft). I was 150 when I started the meds and I’m now up to 184lb. I’m more depressed then ever. I can’t fit into any of my clothes. I’m tired all the time and have been drinking alcohol to escape my depression.
I agree with Kim. My husband was on the same meds as Kim and put on over 50lbs. Now that he is ”better” (he says) the weight is beginning to fall off him and his libido has returned. He was never over weight before and has a physically demanding job and doesn’t drink. Are there other drugs that can be taken without these side effects ?
I have been on bipolar meds with little success in leveling my moods but have gained plenty of weight. The most recent med was Seroquel and it left me unable to operate in every day life and at the time my doctor and the other doctor at the clinic I went to were both leaving the practice so I stopped taking the meds while waiting for a new doctor. In the two months off meds I have lost over 15lbs. So what do you think. I had gained more weight on the meds than I did through either of my pregnancies. The meds have to be a big factor. Abilify, Cymbalta, Lexapro and Lamictal.
No matter my daily walks, physically demanding 40-hour a week job, and meager food rations, I can not decrease my weight. I used to wear a size 8 and now I’m a size 14 or 16. I’m on depakote and resperidol, two drugs known to cause weight gain. When I told my psychiatrist that my weight just kept increasing, he told me to exercise at the gym five days a week as well as “As we age we gain more weight.” I don’t think you’re average 24 year old should be weighing 200lbs, when only two years earlier I weighed 135lb. Bunch of bullocks.
My weight gain is definitely due to the medication. Before I was diagnosed and went on medication I was a size 4 and now I’m a size 18. That’s no coincidence. When I went off of my medication for six months I lost a lot of weight and went back down to a size six, but I had a lot of issues with being off of the medication. When I went back on the medication I gained all of the weight back. It’s very frustrating. I know I need the medications, but the weight gain is so unfair. I’m active and I eat like a normal person, but I’ve gotten so heavy. I also have an underactive thyroid which has also affected my weight.
I just wanted to add my voice to everyone elses here.
I took Depakote for 6 months for migraine headaches (on 600mg a day). I remember it stabalized my mood, gave my a whole bunch of energy and I craved sweets but did not notice an increase in appitite (I have poor appitite at the best of times). I’ve always been thin (5’3″ 108-115 lbs). During the six months my diet did not change from what it was prior to medication. I gained 35lbs in the first month, and 10 more lbs before I quit the medication (it stopped helping my migraines and my mood was so blah, I was sick of being the apathy monster). 2 months after the medicaiton stopped, again with no diet changes, all the weight was lost. When I was diagnosed (for the fifth time) with bipolar 2, I refused treatment with depakote and any anti-psychotics (I don’t have delusions or psychotic episodes of any kind). My psychiatrist basically told me that massive weight gain should be acceptable for “stablility” which seems to me to be pretty hit or miss for every bipolar. Weight gain is a deal breaker for me, I have fibro and I don’t need more stress in my life from being overweight.
These drugs WILL cause weight gain in most people, espcially women, and metabolic syndrome is a serious risk. IMO they aren’t worth that, patchy “stability” packaged up in apathy and numbness is not my idea of stability anyway. Everyone else around me might think so, but I don’t.
My daughter went on a mediicne for bipolar about 1 1/2 months ago–she has gained 14 lbs since then. I don’t think this is due to her–the medicine definitely caused this. She seems to not be able to feel full and wants to eat all the time. (Totally different from a few months ago.)
I was recently diagnosed as bipolar a year ago and have struggled with weight gain. I’ve been blogging about my experience and also my weight loss over on my personal blog http://www.justanothermanic.com. I have found that advocare works for me. My doctor approved it with the exception of the energy drink they have called spark. She said the rest is safe. So far I have lost 5 lbs in 2 weeks. Pictures are on my blog. There is hope!
Another contributing factor not mentioned is the fact that bipolar patients will also self treat with marijuana, which is infamous for causing increased appetite and laziness. At least with my S.O.