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Weight gain with Divalproex - Frustrating
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Weight gain with Divalproex - Frustrating

I went on a diet for 2 weeks and I'm  on Divalproex. I am NOT losing weight. If anything, I gained one kilo. I am really frustrated. What do I do? I am not going to change my medication coz it seems to work for me in other areas
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Avatar_f_tn
Keep in mind that everything that works has side effects.  Not everyone will get every side effect, and some are more likely than others, but you won't really know without trying, unfortunately.  An off label use is one that the FDA hasn't approved the medication for, e.g. trazodone as a sleep aid (it's approved as an antidepressant).  Apparently it costs quite a lot to do the trials to get FDA approval, and for drugs whose patents have run out, it doesn't always make economic sense for companies to do the studies to get new uses approved.  Off label prescribing is legal in the US, but drug companies aren't allowed to market their drugs for off label use.  In the case of Trileptal, it seems to have held up pretty well being used for bipolar, and it's highly related to carbamazapine, which is approved for bipolar disorder treatment.

Your doctor will be able to tell you about a titration schedule for Trileptal.  It might be made more complicated by the divalproex--Lamictal titration certainly depends on whether or not you're taking divalproex or carbamazapine.

Rashes are actually a rare side effect of a lot of medications (like some antibiotics).  Lamictal tends to cause a benign rash in 1/10 people, but the incidence of SJS (the really bad rash) is around 1/3000, and the risk is higher in children and if you go up too fast.  Some doctors are willing to retry it even if a rash developed the first time, taking it verrrrrry slowly (you can start in the pediatric range), especially if it was working really well for you before the rash appeared.  Not all doctors (or patients) are willing to do this, though.  Your mileage may vary.  I've gone and developed acne with Lamictal, but not an actual rash.

Geodon is still an open option that you haven't tried.  You should really discuss it with your doctor and see what he/she thinks.  Bring up your concerns about weight gain and cognitive side effects, and ask about these drugs to see if they think it's a good idea.
74 Comments Post a Comment
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1551327_tn?1389046959
What was your diet plan like?  Schedule?  Foods?
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Avatar_n_tn
I had one piece of bread made from stoneground wholemeal flour and a little vegetable for breakfast. For lunch, just veggies and a fruit. For Dinner, one piece of bread again and veggies. I weighed myself after 2 weeks and I have gained a little weight inspite of my decrease in food intake.
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I have heard of a lot of people gaining weight with that med but it sounds like it is really working for your mind.  Have you ever had or been checked for a thyroid problem?
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Avatar_f_tn
Diet and exercise go hand in hand. If you are able to exercise in addition to your diet I think you will have better results. As was mentioned above, having your Thyroid checked would be a good idea.
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Avatar_n_tn
Hi,

Thanks for your replies. Yes I am on a thyroid pill (thyrox 150) for Hypothyroidism. Ive been on it for many years now. And I did get myself tested recently. My thyroid levels are within the normal range. What would you suggest now?

Thanks
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Avatar_f_tn
I think exercising along with your diet is the best thing to do. You may want to see a nutrionist. I'm not sure you are eating enough. Without enough food your body goes into starvation mode and holds onto fat, this is what I was told. You can do some research about this. You do need a certain number of calories a day for weight loss.
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Avatar_f_tn
It sounds like you might not be getting enough protein with that diet.  One thing that worked for my mom was a low carb diet.  She cut out sweets and bread, aiming for under 20g of carbs/day.  Moderate meat intake, lots of veggies and beans, salad with hard boiled egg, maybe some cheese and ham and a moderate amount of homemade vinagrette dressing for lunch most days, etc.  She would even have bacon and eggs for breakfast (but not toast).  Not much fruit, since it's quite sweet.  She also got more exercise in the form of some heavy duty gardening and taking walks several evenings a week.  

One thing to get for exercise is a pedometer to measure your steps.  They recommend getting at least 10,000 per day.  A pedometer lets you treat it like a game, and lets you know how much walking you're actually doing.  And divalproex is going to make the process a lot harder.  But you've heard my opinions on that in the other thread.
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Avatar_n_tn
Thank you so much for taking a little time out to respond
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Thanks for your response. Appreciate it!
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Should I try taking a weight loss pill to curb the effects of Divalproex?
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Avatar_f_tn
I don't think so.  Most of them don't work, and the ones that do can have nasty side effects.  Definitely talk to your doctor and a pharmacist before trying anything like that.  They might interact badly with your divalproex.  It's a good idea to ask the pharmacist before taking any new med when you're on prescription meds, especially psych ones.  Exercise is really your best bet if you're determined to stay on the divalproex, and there's a lot of evidence that exercise in and of itself helps with bipolar symptoms.
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Avatar_n_tn
Thanks for the response.

In that case then, should I try another mood stabilizer? but definitely not  Lithium?(coz then I would need to go for blood tests and all which I don't want to get into). Could you suggest good mood stabilizers that would not have weight gain as a side effect?
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Avatar_f_tn
Lamictal is weight neutral.  A nice slow titration up is important, and you can even start as low as 2.5 mg/day if you need to and very gradually work your way up.  Tegretol (carbamazapine) and Trileptal (oxcarbazapine) are weight neutral as far as I can tell from the reading I've done.  Trileptal is off label for bipolar, but it apparently has fewer side effects than Tegretol and apparently works just as well.  Tegretol interacts with a LOT of things, and needs blood tests, but Trileptal at least doesn't need the blood tests.  Those are all in the anticonvulsant class.

In the atypical antipsychotics class, Geodon and Abilify are supposed to be weight neutral (olanzapine is an atypical antipsychotic that is known for weight gain).

Lithium has some risk of weight gain anyway, but this is not the case for everyone.  And even the biggest weight gain culprits don't do it to everyone, but some are worse than others.
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Avatar_n_tn
What do you mean by Trileptal being 'off label'? And if I do set out to start on this, what should my dosage be?
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I just read about the side effects of Trileptal, a few among them being rashes and mental sluggishness. I used to take olanzapine and Abilify (together) some time ago, and I went off it because of the mental sluggishness. I could give Trileptal a try but I hope that the sluggishness and rashes don't set in. With Divalproex on the other hand, my mind's capability is affected a bit, but not that much as with Olanzapine and Abilify.

Also,  I had  tried Lamictal a long time ago but discontinued it because I started developing rashes.

So now what would you recommend?
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Avatar_f_tn
Keep in mind that everything that works has side effects.  Not everyone will get every side effect, and some are more likely than others, but you won't really know without trying, unfortunately.  An off label use is one that the FDA hasn't approved the medication for, e.g. trazodone as a sleep aid (it's approved as an antidepressant).  Apparently it costs quite a lot to do the trials to get FDA approval, and for drugs whose patents have run out, it doesn't always make economic sense for companies to do the studies to get new uses approved.  Off label prescribing is legal in the US, but drug companies aren't allowed to market their drugs for off label use.  In the case of Trileptal, it seems to have held up pretty well being used for bipolar, and it's highly related to carbamazapine, which is approved for bipolar disorder treatment.

Your doctor will be able to tell you about a titration schedule for Trileptal.  It might be made more complicated by the divalproex--Lamictal titration certainly depends on whether or not you're taking divalproex or carbamazapine.

Rashes are actually a rare side effect of a lot of medications (like some antibiotics).  Lamictal tends to cause a benign rash in 1/10 people, but the incidence of SJS (the really bad rash) is around 1/3000, and the risk is higher in children and if you go up too fast.  Some doctors are willing to retry it even if a rash developed the first time, taking it verrrrrry slowly (you can start in the pediatric range), especially if it was working really well for you before the rash appeared.  Not all doctors (or patients) are willing to do this, though.  Your mileage may vary.  I've gone and developed acne with Lamictal, but not an actual rash.

Geodon is still an open option that you haven't tried.  You should really discuss it with your doctor and see what he/she thinks.  Bring up your concerns about weight gain and cognitive side effects, and ask about these drugs to see if they think it's a good idea.
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Should I take the Trileptal with the Geodon?
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I am on Divalproex 250 and Olanzapine 5 mg. I purchased Oxetol 300 (Oxcarbazepine) today which is I guess another name for Trileptal. I am going to taper off Divalproex for the next few days and start with Oxetol 300, maybe half of the tablet once a day. My question is can I have that with the Olanzapine 5 mg?
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Dude, do not change your meds around without talking to a psychiatrist about it.  That is what is known as a really bad plan.  I am not a clinician, and my info is from (admittedly) informed reading, but I do not have a medical license.  How did you get your hands on oxcarbazepine without a prescription anyway?
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Avatar_n_tn
I don't think I will be taking the Trileptal. I will however be talking to my doctor about a possible weight loss tablet.
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I spoke to my doc and he has put me on Trileptal. He said that it does not lead to weight gain, but when I checked online, some sites say it leads to weight gain and others to weight loss. Could you tell me what it is actually? Is it weight loss or weight gain?
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Avatar_f_tn
As far as I can tell, Trileptal is supposed to be weight-neutral, i.e. it shouldn't change anything.  If the divalproex was making you gain, a weight neutral drug will probably let you lose the extra, so I would guess you'd see weight loss at first until you got down to what your body would normally be without the divalproex.  But the thing about side effects is that you can never tell which ones you'll get before you take the drug, and some people just have weird reactions.

Also keep in mind that just because something happens after you start a med doesn't necessarily mean it's a side effect of that med.  It might have happened anyway.  Some of the people complaining of weight gain might have had this happen.  And it's possible that if you were really manic and running around like crazy, a weight neutral drug would make you gain weight.  It's hard to say.
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Avatar_n_tn
You said Geodon and Trileptal are weight neutral, but when I read about them online, people's posts say that both cause weight gain. Some say they lost weight. It's kinda confusing. I've been on Trileptal now for almost a week and I think I'm already gaining weight. I don't experience any mania but I definitely am packing on pounds. With the Trileptal, I am also taking Olanzapine 5 mg. Do you think this could be adding to the weight gain?
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How is Topamax? I read about it online and it says it helps to lose weight and it is a mood stabilizer
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As I said, everyone gets different side effects, and there are reasonable possibilities that a "weight neutral" drug might make some people gain (like they are schizophrenic and the kind of catatonic where you never stop moving--you stop the catatonia and all of the sudden you gain weight because you aren't exercising as much).  And the way they get these side effects in the drug info is by having people write down everything they get while trialing it, which is I suspect why almost every drug under the sun comes with a warning of possible GI complaints--they're really common in the normal population, and they don't always list side effects as compared to placebo, or they don't do statistical tests to compare.

As for Topomax (topamax), that's also off-label for bipolar, and another anticonvulsant.  It may make you gain weight.  But it's also gained the nickname "dopomax" because it apparently causes major cognitive side effects in a lot of people.  And olanzapine is a huge weight gain causer in a lot of people.  Maybe you should try a food and exercise diary to keep track of what you're eating and whether it changes.  I think olanzapine (and other AAPs) can cause carb cravings, at least in some people.  If you want more info on meds, google CrazyMeds.  Their med wiki has more information than you probably want, with summaries of drugs as well as links to the full prescribing info that doctors use.  

If you're gaining really fast on Trileptal, get your sodium checked and see if you have some swelling going on.  A more uncommon side effect is to lower your sodium, which can cause water retention and rapid weight gain.  If this is happening (and you should get your doctor to check), you'll need to up your salt intake to balance things.  Remember that you can only pack on so many pounds in a week of fat and muscle, and gaining a lot in a short period is often water, which is quite heavy.  And you often have to try a drug for a couple of months to really see how it will work for you.  Another thing is if you're constipated or haven't pooped in a few days, that can up you by a couple of pounds of poop (I know of a person who was so constipated that they had 15 pounds of poop in them, and their large intestine was outlined on their abdomen from being distended).  That's an extreme example, but your weight tends to fluctuate from day to day, and poop can definitely be a factor.
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As you know I was on Trileptal but I have been noticing blood in my stool lately. It could be the Trileptal causing it. I talked to my doctor about this and he has put me now on Topamax. I take half of the 25 mg tablet. I am going insane. Which med do I take?
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Avatar_f_tn
Were you majorly constipated?  Bright red blood in the stool is usually hemorrhoids bleeding a bit after a tear.  Softening your stool with lots of fiber usually fixes that.  Darker blood/coffee grounds looking stool is indicative of an upper bleed, which is more serious.  Was the trileptal working?  You need to ask your doctor about med changes.  In what way are you going "insane"?
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No, I'm not constipated at all. The trileptal seemed to keep my mind in the same state as the divalproex, but I don't think it was making me lose any weight. So, I am going to try the Topamax.
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I am going insane because I can't find the right med for myself. Do you think I should continue with the Topamax?
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Well, it's supposedly not a good idea to keep switching meds constantly.  You're supposed to give them a few weeks to several months in most cases to see if they'll work, unless there's a truly compelling reason not to (like getting a nasty rash with Lamictal, or sleeping 18 hours a day with something sedating).  

You seem like you want a quick fix for everything and want something to be perfect, and in the process are shortchanging yourself.  The odds of getting something that works perfectly with zero side effects is practically nil.  Lamictal is working great for me, but the acne I'm getting is no joke, and I'm using two meds, one prescription, to cover it.  Screwing with my birth control wasn't any joke either, but I fixed it by getting my pill changed, rather than stopping the Lamictal.  And the Wellbutrin, while I was on it, caused constipation, but I went out and got some fiber supplements, which handled it pretty well.  

What I'm saying is, your first priority should be symptom control, with major side effects just below that, and minor side effects pretty far down the list, especially those you have a good chance of fixing with a small adjustment to other things.
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The Topamax is not working for me. I am not getting sleep at night, so I am going back to my doc. In the meantime, I will be taking Trileptal with Olanzapine which was working fine for me except that I noticed blood in my stool which I think was the result of taking the Trileptal (which stopped when I stopped the Triletptal). You recommended Geodon. Is that an antipsychotic or a mood stabilizer?
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Avatar_f_tn
As I said, adequate fiber intake would probably be enough to prevent blood in your stool (once you're healed).  Sitting for long periods can aggravate hemorrhoids.  Some hemorrhoid cream might help too.

Geodon is an atypical antipsychotic, like olanzapine.  Most of the atypicals are mood stabilizers.  The term "mood stabilizer" refers to its function, not its drug class.  But according to some people, switching your meds up constantly will reduce their effectiveness, so give things time to work if you can.  
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I went back to my Doc. He has put me on Seroquel 50 and he is slowly going to fade out the Olanzapine that I am on. He says that that causes weight gain as well. I have been taking the Seroquel for 2 days now and I am constipated. Can you tell me what I should do now? If fiber supplements is the way to go, then which ones are good? I will be going back to my doc and tell him about the constipation but just wanted to ask you too.
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Well, sometimes side effects that occur at the beginning of a treatment go away after a few weeks, so keep that in mind before switching again.  I use the generic of EasyFiber or Benefiber.  It's sugar free, gluten free, dissolves really well in any soft food or liquid (just don't do it in soda because you'll get overflow from fizz), and it doesn't taste like anything.  I think it's just dextrose, but I'm not 100% sure off the top of my head.  You add 2 teaspoons to your drink at every meal.  You can also eat any fruit but bananas and apples, which actually stop you up.  Dried apricots and prunes are great.  Make sure to drink plenty of water, because the fiber can make it worse if you're a bit dehydrated.  One of the colon's jobs is to reabsorb water from stool, and it will do this more if you need more water.  Fiber helps osmotically keep water in there.  You can try Miralax if fiber isn't enough.  Caffeine is a bowel stimulant which will help your digestive system push things along, but too much can give you diarrhea.  Also avoid eating lots of cheese, because this will constipate you.  Milk should be fine.

Seroquel can cause weight gain, but it's not as likely to as olanzapine, and it's in the same drug class.
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Avatar_n_tn
Hi,

I'm back. I need your advice on something. I was on Divalproex 250 and Seroquel 50 for 10 days. Over the past 10 days, ever since I went off the Olanzapine, I did not put on any weight. I went back to see my Doc today. When I told him that I was concerned that I was gaining weight with Divalproex, he told me to stop that med and just take Seroquel 50 for 10 days. I go back to see him again after 10 days. My question is : Is Seroquel (an antipsychotic) enough to treat my Bipolar?
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It totally depends on the person.  Seroquel is an atypical antipsychotic, in the same class as olanzapine, and is approved for bipolar disorder.  Some people are fine on just that, others need other meds in addition.  Based on my reading, Seroquel seems to be better at depressive phases than manic phases, whereas olanzapine tends to knock out mania pretty strongly.  Your dose is pretty low on the Seroquel right now, so I'm guessing your doc will increase it at some point.  The dosage range given for bipolar is 400-800 mg/day, and you can actually titrate up pretty quickly if you need to (but not without your doctor's say so).  

Lamictal is approved for maintenance in bipolar I (apparently the first drug after lithium for this), and it's weight neutral.  Many people get a minor rash and have to stop it, but only 1/1000 will actually get the dangerous rash they warn about.  You can ask your doctor if it's a good idea, but it's probably worth it to see how the Seroquel goes, because if you can maintain on one drug, your life is that much easier.  Lamictal does take a long time to titrate up, since you're less likely to get a rash if you start slowly.
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Thanks a ton for writing back.

For the past 2 days, I have stopped the Divalproex like my Doc said and am just taking  Seroquel 50. Last night, I noticed that my mind just would not shut off and although I was really sleepy, there were all these thoughts that I could not stop (the mania I guess). So I called my Doc today and told him about this, and he told me to increase the Seroquel to 100. I asked him about the bad constipation effect that I have with Seroquel and he said that the drug does not cause constipation. Anyway, I am going to take Seroquel 100 tonight and hope that it will work. Ever since I stopped the Olanzapine, I have not put on any weight. Hopefully stopping the Divaproex will aid in losing some weight.

Another thing I have noticed is - Over the past 5 years of taking meds for Bipolar, my mind does not work like it used to do before the meds. I was able to concentrate better and think better. Now I find it hard to think - when I want to think deep and hard, there is a block in my head. Also concentration problems and memory problems. Is this a permanent effect of the meds? Is there any med out there that would treat the mania but not affect my thinking, concentration and memory. You must know that sometime during this period of 5 years, I was on Olanzapine 20 and Aripiprazole 20 for 2 years, which I don't take anymore now Thank God coz I felt like a zombie on them.
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Also,  are mood stabilizers better than Antipsychotics in terms of the mind? I mean for sharp thinking, memory and concentration? Because the Divalproex I feel, worked better for my mind than this new med - Seroquel. I can't make out clearly though.
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Avatar_f_tn
I'm not as sure about cognitive effects.  I think the atypicals are a bit more likely to "zombify" you, but some people are fine.  I think a lot of people also feel a little less sharp when they're not getting manic anymore, because mania makes you feel like you're thinking well and clearly, whether or not you are actually thinking better.  I really haven't had the time to say anything personally about long term cognitive effects.  I can tell you that major depressive phases knock the hell out of my cognitive abilities, though, so not taking meds in that case lands me in zombie/stupid mode.

Most antipsychotics and some anticonvulsants, plus lithium in its own class, are called mood stabilizers.  "Mood stabilizer" refers to what it does to your moods, and not how it does it or what specific drug class it's in.  Unfortunately, plenty of the anticonvulsants can have cognitive side effects, at least at first.  Again, you can't know for sure beforehand.  

Have you been trying my suggestions for the constipation?  Water + fiber supplement?  Or you could ask your doc for miralax to help things along.
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Yes, I am taking fiber supplements and its helping me with the constipation. Thank you.
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Hi again,

Ok, I am now on Seroquel 100 - one tablet at night before bed. The constipation has gone away. However, now I am experiencing tooth pain. Could this be a side-effect of the Seroquel? My Doc has told me to visit the dentist. He says it is not because of the Seroquel. Please advise.
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I think you should go see your dentist, and I really doubt it's the Seroquel.  Remember, just because one thing happens after another doesn't mean that the first thing caused the second (I drank water before getting on the train today, but the water didn't make me get on the train).  

There are some drugs that can cause dental issues, but Seroquel isn't one of them.  You probably just have a cavity or a gum infection or something like that.  Why do you trust me over your doctor, though?  
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I trust you a little because some of the things you have told me have panned out. It is not that I trust you over my doctor, it is just that It's good to have a second opinion. Thanks.
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Ok, that's good to know.  I don't want to be responsible for something bad happening if you trusted me over your doctor.  And I know how some doctors won't take the time to actually explain things to their patients, so I'm happy to help with what I can (and I'm certainly cheaper than a doctor's visit :p).  How's the tooth?
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Hi there:

I see that you're struggling with your seroquel.  First of all, it does not cause tooth problems. LOL  I want you to know that although everyone is different, seroquel did save my life.  I have just recently come off it after 2 years of anxiety.  That is why I went on it . Prior to that I was on Divalproex and Olanzepene.  That combination is a GUARENTEED weight gain. Once I got onto the seroquel, I lost 40 pounds however, I was also feeling really good and going to the gym 5 days a week.  I don't think the seroquel caused weight gain for me.  The thing you WILL find being on the seroquel that I could not deal with was the higher the dose the more tired you become.  I was up to  250 mg at bedtime.  Mornings are brutal.  Unless you have a good undisturbed 8-9 hours sleep, you will wake up very groggy.  I went through that every morning for 2 years.  The seroquel has now stopped working for me.  I am bipolar by the way:) I got down to 50 mg.  I must say, although my manic behavior was starting, I was feeling much more alive in the mornings.  Yes, all this medication Does totally fog your mind.  Quite honestly, I don't know who I am anymore.  I have now just gone back onto divalproex with some topomax (topamax) added to the mixture to offset the weight gain IF I get it.  It's been almost a week.  So far so good.  Good luck with your Seroquel, It is a wonderful drug.  For me anyway.  The drowziness is a problem.  
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Avatar_m_tn
I think that adopting a low carb diet will better help you lose the weight than a calorie reduction.  Obviously you can reduce calories on a low carb diet also but the trick is to stabilize your insulin levels.  A low carb diet dose that.  Insulin tends to cause sugars in the blood to be stored as fat.

look up on the net and read about Low carb diets.  I would not go as drastic as NO CARB which is a Ketogenic diet.

Basically eat lean meats and egg whites for protien.  Fruits and vegetables for carbs/vitamins/minerals and modests to small amounts of nuts like almonds for essential fats.

Realize that you are aiming for about 20 to 40 grams of carbs(sugars) and that an apple is about 20 grams of carbs(Fructose).  So basically carb intake daily is 1 fruit and the rest is vegetables.  

If you are hungry even at night eat fat free cheese or egg whites which has only protien and no fats or carbs.  However try night to eat late at night for obvious reasons.  If you find yourself hungry at night regularly then up the amount of protien during the day.

watch out with condiments ketchup/dressings ect as those carbs sneak in and really add up at the end of theday.

No juice because they are usually 40 grams of carbs and you just maxed out your carbs with one darn drink.

I am on Divalproex ( Valproic Acid ) so I know your struggle.  it is mine also.
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Another thing to remember is that sometimes these meds can make you pack on crazy weight like 20 or 30 pounds in 2 or 3 months.  However even if you change to another med it dose not mean you will lose the weight just as fast.  It takes most people 3 to 4 months if not a year to safely and in a healthy way lose that amount of weight.

If these meds play around with metabolic and hormonal balances it may take months before these influences return to normal.  So assuming that a med is putting on weight after 1 , 2, or even 3 weeks may be miss leading.

I think you should wait 2 or 3 months before deciding what the med is doing to your weight.  If you pack on 10 -15 pound more in a month then I agree change it fast.  But if you are no gaining and only fluctuating between a few pounds or so be a little more patient.

try not going on the scale everyday.  Make a good effort with eating low carb and exercise and limmit the use of the scale to once a week.  

Anyways you are not alone.  We are all on the same boat with ya and we understand.  I gained 30 pounds on 300mg seroquel.  I was able to lose 10 of those while on it with exercise and low carb.  It took me 3 months then it stabilized and I lost motivation.  Who knows if i would have continued Maybe after another 3 months I would have lost another 5 pounds or so.  

Don't give up and if ya hit a low point get back up when you can and try again.
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The tooth pain has gone away, so you and my doc were right - Seroquel does not affect the teeth.

I have one concern though - I so badly want to lose some weight. With the Seroquel 100, exercise and diet I should lose weight right? But I am not losing weight. I exercise a few times a week. I can't seem to stick to a diet. I diet for a few days and then I gorge coz I feel really hungry and then go back to the diet. How am I going to lose  weight?
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Avatar_n_tn
Hi,

Thank you for your comment. Yes Seroquel does knock me out at night, which is when I take it, but I am fine in the mornings. However, I do want to lose weight so badly. I was on Divalproex and Olanzapine and I put on loads of weight, but thank goodness I am off them now. I heard Seroquel also makes you gain a little weight although not so bad as Divalproex.
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Avatar_n_tn
Thank you so much for the motivation. I am not going to give up till I lose a considerable amount of weight. Thank you again.
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Avatar_f_tn
Seroquel has the potential to make you put on weight, but it's not as bad as the divalproex or the olanzapine for that.  You could try a low carb diet--aim for fewer than 20 g of carbs per day.  Cut out bread, cereal, sugar, most fruits (go for veggies instead), pastries, etc.  You'll have to eat a lot of veggies to keep your fiber up.  You can have bacon and eggs for breakfast if you want.  Eating a lot of protein helps you feel full longer than eating carbs, so it helps deal with those cravings.  When you feel really hungry, you can have something like water or crystal light, or a clear soup to help fill you up.  You should also try to distract yourself from thoughts of food.  Try to get in some exercise every day, even if it's just walking around the block.  It might help to get a pedometer so that you can see how many steps you are taking per day.  Then you can compete with yourself and gradually increase your goal number of steps per day.
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Avatar_n_tn
Thank you for your suggestions. I'm going to try them :)
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Avatar_n_tn
A query - If I have eggs everyday for breakfast, won't that affect my cholesterol?
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Avatar_f_tn
Possibly.  That's one to talk to your doctor about.  You could always do an egg white omelette instead of a fried egg or whole egg omelette, since it's the yolk that has the cholesterol.  I think you should be fine as long as you don't overdo things, though.  An omelette with cheese, chopped ham, onions, tomatoes, mushrooms, peppers, or whatever other veggie or meat you want to put in can make a great breakfast, and it's a way to sneak more veggies into your diet.  It tastes better if you fry things like onions and ham separately, then add them in after the egg.  Have it with black coffee or tea to help start the day.  Another idea for lunch or dinner is lettuce leaf tacos--make some taco filling with low fat hamburger meat, and then use a lettuce leaf instead of a tortilla, and make little tacos.  Or you could make it like a taco salad but without the tortilla chips.

Also, use small plates (buy some at a thrift store cheap if you don't have any).  That way, you can fill up a plate with less food, which helps trick your brain into thinking you had more than you did.  You can have seconds if you can't actually fit enough food on the small plate.  Another thing is that it takes 20 minutes for your brain to get the message that you're full, so take your time eating.  If you need a snack, have a little something, and then wait a while to see if you really need more.  When eating a meal, some diet plans suggest putting your fork down after every single bite, and chewing each bite thoroughly to slow things down.
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Avatar_n_tn
Thanks!!
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Avatar_n_tn
Hi there!

Long time. Anyway, Just wanted to tell you that I have been watching my diet and I have lost some weight. Also I have been on Seroquel so far. My question is should I just stick to this medicine for life now, or should I visit my doc again? What should I do?
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Avatar_f_tn
That's great that you've been able to lose some weight!  Keep it up!  I've been losing too, and weighed in this week at just under 130 (I'm 5'3") for the first time since mid high school or so (I'm 23).  I've been avoiding unhealthy foods and trying not to eat unless I'm actually hungry, which has led to me eating a lot less overall.

You should be doing regular med checks with your doctor, more often at first and less often if things are still going well and you're stable.  Some people stay on the same med forever, and some people have meds poop out on them or start getting side effects, or opt to try for something that's come out more recently that looks promising.  As a general rule, if the side effects are not horrible (not incredibly hard to live with/worse than your disorder or causing medical problems) and it's keeping you nice and stable, it's a good idea to stay on it.  If it's just stability, you can consider dose adjustments, adding another med, or switching.  It all depends, which is why you should see your doctor every once in a while (and no doc is going to keep prescribing forever without checking in on you).
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Avatar_n_tn

Thanks again for the advice. I do have one problem with this med. It makes me hyperactive at times. I feel like doing a lot of things at one time, and I also sometimes have no peace of mind when I am under stress. What do you think about this?
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Avatar_f_tn
Are you sure it's the med, or are you having hypomania breaking through?  Stress can be a trigger for hypomania, and you could be getting breakthrough symptoms.  If that's the case, you might be able to up the dose, learn to deal with it, add something on, or change meds, depending on severity.  It's definitely something you should talk about with your psychiatrist.  Atypical antipsychotics can also cause a feeling of extreme restlessness/inability to sit still called akathisia.  I can't determine based on your description whether that's your case, but it's another thing to ask about.
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Avatar_n_tn
What do you mean breakthrough symptoms? How do you know so much when you're just 23? :)). I am using Seroquel and the effect that I just mentioned is not severe, but I will definitely talk to my doc about it. I can sit still, but I sometimes feel very frustrated with things. This medicine is something which has actually worked for me after trying Divalproex, Olanzapine (which causes weight gain), Aripiprazole, Lamitrogine, Topamax, Trileptal. I don't want to change this med now, because I don't think there is any other that I can take.
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Avatar_f_tn
Breakthrough symptoms would mean that the medicine is working to some degree on your mood symptoms, but that some of them are still apparent, or "breaking through" the medicine.  So you can have some depressive symptoms or manic symptoms show up even while on medication.

As to knowing so much, I grew up with a doctor in the house and I read A LOT (the vast majority of my psychopathology and psychopharmacology knowledge was gained in the past year).  Nothing like having a condition to get you to learn more about it.
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Avatar_n_tn
So should I just ignore these breakthrough symptoms and learn to live with them? Or should I tell my Doc to adjust the dosage? If he ups the dose, then that might affect my cognitive abilities.
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Avatar_f_tn
Well, you should describe things to him/her and ask if it really is breakthrough symptoms or a med side effect, and see where to go from there.  If it's something you can learn to control on your own, maybe with CBT techniques, you might want to keep the meds where they are.  Otherwise, you can try upping the dose (which can always be brought down later) or adding something else.  
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Avatar_n_tn
Thanks for your reply.

What are CBT techniques?
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Avatar_f_tn
CBT is cognitive behavioral therapy.  You'd have to ask your therapist for specific exercises and goals.  The idea is to restructure your thinking to deal with incorrect thoughts and to change behaviors in order to become more functional.  For example, someone depressed might have the thought that they're worthless, and they'd be asked to list all of the evidence for and against that idea.  They might be asked to go out and spend a certain amount of time with other people, which is a behavior change that can help with depression.  I am not at all an expert in CBT, but it tends to be effective for mood disorders and anxiety, among other things, especially when combined with meds.

Any therapist trained in CBT should be able to give you some things to do to help handle the symptoms you're having, regardless of whether or not you do end up having to make a med change.
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Avatar_n_tn
Thanks!
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Avatar_n_tn
My next question - How often do I visit my Doc?
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Avatar_f_tn
That's up to you and your doc (and maybe the insurance company).  I've been seeing mine every 2 weeks, but we're doing therapy as well as med management.  Therapy is often at least once a week for a while, and it can go down to every few month checkups once you're doing well.  Med management might be every few weeks at first (more often if you're on something that needs careful monitoring), and then might go to every 3 months, then every 6 months, or every year, depending on how you're doing.  Some doctors don't like prescribing large numbers of refills and will insist you come in more often for a check, and others are fine with the longer wait--it all depends.
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Avatar_n_tn
Thanks a ton.

My next question is regarding pregnancy. Should people with conditions such as these get pregnant? Is it better not to? I personally do not want to have kids.
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Avatar_f_tn
That is a very personal choice.  Plenty of mentally ill people have children, some of them before they know they are mentally ill and some of them after.  There is a genetic component to bipolar, but it's not a guarantee that your kids will get it, especially if the other parent is not mentally ill.  

For women, pregnancy is complicated by the fact that many BP meds can injure a fetus, which means choosing between going off meds for a pregnancy and maybe majorly destabilizing, switching meds to something less risky and/or taking the risk of harming a fetus so that you can stay stable on your meds.  

If you think that the stresses of having a kid would be enough to set you off and put you in a major episode, then you probably shouldn't be having kids at the moment.  But plenty of mentally ill people raise kids who turn out just fine.

If you don't want kids, don't have them.  It's completely up to you.
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Avatar_n_tn
Thank You.

Do you really think that people like us can be categorized as "mentally ill"?
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Avatar_f_tn
Yes.  We are sick, chronically so.  People with bipolar disorder have an illness based in the brain that is at least partly biological.  It is maybe more accurate to describe us as people with a mental illness, but it boils down to the same thing.  There's a lot of negative stigma associated with it, and I think a lot of people think of severe, untreated schizophrenia, bipolar, or personality disorders when they hear "mentally ill", but that doesn't make the term inaccurate for us.
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Avatar_n_tn
But if the illness is treated with meds, then is it right to still call us ill?

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Avatar_f_tn
In remission, perhaps, but we're still not exactly healthy.  It depends on whether you take "ill" to mean only acute illness or anything that is not-healthy.  For instance, one can have HIV but be well controlled on antiretrovirals, but I would still say that person is sick, since HIV never goes away.  However, they may not currently have full blown AIDS (metaphorical equivalent of a severe mental breakdown, although perhaps worse for you in terms of continuing to live).
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