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Fat and never myself?


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I've been diagnosed with Bipolar 1 disorder since 2002. I've been on meds full-time since 2006. And during that time, I have to say I've been disappointed with the outcome.

The only med I seem to be able to tolerate is Seroquel. But it makes me feel kind of stupid and non-reactive. I don't feel that I am naturally that interested in much anymore. Plus, I've gained 70 lbs (though to be fair, I was unusually skinny for me when I started, so it's really 50 lbs over baseline). The worst part is that I keep gaining weight, unless I really restrict my food, and then I just stay at the same weight until I stop restricting again. My stomach, in particular, is large. I'm into the 2X clothing sizes. And I don't have a huge appetite.

My doctor is thinking of putting me on metformin to try to encourage some weight loss, but as I understand it, even the best results with metformin don't totally reverse what you gain, so maybe I'll lose say 10 lbs, and is that really worth much? I mean, I'm already 211 lbs, how much better am I going to feel being 201 or whatever?

On top of this, I'm in a depressive phase now because I had a manic episode back in April/May for 5 weeks.

I'm lucky in one sense: I don't have any rapid cycling or anything like that. I can get a good 2 years, sometimes, between manic episodes. Then after a manic episode, I'm depressed for a while, then I'm sort of functional for a few years if I'm lucky. And also, I might be able to get longer if I learn to recognize signs of relapse more quickly. The last two times I relapsed were after 2 and a half years and 20 months without mania, so it's not like it's something I'm fighting monthly or even yearly.

I fight with having insight. Back when I didn't believe the bipolar diagnosis was valid (a few months ago), I thought I could go to therapy and slowly reduce meds and maybe one day come off and be myself again. Well, that strategy failed twice now, and maybe the reason for the last 2 manic episodes was because I was taking too little Seroquel at the time. (But I was trying to be responsible, as I was doing it with the doctor's cooperation and lowering really slowly.) After the latest episode I was convinced it was indeed mania. So at this point all I can think is that I have to be on something forever, and just accept the diagnosis and do the best I can.

But how can I accept being so fat? And how can I accept that even when I'm "stable", I don't feel like myself anymore? Don't feel smart, don't feel excited about hobbies, etc.? I've tried a lot of medications (lithium, divalproex, Geodon, risperidone, olanzapine, haldol, Lamictal, Wellbutrin) and most of them are intolerable for a variety of reasons including akathisia, panic, insomnia, huge appetite, and increased depression. I have doubts that I'll ever find one that makes me feel right, and I really don't want to start putting together complicated cocktails. Back when I was on antidepressants (along with Seroquel), I was even less stable (more frequent hospitalizations), so I avoid those. I have a feeling I'll just have to accept feeling impaired on Seroquel forever.

This is all very disappointing because I did well in school up until I started getting sick around age 19/20 (mostly depression in the beginning), and then it took years to realize what was going on, and years more (and several manic episodes) before they forced me onto meds full-time. I had every expectation of a professional career originally. Now, at 36, I feel like my mind doesn't make connections, and those academic interests seem distant. I feel as if someone has stolen my life from me. I can work part-time when I'm in my "stable" period, which is lucky, but it's not the kind of work I once expected I would do, and it certainly doesn't compare to the work I see others in my family doing (doctors, lawyers). Plus, there's just the simple loss of faith in my own ability to think and react to the events around me, making it hard to live a passionate life and feel like I have a personality. I'm on about as low a Seroquel dose as I can safely be on, too. We're talking 275 mg, not 700 like a friend I know.

I'm going to stop before this becomes a blog. But do you guys think it's possible to not be fat and to feel normal while on bipolar meds? Because my experience so far says no. It says that there will always be an intolerable compromise in quality of life.

frog

 

 

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Well, for one thing, if you feel you can't think clearly, your meds probably need to be adjusted. I know that I am not as sharp a thinker as I used to be, and I do think some of that is from bipolar illness, but from the illness itself, not meds. Also, I'm 25 years older than I was when I was diagnosed, so some of that is just normal aging.

Secondly, I am *pretty* sure that while metformin will only make you loose a moderate amount of weight in and of itself, it gives you the ability to lose weight with diet and exercise, which I understand is almost impossible on Seroquel alone.

Now I have never used metformin, and what I know about it is what I have picked up from other members. So I may be wrong about the diet and exercise part. But the weight you are at (I've been that weight, I'm not judging) is very high, and even 10 or 15 lbs would be an important improvement.

If you want more information about Seroquel, you can go to our meds forum, there is a sub forum for AAPs (Atypical Anti-Psychotics, if you don't know the lingo yet).

I hope more people answer, because I do not have direct experience with either Seroquel or metformin, so I may be talking out of my ass. So we'll both learn.

Good luck.

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Yes, it is possible not to be fat while being Bipolar. I am 7-8 lbs from healthy weight and I have bipolar. 

I never felt "normal" again since my mental illness. I tried the latest meds like Latuda. I still don't feel normal.

When I was on Seroquel for many years, I was overweight too. I would wake up and eat in the middle of the night like crazy.

I started a diet and lost weight with Invega and then Latuda. Those are mostly weight neutral.

I was on metformin but it didn't help me lose much weight.

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Have you gotten your thyroid checked?  If that is "off" it can really affect your metabolism.  Also, have you ever tried naltrexone?  I am on it, and it regulates my appetite in a way so I still get hungry, but not as often.  I used to eat over 10 times in a day, now I am down to 5-6.  I also watch the sugar in the food I eat.  Try my best to keep it low.  But I have lost weight on it.  It isn't a diet pill or anything, just helps me not to binge on incredible amounts of food all day long.

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I need some clarification: is your post about feeling not at home in your body because you don't like your weight, or about feeling not at home in your mind because of the dulling from Seroquel? I took Seroquel XR for years; it was a great med for me, and I can relate either way.

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melissa, yes, my thyroid is fine. The weight gain is from Seroquel. carlos and melissa, I eat a very modest diet and don't experience a large appetite, yet all I am able to do is keep my weight stable. It crept up while I was eating more normally, e.g. allowing myself desserts, but I certainly wasn't ravenous though at the time I would eat at night due to panic. I don't eat at night anymore. But I lost like 3 lbs in a week and since then it hasn't gone anywhere.

Gearhead, I'm talking about both my body and my mind. Though I don't know if the mind is truly sluggish, or if it's my expectations and perceptions that are making me think that. Other people still think I'm smart. I just don't feel as passionate, I guess. But that could be because I'm putting pressure on myself. It's hard to tell. The body thing, though, is really hard.

I keep thinking I'm going to have to change mood stabilizers, which is hard because Seroquel has kept me stable if not happy. I tried lithium a few years ago and was very depressed and flat. Valproate made me panic. Risperidone made me angry and restless (akathisia). Lamictal helped my concentration but didn't really make me feel happier, and when we tried Lamictal monotherapy I went into a really bad mixed episode. Olanzapine made me eat everything in sight and gain weight really quickly. Geodon gave me very bad akathisia. Haldol also gave me terrible akathisia and tremors. I saw Invega mentioned, but as it's a Risperidone metabolite, it likely would screw me up the same way. What's left that I haven't tried? Give lithium another go, maybe with an antidepressant on board or at a lower dose? Try Tegretol or Trileptal? Latuda has no anti-manic properties, so that would be inappropriate.

I'm at my wit's end with this. If I could tolerate a weight-neutral med, I could lose weight easily, as I know lots about healthy eating. (I really can't afford to be 211 lbs while denying myself all dietary enjoyment. I'll get diabetic if this doesn't change.) I wonder if I need an antidepressant or something with antidepressant properties in the mix, though, just to make me feel more normal, or if that would just destabilize my bipolar and cause more frequent manic episodes (like Wellbutrin did, though it caused insomnia). At this point my doctor's suggesting I try metformin and Prozac (at least while climbing out of depression), but I don't have much faith in the metformin. I'm going to make a separate post on the AAPs board about metformin and see what responses I get.

frog

 

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Idk if this would help, but my pdoc prescribed me naltrexone, which helped calm my appetite down, and lose some weight .  I know you said your appetite wasn't revenous though.

Or ask your pdoc maybe try an antipsychotic?  Sometimes those can work too.  I am currently on prozac and have done really well on it.  Weight neutral for me.

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