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Antigone

Mood stabilizer that doesn't cause weight gain?

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I am considering switching off my mood stabilizer of Lamictal to something else.  I have completely flat affect and have forgotten how to smile or laugh at all.  I make weird zombie faces instead.  I'm also on Wellbutrin and Saphris.  I'm also morbidly depressed and don't leave the house so I'm wondering if my mood stabilizer is keeping me unnaturally low on the mood swing front.

 

I cannot gain back the weight I gained on Zyprexa.  I have failed all other antipsychotics, so changing Saphris isn't a good idea.  And we just switched up to Wellbutrin from Effexor so I know it's not that.  I've been having flat affect for a while now.

 

Any suggestions?  Experience?  Thanks in advance.  I've heard Trileptal can work without weight gain.  Can anyone confirm this?

Edited by Antigone

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I don't have any experience with Trileptal, but Depakote (Valproate) has been weight neutral for me. It does not zombify me and I think it even helps to some extent with the depression.

 

Again, that's just me, others might have difference experiences.

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i'm also on valproate, which is "weight neutral"

 

my problem is all my meds are weight neutral [not so much risperdal] but they work, and feeling good for the first time in years has my appetite functioning better than it has in a decade, so i am gorging food not as a side effect, but b/c they work and i feel good

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I've been on lithium going on 5 months and haven't had any weight gain, in fact I've seemed to have lost about 5lbs (probably not lithium's doing, but it hasn't impeded by ability to lose weight). This probably isn't the average lithium experience, and maybe I haven't been on it enough to see any longer term SEs, but if you haven't tried it, maybe it's something to look into?

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I have gained 3KG/7LBS since starting lithium a year ago. I'm 5'9" so it isn't much of a difference. I'm not sure it was from the lithium. I have started Cymbalta and Remeron in the past year which can cause weight gain, too. I also did weight-training and tried to put on weight, so it could just be 7lbs of muscle.

 

Depakote - "Weight gain is a big problem at higher doses" http://www.psycheducation.org/depression/meds/valproate.htm

 

Tegretol and Trileptal - "not clearly associated with weight gain" http://www.psycheducation.org/hormones/Insulin/weightgain.htm

 

lithium -  "At first almost everyone will gain a few pounds as their body hangs on to more water (salt effect). Some people can continue to gain weight, though. This is much less of a problem with lithium than with valproate, both in how often it happens and how much weight is gained." http://www.psycheducation.org/depression/meds/lithium.html

 

Out of the four, lithium has a better evidence for antidepressant activity as well as antimanic, and also for preventing recurrences http://www.psycheducation.org/depression/meds/moodstabilizers.htm

 

ETA: Some also say that because lithium makes people thirsty, people often drink more high calorie drinks such as soda, and that is the main mechanism for weight gain. I don't know if that's true. I do drink more on lith, and I hate water. It's usually coffee, black, green or herbal tea that I drink, though, which is perhaps not as bad as soda.

Edited by mcjimjam

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Thanks for the great information.  I'm wondering what my psych will suggest and I want to be prepared with as much info as possible.

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You can't purely go by the "standard" weight estimates. The first time I used Depakote I lost a huge amount of weight, and it is notorious for weight gain. The second time, I gained weight. The first time I used Neurontin was probably the only time in my adult life i was actually the right weight. The second time I piled on the pounds REALLY fast, I was shocked, and I had to come off of it right away. I've lost weight on lithium. I have been kind of watching how I eat, but mostly it is watching myself eat too much ice cream. But I am 20lbs less than when I started it 2(?) years ago. I gained weight on Tegretol, but it was over 3 years of law school, and a lot of people gain a lot of weight in law school.

 

You have to try it for yourself.

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I know many people for whom valproates like Depakote are not weight-neutral.  But for me, it has been so.  Make of that what you will.

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I see that you also get migraines.  Topamax along with Seroquel has been really great for me.  I know Topa on it's own isn't ideal for mood stabilization but definitely helps me.  My pdoc just added a tiny dose of lithium because it's "my season" where my cocktail without it wasn't enough, but Topa as an add-on should make the gainers be at least weight neutrals, not to mention you'll hopefully knock your migraines on their ass.  If it were me, that's the route I'd take.  A more typical stabilizer plus 75 or so of Topa.

Edited by ray_of_sunshine

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I take Topamax. It is nicknamed "Dopamax" and is hit or miss, and often a last resort.. I lost a lot of weight. It works for me, I take 150mg daily in my cocktail.

 

Gabapentin was weight neutral for me, but I had a mixed/manic episode and ended up in the hospital. You can go up really high doses on that and it's also great for anxiety. I was on 900mg.

 

Lithium made me retain water and did funky things to my kidneys.

 

Tegretol and Trileptal are supposedly weight neutral, but aren't the best.. Tegretol has a tendency to make other meds less effective, and Trileptal can dump your electrolytes (I believe, if I'm wrong, let me know)

 

Topamax can be added on the side as a "diet pill" (as a physician accidentally said once). It can give you a case of the stupids and has a long titration and shitty side effects at the start. It can be hard to tolerate at the beginning, but it does go away. 

 

Geodon is weight neutral in a lot of people, also. I found I'd lose weight on it, but it wasn't strong enough for psychosis and didn't help with moods, hence taking Haldol now.  YMMV. It's a discussion to have with your doctor.

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My husband has struggled to keep his sodium high enough on Tri-leptal, so I think you are right, system.

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Gabapentin has been helping lift my mood as well as tone down my physical anxiety symptoms. For me, it makes me not want to eat much so I've actually been dropping a bit of weight, not gaining. Next month I may ask to up it a little, since I'm on 600mg and I'd just like to see of it takes a bit more of the edge off at say, 900mg. Everyone is different, but I like it so far.

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Abilify helps me out a lot and is weight neutral for me.

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any thing is weight nutruel with the right amount of stims, and yes wellbutrin counts as a stim too.

 No necessarily.

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Tegretol and Trileptal are supposedly weight neutral, but aren't the best.. Tegretol has a tendency to make other meds less effective, and Trileptal can dump your electrolytes (I believe, if I'm wrong, let me know)

 

The interaction of Tegretol (carbamazepine) with other meds is really not a big problem. It just means that you have to adjust the dosages of the other meds (usually upward). I've never had a problem with it.

 

I believe that Trileptal (oxcarbazepine) is also an enzyme-inducing med which means that you have to look out for interactions and adjust dosages similarly as with Tegretol. It's just that pharmacological companies usually test their meds against Tegretol. Perhaps it is not such a big offender like Tegretol, but it still is an enzyme-inducing drug. If I am wrong on this point, someone please correct me as I don't take Trileptal. I think you are right that Trileptal can cause a problem with electrolytes, especially sodium.

 

For me, Tegretol is very effective and completely weight neutral. The meds that cause me to struggle with weight are not my anticonvulsants. However, one time I took Depakote which was definitely NOT weight neutral for me. I ate everything that wasn't nailed down when I was on Depakote.

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any thing is weight nutruel with the right amount of stims, and yes wellbutrin counts as a stim too.

 

What on earth are you talking about, and specifically what advice do you think you're giving the OP?  Please don't bomb threads on the medication forums with random, unsubstantiated one-liners.  

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I gained fifty pounds after I added abilify. I switched to Geodon and have been slowly (very slowly) losing it. I also take lithium. It has been completely weight neutral for me and I have been on it for years.

 

Gaining weight sucks, yes, but not having symptoms under control is worse. It might be a good idea to balance your need of being weight neutral with the efficacy of a given drug.

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I do not have bipolar disorder but two mood stabilizers that I've been on before they nailed down my dx that never caused weight gain were lithium and topamax. Granted they did absolutely nothing for me otherwise haha. 

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I do not have bipolar disorder but two mood stabilizers that I've been on before they nailed down my dx that never caused weight gain were lithium and topamax. Granted they did absolutely nothing for me otherwise haha. 

 

I'm taking lithium and lamictal and I've gained weight.  but.  I've been hypomanic literally for years. So since I'm not zooming around cleaning the refrigerator with a toothbrush, hiking mountains in all kinds of weather, etc, I think that's why I'm having some weight gain.  I spend a lot more time just chillin. Sometimes I don't do anything outside the house for a whole week!  That's like amazing.  

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