Weight gain with Divalproex - Frustrating

[mutant2012]

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

[Anonymouse88]

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).

[mutant2012]

But if the illness is treated with meds, then is it right to still call us ill?

[Anonymouse88]

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.

[mutant2012]

Thank You.

Do you really think that people like us can be categorized as "mentally ill"?

[Anonymouse88]

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.

[mutant2012]

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.

[Anonymouse88]

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.

[mutant2012]

My next question - How often do I visit my Doc?

[mutant2012]

Thanks!

[Anonymouse88]

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.

[mutant2012]

Thanks for your reply.

What are CBT techniques?

[Anonymouse88]

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.  

[mutant2012]

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.

[Anonymouse88]

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.

[mutant2012]

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.

[Anonymouse88]

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.

[mutant2012]

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?

[Anonymouse88]

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).

[mutant2012]

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?

[mutant2012]

Thanks!!

[Anonymouse88]

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.

[mutant2012]

A query - If I have eggs everyday for breakfast, won't that affect my cholesterol?

[mutant2012]

Thank you for your suggestions. I'm going to try them :)

[Anonymouse88]

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.