Bipolar disorder can be treated with a number of medications. Some of these medications can increase your appetite or cause changes in metabolism, so it’s not uncommon for people to report weight gain as a side effect when taking certain medications used to treat bipolar disorder.  

Whilst several medications used in treatment increase your blood sugar level, which can lead to weight gain, others affect your energy levels. During manic episodes for example, you typically may not sleep much and may burn off lots of energy. Taking bipolar medication can calm your mood and help you to sleep. In turn, these effects could decrease the amount of energy your body burns. This can lead to an increase in weight, especially if you don’t adjust your diet.

Medications for bipolar disorder include mood stabilizers, antipsychotics and antidepressants. The way these medications can affect your weight and other side effects varies from person to person. Also, how well the medication works to treat bipolar disorder symptoms differs among individuals. Because of this, finding the medications that best treat your symptoms may require some trial and error. You must always consult with your clinician before making any changes to your medications. 

Below we’ve detailed those medications which are at greater risk of causing weight gain. Some of these medications may be less likely to cause weight gain when taken alone, but many people need more than one medication to control bipolar symptoms. 

Mood stabilisers

Mood stabilisers used to treat bipolar disorder include lithium (Lithobid), valproic acid (Depakene), divalproex sodium (Depakote), carbamazepine (Tegretol, Equetro, others) and lamotrigine (Lamictal). All of these medications are known to increase the risk of weight gain except lamotrigine.

  • Low risk of weight gain: Lamotrigine (Lamictal) is most likely to cause weight loss. However, it can also cause weight gain.
  • Risk of weight gain: Valproate is likely to cause weight gain. It may also cause tremors, headaches, dizziness, and nausea.
  • High risk of weight gain: Lithium is known for causing weight gain.

Antipsychotics

Antipsychotics prescribed for bipolar disorder include olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), aripiprazole (Abilify), ziprasidone (Geodon), lurasidone (Latuda), cariprazine (Vraylar) and asenapine (Saphris). It appears that aripiprazole, ziprasidone, lurasidone and cariprazine are more weight neutral than the others, but that can vary from person to person.

  • Low risk of weight gain: Lurasidone has a low risk of weight gain. Other side effects of this drug may include the development of breasts in men, low blood pressure, and fainting.
  • Risk of weight gain: Quetiapine can cause weight gain.
  • High risk of weight gain: Olanzapine is very likely to cause weight gain because it increases your appetite.

Antidepressants

Antidepressants along with a mood stabiliser or antipsychotic may be used in treating bipolar disorder, although antidepressants alone could cause mania or rapid-cycling in people with bipolar disorder. Some antidepressants may be more likely to cause weight gain than others, but this can vary from person to person. Talk with your clinician if you have concerns. 

Antidepressant-antipsychotic combination

Antidepressant-antipsychotic combination medication works as a depression treatment and a mood stabiliser. The medication Symbyax combines the antidepressant fluoxetine and the antipsychotic olanzapine and is associated with weight gain.

Whilst weight gain may be inevitable when taking medications for bipolar disorder there are strategic ways to deal with this. Below are six tips for reducing the risk of medication-induced weight gain: 

  1. Keep track of your calories
  2. Eat more fibre
  3. Choose portion control over "low-fat" products
  4. Be wise when choosing calorie-free drinks
  5. Limit your snacking
  6. Never shop on an empty stomach 

Keep Track of Your Calories

The simple act of counting calories can help you better understand not only how much you eat, but when and what you eat. This is not to suggest that weight loss programs should be based solely on numbers; rather it should be a means by which to gain awareness about how certain habits may contribute to medication-induced weight gain.

Even beyond counting calories, you can keep track of the nutritional information of the foods you eat. There are plenty of free online tools that can assist you.

Eat more fibre

The types of foods you eat matter as just much as your caloric intake. To this end, focus on food rich in fibre. Fibre is the key ingredient to a weight loss program as it keeps your bowel regular, keeps you feeling fuller longer, and keeps you from experiencing fluctuations in your insulin response. By doing so, your body stores less fat, and you simply feel better.

Focus on viscous fibre found in plant foods like beans (legumes), flax seeds, asparagus, Brussels sprouts, and oats. Do so as part of a balanced diet while reducing your intake of red meats and refined sugars. 

Choose portion control over "low-fat" products

While eating lower fat foods is a good thing, it shouldn't be the sole focus of a weight loss program. In fact, many so-called "low-fat" products can end up having far more sugars their full-fat counterparts.

Instead, focus on portion size. This not only helps cut back calories, but it may also increase your awareness about when you actually full. Oftentimes, having a big plate of food in front of us is something we feel obliged to eat, even when we are already full. 

In addition to volumes of food, pay attention to how fast you eat. Research has shown that it takes 20 minutes on average for your brain to receive the message that your stomach is full. So, take your time, put down your fork between bites, and avoid the habit of wolfing your food down. By eating slowly, you may realize that you've had already enough even before finishing your plate.

Be wise when choosing calorie-free drinks

Forget zero-calorie "diet" drinks saturated with artificial sugars. Focus instead on naturally calorie-free drinks that will keep you hydrated and still tempt your palate. Try replacing soft drinks and high-fructose juices with seltzer, sparkling water, or club soda infused with cucumber, mint, strawberry, watermelon, or citrus slices.

Avoid caffeinated drinks, including coffee. They not only have a diuretic effect (which offers nothing in the way of real diet loss); they also act as a stimulant, which can exacerbate certain bipolar symptoms. Instead, opt for decaffeinated coffee or caffeine-free tea. 

Limit your snacking

Snacking is the killer of weight loss programs because it is driven less by hunger and more by impulse. As such, we'll often convince ourselves that we'll "make up the difference" in our regular meals, but it doesn't really work that way. Until you are able to constrain the snacking habit, you will never really fully take charge of a weight loss effort.

The simple rule is this: avoid eating when you're not actually hungry. When you do need a snack to get you over a hump, opt for something healthy and full of fibre. Or, even better, try a glass of water or herbal tea and see if that helps. Oftentimes, we mistake thirst for hunger, and a nice glass of water may be all that is really needed to satisfy a pang.

If you just can't get a snack craving off your mind, try brushing your teeth. It seems to be a trick to work for a lot of people, stimulating the taste buds without taking in unneeded calories.

Never shop on an empty stomach

An even better way to avoid snacking is to not buy snacks. And the best way to do this is to never shop hungry. If you head to the supermarket after a full, satisfying breakfast or lunch, you'll be less prone to reach for that bag of chips or box of cookies. So be strategic and plan ahead of shopping by:

  • Putting together a detailed shopping list
  • Never veering from that list
  • Scheduling grocery shopping right after a satisfying meal 

In the end, a diet plan should not be founded on drastic exercise programs or severely cutting back on food intake. It's more about viewing nutrition as part of an overall effort to improve your health. Body and mind play a part in how you manage your condition and, by looking at treatment holistically, you lose weight and feel better without compromising your health.

 

Additional Reading 

Mangge H, Bengesser S, Dalkner N, et al. Weight Gain During Treatment of Bipolar Disorder (BD)-Facts and Therapeutic Options see article here.

Grootens KP, Meijer A, Hartong EG, et al. Weight changes associated with antiepileptic mood stabilizers in the treatment of bipolar disorder see article here.

Rosenblat JD, Simon GE, Sachs GS, et al. Treatment effectiveness and tolerability outcomes that are most important to individuals with bipolar and unipolar depression see article here.

Fang F, Wang Z, Wu R, Calabrese JR, Gao K. Is there a 'weight neutral' second-generation antipsychotic for bipolar disorder? see article here.

Holder SD, Edmunds AL, Morgan S. Psychotic and Bipolar Disorders: Antipsychotic Drugs. Kemp DE see article here.

Managing the side effects associated with commonly used treatments for bipolar depression see article here.