Expert: Ivan Goldberg, M.D. - 10/16/2008

Question
QUESTION: Hi. I have been diagnosed with Bipolar I, and I used to be on Risperdal (5 mg), Lithium (1800 mg), and Geodon (60 mg twice a day). Due to a great deal of weight gain (I am a 5'4 28 year old female and went from 108 lbs. to 204 lbs.), I recently switched to just Abilify. My psychiatrist told me to start with 15mg, but I went up to 30mg since going off the Lithium so rapidly caused a bit of mania. I would like to switch back to 15 mg. since I have a lot of restlessness. It's nice to have energy, but I'm a little too restless.

Anyway, I have been on Abilify for 2 months now, dieting and working out and have only lost 10 pounds, which I lost rapidly when I went off of Lithium and Risperdal. Now my weight is creeping back up; it went from 192 to 197 in two weeks.

I am disappointed because I thought it would be easier to lose weight on Abilify. Can you offer any insight or suggestions?

Also, will lowering the dose help with the weight and restlessness issues? My hands make weird movements all the time too and it's really annoying. I wish I could be on just a weight-neutral mood stabilizer, but I had severe psychotic features during my episodes.



ANSWER: Hi Courtney . . .

It is not clear to me exactly what medications you are currently taking. Is it just Abilify 30 mg/.day,or are you taking something else?

Do you happen to know when you thyroid was last checked, and what your TSH level was found to be?

Best regards . . .

Ivan
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---------- FOLLOW-UP ----------

QUESTION: I am now on just 30mg of Abilify. I haven't had my thyroid checked since last year, and the doctor said it was normal.

Answer
Hi . . .

Ability is an antipsychotic drug that si also approved as a treatment of people with bipolar disorder. Many psychiatrists reserved the sue of antipsychotic drugs as they have the ability to induce the "metabolic syndrome (The details of which you can discover through Google).

If you require an antipsychotic medication, an older medication called Moban or molindone is effective and more often causes weight loss than weight gain.

Among the medications that are usually prescribed on a long-term basis to help control bipolar disorder are lithium, Tegretol, Depakote and Trileptal. metformin and/or Topamax are sometimes prescribed along with these medications to prevent and/or treat weight gain.

Best regards . . .

Ivan
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