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Avatar universal

lithium and weight gain

If you are on lithium, have you gained weight? If so, did this happen seemingly overnight or was it gradual? Do you think it's a metabolic issue or a diet issue? When I quit smoking, for example, I gained 15 pounds in two weeks without changing my diet. It was a metabolic issue and I was told that in a few years things would straighten out on their own. I started smoking again right about two years later, so I don't know what would ultimately have happened.

My psychiatrist said I might not gain weight and even if I did it would probably be "only" 5 to 10 pounds. That is enough to need larger size clothes. I'm concerned because I have a lot of difficulty losing weight and had finally managed to get back into my clothes after gaining weight 3 years ago. I'm facing menopause and the weight battle will only get tougher. I'm scared to death. I think my clothes are already getting tighter...

Thanks for any responses.
38 Responses
585414 tn?1288944902
To me and a lot of people. Its a metabolic issue and a common side effect. It can be controlled with changing your diet but the urge to eat more and the metabolic changes with it won't stop. If you find it intolerable, Lamictal is one option that won't cause it.
607502 tn?1288251140
I did not gain weight on lithium but I sure have on Mirtazapine (Remeron).  

Weight gain is not a certainty on lithium nor on any drug but the majority of AD, AP, MS and a pile of other drugs used in mental illness treatment have Weight Gain as a possible side effect.
Avatar universal
thanks for your responses. I have been on Lamictal twice. It didn't seem to do anything at all. I don't have much of an appetite and, if anything, I've eaten less since I started the lithium. Guess I'll wait and see what happens.
Avatar universal
This is interesting as I have always associated lithium with weight gain and this is one of the reasons I have always been to worried to go on it.  Depakote has had the same side effect however!  I have found that a lower dose of the depakote did help but I had to make a decision - was it better to be slightly heavier but mentally more stable or happy with my weight but mixed up in my head.

It is very difficult because being overweight can also have an impact on how we feel moodwise.  I know that if I go past a certain weight I get very depressed, low self esteem etc.

Look very closely at your diet and fluid intake and try eating smaller meals but more often and also exercising where possible even if its just a 20 minute walk in the fresh air.
Avatar universal
A friend was on depakote. We called it the fat, sleepy drug. I won't take it after what she's gone through. There have been times she has been on 6 or 7 different meds at once and some of them were just to manage the side effects of other ones. Not for me.

I had high hopes for the Lamictal and was very disappointed. For a long time, I had managed to avoid almost all the meds that might cause tardive dyskinesia, weight gain or fatigue. That's why my bipolar went untreated for so long. I had been misdiagnosed earlier in my life and tried a whole bunch of other meds, so I'd had a lot of other side effects and just decided I couldn't tolerate a lot of them. The sad truth is that we don't have high hopes for the lithium. I know that the idea is probably to be positive about things, but sometimes meds aren't helpful and can do a lot of harm.

My diet is awful. Sometimes I don't eat at all for a couple of days. That's probably why I gain weight so easily. My body latches on and doesn't want to let go. I know what I'm supposed to do. Doing it is another thing altogether. I can start to do something and hours later I still haven't done it. I usually have good intentions, but somewhere along the way I'm sidetracked by something else. My biggest issue is that I get most of my calories from fluids. It is dry here and I do drink a lot. And, no, I don't drink water. I have never liked water and even though I've gotten plenty of lectures about it, I can't seem to learn to like water. It's funny because I have not noticed wanting to drink more because of the lithium, but it seems like I am on the verge of a urinary tract infection because when I have to go, I really have to go.

I have the opportunity for lots of exercise. Spent about 90 minutes outside in fresh, crisp, snowy 15-degree weather cleaning up after the horses. I have to be careful because I have a back problem, but I try to get out there. It's not easy with the agoraphobia. Sometimes, I have a real hard time getting outside. It was the absolute worst for me when we were boarding a few months ago so that we could use the facilities for training. Driving the car, dealing with people... It seems such a stupid thing to worry about, but it's overwhelming for some reason.  

I know what you mean about the weight gain and self-esteem. I had lost a lot of weight and was thinner than I'd been in probably 20 years. I was riding and had a nice, flat stomach. Then we moved to this place and everything fell apart. I gained 25 pounds over 2 years. I got rid of some of it, but I feel like a whale. I hate how my clothes look.  That is why I really, really hope that I don't gain anything on the lithium. It would be a huge blow.

Thanks for the input.
607502 tn?1288251140
The only way to fight the side effects is regular balanced meals and exercise.

Im interested - what are you drinking if not water?
Avatar universal
I like coffee drinks, milk, soda and juices. In the morning, it's hot tea if I haven't made it to the store and run out of my coffee drinks. I don't drink anything unusual, but I constantly have something to drink. It is extremely dry here and I had previously lived in humid areas. I'm always thirsty. We want to add a built-in humidifer system when we renovate the house. I get nose bleeds and alligator skin, especially in the winter. I don't drink as much when I visit my family. It's not dry where they live.

Depending on how bad the side effects are and how much relief I actually get, I may not keep taking it. It is one thing to get a good result and minimal side effects and another thing altogether to get minimal results and lots of side effects.

I looked at a lot of research before we started this. My psychiatrist gave me articles and studies from the past 4 or 5 years. I can't remember a lot of the details, but I did note that not that much has changed since my original diagnosis in terms of treatment. I'm not under the illusion that there is necessarily a medication for everyone. It's simply not true. If this works, then I think a lot will change in my life. If it doesn't, we may try something else. There's always a tradeoff. I have managed to stay alive and out of the hospital for over 20 years. If I can't/won't tolerate the side effects, we'll just have to deal with it. We'd previously discussed having someone move in here, so that is an option. I know - little Mary Sunshine, right?
505907 tn?1258372940
Okay, so lithium and Depakote make you fat. Guess which two drugs I am on. I have been all over the net and read all kinds of horror stories. Concerning Depakote - an article in "Time" magazine mentioned women who were120 lb going into a psychiatric facility being checked in a few months and being 200lb! I'm taking this stuff for depression and I'm about to lose my figure but I'm going to be more perky? Anyway, what I was searching the internet for the answer to was this question. "HOW does Depakote make you fat?" There's been some discussion of this here so I just thought I'd tack my inquiry on to this. Thanks.
607502 tn?1288251140
Water has no calories, no sugar and no weight gain.

Most people don't realise just how much sugar, fat and empty calories are in milk, juices and soda's and how much of a difference changing makes - I moved to diet coke from coke and lost 1/2kg a week.

Its hard drinking a lot of water and I sympathise, I try and drink as much as I can and still drink other things, its good to have an idea what you are taking into your body though and reading the nutritional information is an eye opener - for the average adult male 2-3 cans of soda a day add about 500-600 calories onto the diet and whole milk coffee no sugar adds about 120-170 calories as well, thats before you get to portion sizes.

Having seen what the US calls a portion for one im not surprised that the country has such a weight problem.. I was seriously amazed in Hawaii at what the people around me, mainly from the US mainland, considered a normal breakfast - at up to 1000calories there's nothing normal about it.

The trick I found to weight loss (and I managed to lose 30kg) is understanding what you eat, controlling what you eat, exercising and cutting out the junk food and snacks and lowering portion sizes.  Im doing it again now as I have put on weight on the Remeron.
Avatar universal
I'm not sure they know why so many of these cause weight gain. I tried to find out more info and got nothing definitive. That's why I asked here. I was wondering if anyone had kept tabs on exactly what they put in their mouth and whether or not the weight gain was the result of a ramped up appetite and more food. I know a lot of things can mess up your metabolic rate and that is something that takes time to fix - if you can fix it at all.

Avatar universal
What is the conversion for kg to pounds?

I'm not most people. Smile... I acknowledge most of my caloric intake is from fluids - in an average day, I would estimate about 800 calories. My coffee drink has only 100 calories (Starbucks Mocha Frappuccino Lite). Then again, sometimes I have two... Often, I ingest less than 300 or 400 calories of actual food - sometimes it's only a 100-calorie bag of popcorn or a pouch of tuna that runs 80 calories. On a really good day when I have my act together, I might manage a bowl of cereal along with the above. Not ideal. I'm well aware of that and it's a work in progress. I understand diet. What I wanted to understand was how this medication affected a person and, potentially, caused weight gain.

You are correct about portion size and obesity in the U.S. I am not wild about stigmatizing people, though, and often discussions about weight become accusatory or insulting. Smokers and the obese are the last acceptable folks to bash on. As a smoker, I get lots of unsolicited comments and advice. My overweight friends and relatives get dirty looks, especially if they eat anything. Apparently, they are never allowed to eat in public. What has happened to me before is gaining maybe 3 pounds a year. It's so slow you hardly notice. I've never become obese, but I have become closer to the average size woman than I'd like. The last weight gain was pretty sudden and unexpected so I am struggling. I'm naturally petite and small-boned. I should stay closer to 120 pounds than 140 pounds. My take on the health and exercise aspect is that we're all gonna die anyway. I've got good genes on my side. Lots of smoking and/or drinking people who were/are kicking around far into their 80's and 90's, so for me, the weight is more about vanity than health.

I wonder how many calories are in a typical English breakfast. I gained a little weight when we lived over there. It would have been a lot of weight if not for all the walking.  I don't think folks in the U.S are the only ones with high caloric intakes. One meaningful difference is that we have to drive here and exercise is something most of us have to plan as opposed to something we naturally incorporate into our lives. It's not the norm to walk anywhere and some people live in places where it wouldn't be safe to walk due to crime... Sorry, I'm just babbling at this point.

222267 tn?1253305810
I am on lithium.  The only weight I have gained is consistant  water weight.  My Pdoc told me this would happen.  He also said that Lithium makes you crave more sugar (because it's a salt) and to not drink juices and soda, which I don't anyways.  I can just look at water and gain a pound.  It's amazing.  I drink large amounts of water everyday of course.  I don't know if it helps or makes it worse.  Ya, I gained a few pounds.  I might have kidney problems down the road too.  I have to weigh the benefits and the negatives.  I'm staying on the Lithium.
I was on an extremely low dose of Remeron for a very short time because I  never sleep.  Talk about gaining weight.  I stopped immediately.  I refuse to take it.  I would rather not sleep, I was gaining weight so quickly.  Not worth the benefit to me.
607502 tn?1288251140
Oh the ones in the US are not the only ones, her in Australia its just as bad trust me though thank god not quite up to the insanity of the US yet in calorie terms - my fav example was Hungry Jacks (Australian name for Burger King released a burger called the Quad Stack Burger, which contained four beef patties, four slices of cheese, two rashers of bacon, barbecue sauce and two sugared buns -  71g of fat, 34.7g of saturated fat, 1930 milligrams of sodium and 74.8g protein and topping out at 4250 calories !

Combine that with a large fries and a coke and its a 5000 calorie meal.  The outcry was huge and in the end the burger was pulled from sale.

So its not just the US.

I was more talking from a general point BTW not aimed at you because we often do not realise how much we take in from fluids, its a surprise to many people !  The big killer here is Red Bull and the like which are packed with calories and sugar and being consumed like no toomorrow.

I hear you on smokers, I get it constantly and ironically i started again on orders of my pdoc !.

222267 tn?1253305810
Started smoking again on orders from you pdoc???  Is that because of weight gain?  It's weird that you say that because I was on Geodon for a long time and constately complained about fatigue.  My pdoc said that smoking was a stimulant.  It seemed he was insinuating I start smoking.  It doesn't make sense to me.
We in the US love our Red Bull as well.  I don't drink it (don't consume caffeine) but just about everybody I know does.  They do have a sugar free version.  But what's the fun in that? :)
Avatar universal
--- monkeyc - The meal you described made me my stomach roll over. It sounds disgusting. I can't imagine eating that. It'd probably feel like you had ingested a car tire. If I could manage to actually get breakfast in my mouth before 4pm, I would feel like I'd made a step in the right direction. I like some very healthy foods - salmon and broccoli are favorites. It's hard cooking for one, though. My husband is gone 4 1/2 days a week, so it is easy to skip meals.

My mother-in-law freaks out over US portions. They aren't as bad in New Zealand, apparently. I can't say I ever noticed, but she gets upset whenever we go to a restaurant here. I always plan to get to get a doggie bag and that seems the sensible way to handle things. My husband said she lost it when they were in Chicago. Maybe the portions are even bigger there. She was literally in tears. He tried a buffet place finally, but she got upset about how much food must be wasted. (She has some kind of mental illness and everyone just ignores it and works around it. My husband tolerates me because he grew up with someone even more difficult). We now live near what was the healthiest city in America for several years. Maybe portion size is slightly more reasonable in this area.

Because we'd been discussing it, I tried a 10-calorie drink. It isn't too bad. Usually, when I have a diet drink, I have to mix it with something else to kill the aftertaste of the artificial sweetener. This one is not great, but even if I mixed it with juice I would still cut way down on the calories. It's pomegranate and acai. The same company makes drinks with watermelon juice and various other stuff. I normally have one of their other non-diet drinks every day - it is 90 calories per serving, but a bottle is 2 servings, so I'm getting 180 calories from that one drink alone. Its delicious, though. The draw on these drinks is that they're supplemented with vitamins and calcium. Since I can't ever remember to take vitamins or supplements and have such a poor diet, I've justified the calories by pretending it's healthy.

--- jst4shanell - I was not aware that it could cause sugar cravings. That is interesting. I don't usually keep sweets in the house. I get plenty of sugar from soda. I do make sure my husband has a chocolate supply most of the time, so I guess I'll have to watch for that. If I started to eat dark chocolate, I would know there was something unusual going on.

Do you sleep now? Have you ever had drowsiness from the lithium? I have a sleep problem, but I'm not sure it is related to bipolar or just the whacky way I operate. I am averse to sleeping.
222267 tn?1253305810
Lithium has never caused me drowsiness.  I don't really sleep much.  Or I will sleep in increments.  Most of the Lithium side effects went away after a few months (diarhea, thirst, frequent peeing, sugar cravings, not much really).  Yes, Lithium does cause sugar cravings.  But that went away after a little while.  Not a big deal.  I say, eat the chocolate.  It's good for the soul. :)
561706 tn?1333950874
First I just want to say I really liked the way you described the lack of motivation in you Dec 4 post directed to bulldozer.  That is exactly how I feel, but it's hard to describe to others.
Second, I've been on Lithium for years and never had problems with weight gain from it - honestly.  Now, I did have giant weight gain on Remeron- almost 40 lbs.  Went from 115ish to 155 lbs.  This was three years ago. I started exercising and doing a diet plan and lost 19 lbs a few months later.  Then I became hit-or-miss with my exercise and I've remained at 140.  I'd still like to lose 20 more.  

I may be fighting an uphill battle because of my meds (Seroquel and Lamictal), but not an impossible battle. I'm hopeful because I already lost.

I like Lithium a lot as it works for me and I don't have problems, so I'd suggest giving it the recommended amount of time to see if it's helping.  MonkeyC here also uses Lithium and can probably address some of your concerns, as he's researched it a lot more than I have.

(Apologies to MonkeyC - I hope you don't mind the reference, I just always like to read what you have to say on the subject and I know you've done homework).
607502 tn?1288251140
Ive taken lithium for nearly 2 years or so I think - I do not get drowsiness, its not a common side effect of the drug but it can happen to some.  Lithium has been around so long and used so much that it has a long list of very low probability side effects, the majority of lithium patients suffer from increased thirst, fine motor tremors (mine are more pronounced under stress and when tired) and in some patients weight gain caused by water retention is a problem - the drug also needs careful titration and levels monitoring because the toxic level is not that high, however its hard to reach if you follow the instructions and watch what you do.

Sugar cravings can happen, not to all but to significant portion  (me too) but if you mange it with fruit and healthy foods you are ok.

Lithium is the only drug which is fully effective in both manic and depressive phases and its also cheap and generic.

Reality is its not the worst for weight gain - the anti depressants are bad for it as well and apparently Valproate is almost certan to cause weight gain I am told
Avatar universal
--- jst4shanell - I am very relieved to hear that the urgent need to pee will go away. That is about the best news I've had all day!!! I like chocolate, but I don't need it the way my husband does. We buy Halloween candy every year in spite of the fact we have never had ONE child come to the door. I buy the candy we like and we eat it. :-)  I have been pleased so far to not have any troubling side effects from the lithium. I may be imagining my pants are tighter. My period is due, so that could be it. I really don't feel any different, one way or the other. I haven't been on it long enough for a therapeutic effect, so it's a waiting game.

--- Lizz67 - First, thank you. I'm not sure which part you meant, but I'm glad I said something that made sense to someone! Second, are you still on lithium? Or, did you change to Lamictal and Seroquel and drop lithium entirely? The first time I was on Lamictal I was also taking Topomax. They said that one or the other of those was likely to cause a slight weight LOSS and reduced carbohydrate cravings. But, maybe that was the topomax...

I'm pleased to hear you didn't have weight gain on lithium, but sorry that you have experienced it taking other meds. Do you find the Seroquel effective?

--- monkeyc - when you say lithium is the only drug that is fully effective in both manic and depressive phases, where does that come from? I'm curious because I'd been warned that the bipolar depression might be very difficult to treat. My psychiatrist has said lithium is only step one for me. There are other things to tackle, but bipolar was the priority. Seems like many people are taking anti-depressants along with lithium and I personally never had the expectation that it would necessarily be effective enough to be a stand alone medication for me. I'd be thrilled if it was, though. Even cheap drugs add up when you're uninsured.

Thanks all!!!

222267 tn?1253305810
I paid $400 for some of my meds yesterday.  My insurance company cut me off for the rest of the year.  

I do take Wellbutrin.  Only 150mg.  The smallest dose.  Any more and i'm manic. But it worked miracles for the lingering depression I had.  I havn't been depressed since.  I am taking a lot of medication, but the one I responded to the most was Lithium. I'm so grateful for it.
561706 tn?1333950874
Thanks for your thanks!  I am still taking Lithium and went back on Seroquel three years ago after a manic episode and hospitalization. Then I was in that crashed condition and my doctor added Lamictal for my depression.  That helped a little, but I had lost my job and home, and was pretty bad off at the time.

This past summer I went through a period of being really suicidal and I went on Prozac as well as the others.  Immediately my sucidal ideation stopped. It was almost miraclous - it was such a dramatic change. I've slowly come up since then.

I really like/love Seroquel. It has twice brought me out of psychotic manias and I've stayed stable every time I've been on it.  It helps me sleep like nothing else has.

A caveat:  I was just diagnosed with cataracts which is a rare side effect of Seroquel.  I need to make a decision about whether to keep taking it or switch.  My eye doctor recommends I stay on it since I'm doing so well and look at cataract surgery in the future if my vision gets worse. I've yet to talk to my pdoc, as this just happend two days ago.

So, stay positive. Many of us here have found a good mix and are doing well.  Keep posting.
607502 tn?1288251140
Ive read that lithium is the most effective on both in several places and books - it works to stabilise moods in manic and depressive phases however you also need to understand what a mood stabiliser is and what an anti depressant is.

An MS won't deal with a depressive episode on its own, at best it will shallow the drop and make it more manageable but not prevent it - the mechanism of action is different and an anti depressant will not act the same.

An MS which has AD capabilities is a good thing because using AD drugs long term has serious issues and most doctors like to limit the number of drugs they prescribe to a patient where possible
Avatar universal
*** just4shanell - I wonder if the Wellbutrin would work for me now that I'm on lithium. I've been on it before. I've been on a whole lot of anti-depressants in the past and some didn't work at all, while others would send me up. The worst, I think, are the SSRIs that I've been on. Zoloft was so bad I never got more than a couple of hours of sleep the whole time I took it and sometimes I felt I was coming right out of my skin. I didn't last long on that one.

We haven't had health insurance for about 8 or 9 years now. It isn't so bad except that the managed care concept has changed the way almost all doctors do business, including mental health professionals. So, when I would go to a new doctor, there was always that $250-275 out-of-pocket expense for the evaluation. I saw 2 doctors who didn't work out before I found this one and I think he is a keeper. The first one was okay, but things weren't changing and then I got charged for a missed appointment. Normally, that wouldn't have been a big deal but there was a lot happening. That struck me wrong since other docs here all do reminder calls, I'd asked for those and he wouldn't do it - and he knew about the head injury and how much difficulty I was having. I was seeing him when it happened and he was well aware that there lingering affects from that, especially ongoing memory problems, speech ephasia (sp?), etc... The second one was a real waste of time and money because he just flat didn't listen to what we told him; often, my husband would be there with me and he didn't listen to him either. I really resented paying him $80 for 15 minutes and then it took him 5 minutes to remember who I was... I feel your pain about the prescriptions. My husband is on a couple that aren't cheap, then I have other ones because of IBS, migraines, back and various other injuries I get. We try not to worry about insurance, though. When we had it, they looked for every excuse not to pay anyway.

***Lizz67 - Thanks for the words of encouragement. I am hoping for the best. I am sorry to hear about the cataracts. I hope that they do not get worse too quickly. The good news is that the surgeries seem to go well. My mother-in-law and some of my older relatives have had excellent results. I'm pleased that you are doing so well. Sounds like you had a very rough time. I am glad the meds have you stabilized even though it seems there are so many of them.

***monkeyc - I was curious about that because I'd read and been told that the bipolar depression was the toughest thing to control. I guess I'd assumed that meant that the episodes themselves would keep occurring and that it would be unlikely I'd notice much difference in terms of severity. For someone who is depressed most of the time, that didn't sound very hopeful. I figured that I would end up also taking a antidepressant at some point. So, maybe we both are really thinking the same thing but I probably didn't say it using the right words. I'll be real upfront and say that I no longer remember most of the terms for a lot of these things, not the technical names of the states and often not which drugs fall into certain classifications. I just can't seem to hang on to new facts any more and I have lost a lot of what I used to know. I used to spout this stuff off like my physiological psych professor, but now I'd do well to name more than a handful of neurotransmitters. Oh well. When I ask for clarification, please realize that I'm not being difficult. I just can't recall the memory - and I know it's in there...

Did I say before that the psychiatrist told me that eventually the lithium would "destroy my thyroid"? His exact words. Now, has he told me certain things just to give the worst-case scenario or is it likely that if I stay on the lithium 20+ years that I will have thyroid issues? And, is it perhaps the effect of lithium on the thyroid that contributes to the weight gain? I know no one really knows, but wouldn't that make sense? It's so obvious that someone had to study and discount it, surely? Or not. Just thinking out loud...

*** All - Thanks!
222267 tn?1253305810
I spoke with my pdoc about the thyroid issues.  He did tell me that the Lithium can mimic the way the thyroid works and not function normally.  He did assure me and reassure me that it did not cause long term damage.  He said once you get off it the thyroid starts working normally again.  Unless you have thyroid issues to begin with.  I was really worried about this because I don't want weight gain and all the other issues that comes with it.

About the Wellbutrin.  I take only 150mg a day.  My pdoc was hesitant to put me on any antidepressant at all because it makes me manic.  We tried 300mg a day and I instantly became manic.  It just depends on the person.  150mg is just the right amount I need to keep the depression at bay.  Of course the Lithium and other mood stabilizers help.

I also take Centrum Silver.  Yes, it's the old people vitamins.  It has helped tremendously with my moods.  He told me it has extra stuff for the brain than normal vitamins do.  I swear by it.  Worth a try.  It's only like $10.  I always take it at night.  It absorbs into the body more.
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