Depression Symptoms Treatment

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Question. I used to take 100 mg of imipramine per day for depression. Then I was diagnosed with mixed bipolar and was switched to 750 mg Depakote and 225 mg of Effexor per day. I gained about 50 pounds during the first three months and have not been able to lose any of it. I have a lot of problem with my weight and it has been starting to make me really depressed. Is there a medicine that will not give me this side effect, or should I try a diet or diet pills?

Answer. First of all, I can appreciate your frustration. Weight gain, unfortunately, is a common side effect of many mood medications, including Depakote and Lithium. Effexor, on the other hand, is not commonly associated with weight gain. I do not recommend diet pills, since the long-term consequences of their use are not well-known. Nutritional counseling and a moderate exercise program are very important parts of weight management, though I do not want to mislead you. Even pushed to the maximum, these are unlikely to shed 50 pounds. Still, you may be able to take off 8-15 pounds with major dietary changes and regular, vigorous exercise, as medically prescribed.

Changing from Depakote to carbamazepine (Tegretol) might lead to less weight gain, though Tegretol can have its own side effects and risks. This would require a thorough discussion with your doctor. It is also important to make sure that your thyroid function is adequate. Women with bipolar disorder have a rather high rate of hypothyroidism, which can lead to weight gain. Thyroid hormone combined with a mood stabilizer can sometimes reduce mood swings. In my experience, it can prevent further weight gain for some patients. However, thyroid medication should not be used as a diet pill, and also has its own risks. While lithium can also promote significant weight gain, it is possible that for you, the weight gain might be less than with the Depakote. There is no way to predict this. Lithium, however, is not as effective as Depakote for mixed bipolar disorder.

I wish I could give you a quick and easy solution to your problem, but there is really none that I know of. And, it is very important that you continue with your medications until and unless a change is made. Finally, it is also important to discuss your feelings of depression with your therapist, and to consider a support group or other means of addressing these feelings. I wish you well.