Expert: Ivan Goldberg, M.D. - 6/3/2008

Question
Hello
I've been diagnosed with Bipolar..I think rapid(very rapid) or mixed bipolar. I've been put on 600mg Depakine per day. It's not been very long yet but I've done lots of research and I'm very concerned about weight gain. I'm not overweight now, but I do also suffer from Bulimia and have had food/weight issues for a very long time. The thought of gaining weight really makes me very anxious and my hair pulling/stressing has worstened. The medicine(after on a week) has made me constantly hungry even after a huge meal and I'm finding it very hard to control craving to binge..and we know what comes next!! My research leads me to a drug called Topamax which some say is good for stabilizing moods and also controlling binge eating without too many side effects. I will see my doctor in the next few days and I want to push this idea, because , frankly, Id rather be a bit looney and manic than gain weight. Over the last few years Ive made my whole lifestyle healthy and full of exercise and good food in order to combat these eating problems...Im so close to getting better and almost loving my body...weight gain now would be devestating and I don't know what I would do. I have already gained at least 2kg's from the meds..IN A WEEK!! That is with my 3 hour dailing exercise and vegetarian , vegetable and tofu based meals.
Other names that came up were ABILIFY and ZONISIMIDE.
May I add that Im in south Korea, Im a student, are these available here? Can you suggest anything else. My doctor speaks english ok, but not perfect so I need to plan what Im going to say before hand to make it clear and simple.
Help please.
p.s the meds Im on now make me very drowsy , sleepy...is this a side effect of all bipolar meds? Also frequesnt urination and stiffness of body.

Thanks so much.
Om

Answer
Hi, Kayte . . .

I ma not sure exactly what you are asking in your query.

Topiramate (Topamax) is somewhat useful in the treatment of people with bipolar disorder and it has been shown to also be useful for people with bulimia. The major problem with topiramate is that by itself it is often not potent enough to do a good job controlling the bipolar cycling process. I often use topiramate as a way of controlling the weight gain caused by other mood stabilizing drugs such as valproate. Because of the risk of tardive dyskinesia and neuroleptic malignant syndrome I never prescribe antipsychotic medications such as aripiprazole (Ability) for patients who are free of psychotic symptoms. Zonisimide (Zonegran) may have some weak mood stabilizing properties but I doubt that ti will turn out to be a major drug used to treat individuals with mood disorders.

I have no idea which of these medications are or are not available in Korea.

Best regards . . .

Ivan
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