People with bipolar disorder (BD) experience periods of high and low moods, sometimes referred to as mania and depression, respectively. BD can also cause changes to a person’s energy and activity levels.
BD can be chronic and persistent or occur at irregular intervals. The impact of BD on daily life can vary from person to person. However, treatments and support are available, including medication.
Medication treatments for BD include mood stabilizers such as lithium, anticonvulsant medications, and antipsychotic medications. Some of these medications may cause a person’s weight to change. A common side effect of BD medication is weight gain rather than weight loss.
This article discusses whether bipolar disorder medications cause weight loss. It also looks at other potential side effects of BD medications.
Understanding Bipolar Disorder and Its Treatment
Treatments for BD include medications, psychotherapy, or a combination of treatments. Different types of medication can have different effects on a person’s body, including weight changes.
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BD medications may cause weight gain rather than weight loss. Some BD medications may cause weight gain by increasing a person’s appetite, especially for sweet or fatty foods. Some medications can also interfere with a person’s sleep patterns, which can lead to weight gain.
However, not everyone who uses BD medications will experience weight changes the same way. Additionally, other BD treatments may also cause weight gain.
Tips for managing BD-related weight gain include:
- making lifestyle modifications, such as dietary changes
- increasing physical activity
- trying therapies such as motivational interviewing and cognitive behavioral therapy (CBT)
- taking weight loss medications
- undergoing surgical treatments
Mood Stabilizers and Weight Changes
Mood stabilizer medications help reduce mood swings in people with BD. These include:
- lithium
- valproate
- anticonvulsant medications, including: carbamazepine and lamotrigine
One common side effect of valproate is weight gain.
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In a 2022 meta-analysis, researchers looked at the effects of lithium and other medications on weight in people with BD. They found that lithium did not lead to significant changes in weight. In addition, the medication lamotrigine was associated with no weight change or sometimes weight loss.
Antipsychotics and Weight Changes
Antipsychotics are medications that can help treat episodes of mania, or high mood periods. They can also work as a long-term mood stabilizer. Some antipsychotic medications include:
- haloperidol
- aripiprazole
- asenapine
- olanzapine
- cariprazine
- clozapine
- quetiapine
- risperidone
Weight gain is often a side effect of antipsychotic medications. The medications olanzapine and clozapine are associated with the highest risk of weight gain.
Weight gain is also sometimes a side effect of the medication aripiprazole. However, it is less likely to cause weight gain compared with other antipsychotics. People taking aripiprazole may also experience weight loss as a side effect.
Side Effects of Bipolar Disorder Medications
Many people experience no or few side effects while taking lithium. However, temporary side effects can include:
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- nausea
- stomach cramps
- thirst
- fatigue
- headaches
- mild tremors
More serious side effects people may experience include:
- vomiting
- diarrhea
- extreme thirst
- muscle twitching
- slurred speech
- confusion
- dizziness
- stupor, or reduced consciousness
If someone experiences any of these severe symptoms, they should seek immediate medical assistance.
Side effects of anticonvulsant medications may include:
- fatigue
- muscle aches or weakness
- dry mouth
- constipation
- diarrhea
- loss of appetite
- nausea
- skin rashes
- headache
- dizziness
- temporary hair loss
- decreased sexual interest or libido
People may also experience severe side effects that require immediate medical assistance, such as:
- confusion
- fever
- jaundice
- unusual bruising or bleeding
- vomiting
- vision problems, such as double-vision
- swelling of the lymph glands
Other side effects of antipsychotics may include:
- blurred vision
- dry mouth
- constipation
Common Questions About Bipolar Disorder Medications and Weight
Here are some questions people frequently ask about bipolar disorder medications:
Is there a bipolar medication that does not cause weight gain?
Lamotrigine and lithium do not usually affect a person’s weight. However, weight gain can still be a side effect. Lurasidone also has a low risk for weight gain in people with bipolar disorder.
Which antipsychotics cause weight loss in people with bipolar disorder?
Most antipsychotics cause weight gain. However, people may experience weight loss as a side effect of aripiprazole.
How do you lose weight while on bipolar meds?
People may be able to manage weight gain while on BD medication through lifestyle modifications, such as diet and exercise. They can speak with a healthcare professional for advice on how to lose weight and maintain a moderate weight.
Lithium and Weight Gain: A Deeper Dive
There are various medications to help treat and manage bipolar disorder. Most will affect a person’s weight, typically through weight gain.
Scientists investigating the side effects of lithium found it does not cause weight loss. However, other medications may cause slight weight loss or no weight change. BD medications less likely to cause weight gain include lamotrigine, lurasidone, and aripiprazole.
Are you afraid of Lithium weight gain? About one in every four people experience rapid weight gain from taking the mood stabilizer lithium, as reported by Acta Psychiatrica Scandinavica. Based on the research conducted on this issue, the average weight gain that people who take lithium experience is usually between ten and twenty six pounds. Some studies show that people taking lithium are likely to gain approximately 8% of their total body weight.
For those who experience weight gain through lithium, it is recommend that they limit the consumption of high calorie food and drinks. Lithium is notorious for making people thirsty. It is therefore recommended that people on lithium drink a good deal of water or other low-calorie liquids to help satiate their thirst and avoid excess weight gain. High calorie drinks should be avoided.
There are a number of theories as to why lithium side effects cause some people to gain weight. Causes include increased appetite and thirst, sodium retention and changes in metabolism. Swelling and bloating can also occur when more salt and water is retained. Lithium is also known to cause fatigue in some, which can lead to less physical exercise and a more sedentary lifestyle.
Patients should always consult with their physicians about how they’re tolerating their medications. Physicians can help patients develop a strategy to deal with any weight gain associated with lithium or they might be able to identify an alternative medication altogether. For example, Lamictal has been shown to be less likely to cause weight gain than other mood stabilizers in clinical trials. But Lamictal is also not indicated for treating acute manic episodes: it’s more of a maintenance drug where as lithium is something that can be used for both manic and depressive episodes as well as both acute and maintenance treatment.
People use lithium supplements for alcohol use disorder, Alzheimer disease and certain other conditions, but to date there is not strong scientific evidence to support its efficacy. In some cases, weight gain can be a common side effect associated with specific medications that treat bipolar disorder. To help mitigate this, it is important to maintain a balanced diet with nutritious foods and engage in regular physical activity weekly.
Before taking lithium it is important to be aware of the common side effects such as increased thirst and tremors, potential serious side effects such as thyroid or kidney issues, and the requirement of routine blood tests to monitor your lithium levels. Possible negative symptoms from taking lithium can include increased thirst, frequent urination, weight gain and tremors. In some cases, kidney and thyroid problems can be associated with taking lithium.
It is very important that your doctor check your or your child's progress at regular visits to make sure that this medicine is working properly. Blood and urine tests may be needed to check for unwanted side effects. Using this medicine while you are pregnant can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant. If you think you have become pregnant while using the medicine, tell your doctor right away.
Call your doctor right away if you have diarrhea, vomiting, drowsiness, muscle weakness, tremors, unsteadiness, or other problems with muscle control or coordination. These may be symptoms of lithium toxicity.
Make sure your doctor knows if you have a heart disorder called Brugada syndrome. Brugada syndrome can be life-threatening and requires immediate medical attention. Call your doctor or the emergency department right away if you have a fast, pounding, or uneven heartbeat, unexplained fainting, lightheadedness, or troubled breathing after using this medicine.
This medicine may cause pseudotumor cerebri (increased pressure in the brain). Call your doctor right away if you have blurred or double vision, dizziness, eye pain, severe headache, or nausea and vomiting.
Encephalopathic syndrome (brain problem) may occur in patients using this medicine together with a medicine to treat mental illness (eg, chlorpromazine [Thorazine®], clozapine [Clozaril®], fluphenazine [Prolixin®], haloperidol [Haldol®], perphenazine [Trilafon®], risperidone [Risperdal®], thioridazine [Mellaril®]). Check with your doctor right away if you have the following symptoms while using this medicine: fever, confusion, drowsiness, difficulty with speaking, uncontrolled body movements, and unusual tiredness or weakness.
Check with your doctor right away if you have anxiety, restlessness, a fast heartbeat, fever, sweating, muscle spasms, twitching, nausea, vomiting, diarrhea, or see or hear things that are not there. These may be symptoms of a serious condition called serotonin syndrome. Your risk may be higher if you also take certain other medicines that affect serotonin levels in your body.
This medicine may cause some people to become dizzy, drowsy, or less alert than they are normally. Do not drive or do anything else that could be dangerous until you know how this medicine affects you.
Use extra care in hot weather and during activities that cause you to sweat heavily, such as hot baths, saunas, or exercising. If you have an infection or illness that causes heavy sweating, vomiting, diarrhea, shakiness, or muscle weakness, check with your doctor right away. The loss of too much water and salt from your body could lead to serious side effects from this medicine.
Do not go on a diet to lose weight and do not make a major change in your diet without first checking with your doctor. Improper dieting could cause the loss of too much water and salt from your body and could lead to serious side effects from this medicine.
Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal (eg, St. John's wort) or vitamin supplements.
Managing Lithium-Induced Weight Gain: A Case Study and Treatment Strategies
Lithium is the first line treatment for maintenance treatment of bipolar disorder. Among the long term adverse effects, weight gain is likely to affect a subset of patients. There is no specific guideline for the treatment of lithium-induced weight gain.
One case reported a young male with bipolar disorder who had significant weight gain with lithium (25 kg), which responded to metformin treatment at 500 mg twice daily.
Lithium is considered as the most effective maintenance treatment for bipolar disorder by virtue of mood stabilization, neuroprotective and antisuicidal properties. There are several adverse effects associated with long-term lithium maintenance therapy. Among others, impairment in renal concentrating ability, hypothyroidism, increased calcium and cognitive adverse effects need monitoring.
Although not very common, weight gain is another adverse effect seen with chronic use of lithium. An early study had found that lithium maintenance therapy stimulated weight gains of over 10 kg in 20%, which was attributed to increased thirst in majority of individuals. In a recent meta-analysis, it was found that those receiving lithium had significantly more weight gain than the placebo group (odds ratio 1.89, 95% confidence interval [CI] 1.27 to 2.82; p=0.002). In a retrospective chart review, body weight gain with lithium treatment was 6.3 (standard deviation [SD] 9.0) kg, which was almost similar to that of sodium valproate (6.4 kg, SD 9.0). In comparison to lithium and valproate, weight gain with carbamazepine and oxcarbazepine is much lower.
The pharmacological strategy for treatment of lithium-induced weight gain is not clear.
Case Presentation
A 22-year-old male, height 173 cm, presented with history suggestive of mania of 2 weeks duration. He had two prior episodes of mania that responded well to lithium, which he discontinued following remission of symptoms. His birth and developmental history was unremarkable and premorbidly he was well adjusted. There was no family history of any psychiatric illness. Physical and neurological examination was normal. Mental status showed features supportive of euphoric mania. Baseline investigations including blood count, thyroid profile, fasting and post prandial plasma glucose, lipid profile, liver and renal function test were normal.
Considering past response, he was prescribed lithium carbonate 1,200 mg/day (with serum level of 1 meq/L) and quetiapine 400 mg/day with which there was complete resolution of manic symptoms over next two months. After nine months, he reported of weight gain of 12 kg from his baseline weight of 68 kg (body mass index [BMI] 22.72 kg/m2), while on maintenance dose of lithium 1,200 mg/day. He was suggested diet control and physical exercise (no formal program), and was maintaining well for next two years, after which he reported further weight gain of 13 kg (i.e., 93 kg, BMI 31.07 kg/m2, class I obesity). Investigations including blood sugar, lipid profile and thyroid functions were within normal range. Considering previous good response, lithium treatment was continued at the same dosage. He was started on metformin 500 mg daily which was increased to 500 mg twice daily for weight gain related to lithium. After six months, there was reduction of 8 kg (i.e., body weight of 85 kg), without any emergent adverse effect.
Discussion of the Case
This patient gained 25 kg over three years while on lithium maintenance therapy for bipolar disorder. Although he was receiving quetiapine along with lithium in the initial two months, it was tapered off and the weight gain occurred while on lithium monotherapy. In absence of any other cause, it appears that weight gain is related to lithium. On Naranjo adverse drug reaction probability scale, score was 7, which is suggestive of probable association.
It has been suggested that lithium-induced weight gain is a dose-dependent effect seen over serum concentrations more than 0.8 mmol/L, and this case had a serum level of 1 meq/L. Treatment of lithium-induced weight gain includes non-pharmacological measures such as exercise, avoidance of liquid calories and restricted calorie intake, as well as several medications that have been useful for psychotropic-induced weight gain.
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