“Side effects from medication” is one of the top reasons people with bipolar disorder don’t comply with treatment. Second-generation antipsychotics, specifically, are more likely than others to cause significant weight gain as a side effect. Since patients already have to endure the stigma of simply having bipolar disorder, they may not feel that it’s worth it to some to add more stigma because of their body weight, even if the medication is effective.
Approximately 60% of bipolar disorder patients take antipsychotic medications for maintenance therapy. Newer antipsychotics include drugs like aripiprazole (Abilify), clozapine (Clozaril), lurasidone (Latuda), olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal) and ziprasidone (Geodon). Taking these medications for prolonged periods almost guarantees weight gain.
There are four other factors that are associated with weight gain due to antipsychotics. If patients are younger, non-white, have non-rapid cycling bipolar disorder and have a lower weight when they begin taking the drug, weight gain is more likely.
While the actual amount of weight gained varies between patients taking second-generation antipsychotics, 55% experience weight gain. Some can expect to gain 20-35 pounds in a single year. Clozapine and olanzapine have been shown to cause the most weight gain. Aripiprazole and ziprasidone, however, show minimal weight gain.
There are multiple factors that contribute to weight gain associated with antipsychotics. The first is the inherent way antipsychotics work in treating mental illness. Second-generation antipsychotics work by interfering with serotonin, histamine and dopamine in the central nervous system. For maintenance therapy, the results are lowered anxiety and more stable mood.
Unfortunately, the same mechanism that makes antipsychotics work in the first place also increases appetite.
When histamine is blocked with the use of antipsychotics, it triggers an enzyme called AMPK to overact. AMPK is used by the body to regulate metabolism and glucose. When it overacts, it can significantly increase appetite and food intake as well as interfere with blood sugar and lipid metabolism. Zyprexa, specifically, has also been linked to the development of type II diabetes as well as increased cholesterol and triglycerides.
People with bipolar disorder are twice as likely to have metabolic syndrome than the general population, so it’s important to keep body weight in check. There are two ways doctors go about this.
One option to combat weight gain associated with antipsychotics is adding another medication. The drug metformin, used to treat insulin resistance and PCOS, has shown to be minimally effective at treating a weight gain of more than 10%. One study showed a body weight decrease of 5% with only the use of metformin. However, this treatment is not generally recommended.
The best option for treating weight gain associated with the use of second-generation antipsychotics is the same option recommended for everyone else- diet and exercise. Eating fewer processed foods, more vegetables and more foods high in omega-3 fatty acids can help ease symptoms of bipolar disorder.
Motivation can be hard to come by with bipolar disorder, so it’s important when planning exercise routines to find an activity that is enjoyable and doesn’t feel like a chore. It’s also important to start slow to avoid burnout. Need help finding an activity? Speak to a therapist to get some ideas going.
*Always consult a doctor before beginning any diet or exercise plan.
*Do not discontinue medication without speaking to a physician;withdrawal effects are not fun.
Image credit: Mason Masteka