Bipolar Disorder Community
medications for bipolar.
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medications for bipolar.

What are some good medications for bipolar other than topamax (what I am on now) that still make you lose weight? I have been on this medication for over 9 years and I am sick of going on and off of it because of the hair loss and bad side effects that it has, and I also cannot take my birth control pills on this pill or get pregnant in the future.
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Avatar_f_tn
There are a lot of medications for bipolar, both on and off label, and how well they work is really individual.  First choices depend on which type of bipolar you have (I, II, NOS, cyclothymia) and what your main symptoms are.  For instance, if you have psychosis with your episodes, and atypical antipsychotic might be a good place to start, but most of them can cause weight gain.  Geodon is the exception, being weight neutral (and Abilify is almost as good apparently from the weight standpoint).  If you're BP II, especially if you're mostly depressive, Lamictal is a great place to start, and is weight neutral.  I was one of the rare people who had it interfere with my birth control a bit, but changing the pill I was taking fixed that completely (I just got major spotting).  It's pregnancy category C, which means that you can keep taking it if you and your doctor decide that it's worth it.  Trileptal is off-label, but is described as the new improved version of Tegretol (carbamazepine), with fewer side effects.  It's also weight neutral.  

Check out the CrazyMeds wiki for larger lists of drugs.  They do a good summary of various different drugs, including the off label ones, and include common side effects, not so common side effects, effectiveness, and weight gain potential.  

It does sound like you could use a change of meds, so look over the ones I suggested, and any others you think could be likely, and then take the list to your psychiatrist to talk about what would be a good option for you.  Remember that side effects are inevitable, but you really don't know if you'll get any bad/annoying ones until you actually try a drug, so try not to let that limit you too much.
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Avatar_f_tn
I just looked it up and a common side effect of Trileptal is that it interferes with birth control pills. It can also cause suicidal thoughts. Not a good choice.
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2190999_tn?1397182731
I'm BP 2 with depression as my main issue.

Librium made me GAIN a significant amount of weight. I was miserable.

Lamictal has helped me a lot and I've had no weight problems with it.

psycheducation.org was a site I used to help educate myself about different meds.

Not sure about using contraceptives with any mood stabilers. I'm past that point in life :)

Best wishes.
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Avatar_f_tn
Most psych drugs (especially the SSRIs) have a black box warning about suicidal thoughts.  I think if you screw around with brain chemistry, especially in someone who's prone to those thoughts, it's bound to happen in someone.  That's not a reason to not try a med, although it's a reason to monitor oneself carefully for worsening of symptoms.  

Birth control pills interact with a lot of things.  It looks like taking one of the high dose pills could mitigate the effect, although I would still use condoms or a diaphragm.  I guess you could follow your temperature and cervical mucous really closely for a couple of months to see if you were ovulating or not.  And the study only looked at ethinylestradiol and levonorgestrel, not other forms, so there's no word on how those are affected, if at all.  And it's listed as less likely to screw with your BC than Tegretol.  Or if you really don't like condoms, the paraguard IUD wouldn't care about any of those drugs, because it doesn't use hormones to work.  

My Lamictal screwed with my birth control.  Yes, you heard that right.  It's the bc that's supposed to lower the Lamictal levels, not the other way around.  But apparently it can tweak your progesterone levels, which was enough to cause really slow spotting for 3 weeks turning into a full period while I was still taking active pills.  Switching to a higher dose pill fixed it completely.  Thankfully, I don't use my bc as my primary method of not getting pregnant, and I haven't been dating anyone for months.  My bc still does what it's supposed to do, which is keep away the PMS and the nasty cramps and heavy flow.

Midijane, were you on Librium or Lithium?  Just curious, since a few people end up on benzos for BP, but not many.  And I really like psycheducation's explanations of different flavors of BP.
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Avatar_m_tn
most meds will cause some weight gain,,dependin on your age also..the thriod changes with most bp meds..i,m on 600 mgs of lithium,i walk 3 miles aday I beat it.im 50 yrs old also.the meds that I gained 90 pounds was 100mgs serquil immt relase..and Geodon,zyprexa the worst..im on 3 meds that stabe me,,lithium,,lamctal,xanax..
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Avatar_f_tn
I have been well managed for 5 years on a combination of lamotrigine, venlaflaxine , and Zoplicone. I have been bipolar, well all my life obviously but not properly diagnosed until 27. My swings are so predictable, I mark them on a calendar to know when to expect one. Usually every 70-90 days. I have no psychological symptoms but the physical are still there. That's let's me know I'm swinging for sure. You should implore the help of a young psychiatrist. Old docs are stuck in outdated ways like prescribing lithium which is terribly dangerous and so old school. Young doctors are more open minded and more opt to suggest drugs based in newer research. For instance, lamotrigine is an anti-epileptic med. it's great, as long as I remember to take it. Venlaflaxine is dangerous like Paxil or Prozac and can have terrible side effects after missing three days. You do NOT wanna mess around with it. I am Canadian so your drugs there might be different. Ask about anti epileptic drugs based on the nature of your bipolarism. Mine is severe and text book, yours might not be.
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Avatar_f_tn
I gained weight at first in these meds but you just loose it by being healthy. It's really mind over matter. I used to complain, "oh the drugs make me fat" til I realized it was ********. They say that about birth control too, it's ********. I have been on the same BC since age 20. I only use condoms with strangers which is not very often. I have had unprotected sex probably millions of times with people I know and trust. I get STI checks every 6 months, active or not. I have never EVER had even much as a scare. I have never taken a pregnancy test. I'm 31. Everyone reacts differently but girl, there are certainly better meds out there. The difference is, I'm Canadian and you might not be. Your medical system is based on money, mine isn't really. Plus they sell generics here which are much more affordable to consumers,  I don't think they do there.
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Avatar_f_tn
There are plenty of generics for sale in the US.  There's a limit to how long companies can hold exclusive rights to a drug.  Seroquel and Abilify are still brand only, but all the others I can think of have generics.  We just tend to mention the brand names because in some cases they're easier to type, and they're more recognizable to people.  

As for weight gain with drugs, it only happens to some people, just like with birth control.  Hormones can screw around with metabolism and hunger drives.  The atypicals can screw with your sugar metabolism, to the point of causing diabetes in a small percentage of people taking them.  Exercise and diet certainly help, but people not on meds have just as hard of a time doing that, and they don't seem to gain as much weight for their bad diets and lack of exercise as some people do on these meds.  And you're not currently on anything that tends to cause weight gain, so please don't be so quick to say it's easy to keep weight off.

I don't like the idea of going on Effexor (venlafaxine), because it's apparently hell to get back off of for many people (brain zaps).  Antidepressants, especially SSRIs or SNRIs, are also not always the best idea in bipolar, although they work for some people.  

Lithium is dangerous if not properly regulated, but for some people it's the only thing that works.  I agree in general about younger doctors (although not too new).  I find it easier to relate to someone close to my age anyway.  Sometimes the younger ones are a bit too eager to change to really new drugs, which can destabilize someone who was doing fine on an older drug.  And some of the older drugs work better than the newer ones, but have much suckier side effects, so it's a trade-off.

Topamax IS an anticonvulsant, but it's off label for bipolar.  
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Avatar_f_tn
Over the past 18 years I have obvious taken more drugs then the combination I mentioned. I was in one of the worse ones. It does cause weight gain initially but it certainly isn't an excuse to accept the weight gain. It's a cop out.

You're right, Effexor is hard to get off but I have done it, and Paxil, and Prozac. They all give you what I call, the whomp whomps. You just have to taper down and it's fine. Don't be afraid if a drug because it may be potential hard to get off. That again, is a cop out. I appreciate your post but don't try to scare people away from things because of what you "heard". Let people find out for themselves, you don't know what helps each individual so stop generalizing. There are lots of things I learned by studying medicine for 8 years, but the main one is, everyone is different and responds differently to everything.
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909415_tn?1390585342
Aripiprazole is supposed to have the least metabolic effects.  I think the trade name is Abilify.
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Avatar_f_tn
The Effexor thing is more of a personal hangup than an anti-endorsement.  Just to make that clear.  Drug effectiveness and tolerability/side effects is very individual after all.  I wouldn't jump at taking the old generation MAOIs either, because of all the interactions, but for some people they work absolute wonders.  And my philosophy is along the lines of "find what things are likely to work, and then of those, figure out the one with the best side effect profiles for me, and try that first".  I was very glad when my psychiatrist suggested the med I had already researched to be the best fit for me based on that model (lamotrigine).  Effexor falls in the "I would probably want to try other similar things first" category.  Just to clarify my position/try not to sound like advocating on choosing solely on side effects.  

Prozac was actually super easy for me to get off of, I think because the half life is so long, which gives you a much more gradual taper than other things will.  

All other things being equal, when a med consistently makes people change weight in a double blinded, placebo controlled study, I'd say it is the med's fault.  How easy/possible it is to counteract those effects is another thing, but it's still going to be easier for some people than others.

@rogelio63: I think that only holds true out of the (atypical) antipsychotics, although I think Abilify is slightly more likely to make you gain than Geodon is, statistically speaking.  The anticonvulsants (valproates excepted) tend to be weight neutral, although some of them screw with the metabolism of other drugs or have food interactions.
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Avatar_m_tn
To answer the initial weight loss question:

Not sure how it reacts with birth control, but Cymbalta as an anti-depressant has a side effect of weight loss. I take that, Topamax, and lamictal and lost about 50 pounds over the course of 4-5 months.

My experience about 15 years ago with Effexor was the zaps and diarrhea with each meal, so maybe that would be good for weight loss, too- lol :)

Good luck.
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Avatar_n_tn
Hi there:

It is strange how certain drugs affect people in different ways.  Just wanted to say that you are very well spoken:)
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