For many of us, we are expected to be fat and happy on bipolar medication. This is because many people gain weight as a bipolar medication side effect – sometimes a lot of weight. You can easily go from a size 8 to a size 18 because of bipolar medication. This is not what happens to everyone, but for those for whom it does happen, the question is, can we be fat and happy on bipolar medication?
Being Fat on Bipolar Medication
As I said, some bipolar medications make some people gain weight. This is a major problem with antipsychotics (although it can happen with other medications as well). According to one study:
Almost all AP [antipsychotics] showed a degree of weight gain after prolonged use, except for amisulpride [Solian, not approved in the United States), aripiprazole [Abilify] and ziprasidone [Geodon], for which prolonged exposure resulted in negligible weight change. The level of weight gain per AP varied from discrete to severe. Contrary to expectations, switch of AP did not result in weight loss for amisulpride, aripiprazole or ziprasidone. In AP-naive patients, weight gain was much more pronounced for all AP.
Believe me, being fat on bipolar medications is a real problem. (And to make matters worse, doctors often don’t mention how severe this side effect is and they don’t seem to care much about it.)
Additionally, being on medication that makes you gain weight also tends to make losing weight almost impossible.
Being Happy on Bipolar Medication
However, that being said, bipolar medication saves lives and makes lives worth living every day. Without antipsychotics, for example, people with schizophrenia or bipolar may be in extremely prolonged and recurring psychosis. This can easily destroy families, careers and relationships. Bipolar medications may be the only thing to make you feel happiness again. I have had this experience. I have had an antipsychotic change my life. I know it happens.
Being Fat and Unhappy on Bipolar Medication
Nevertheless, dealing with weight gain can be difficult. Some people say that medication for depression that makes them gain weight just makes them depressed because of how they look. I understand this. And worse yet, sometimes bipolar medication makes you fat and it doesn’t even have positive effects. Then you have to try something new and see if it makes you gain more weight. It’s a painful cycle.
People flippantly say “sanity before vanity” and seem to think this will change everyone’s perspective. It can help, and it’s certainly a valid point, but that doesn’t mean that being fat on bipolar medication is easy.
Is It Possible to Be Fat and Happy on Bipolar Medication?
In short, being fat and happy on bipolar medication may be your only option to reach the “happy” point. There may simply be no way to treat your bipolar disorder, gain stability and regain happiness outside of a bipolar medication that makes you gain weight. This is incredibly sucky but true.
There are three things you need to know about being fat and happy on bipolar medication:
- Most people have a limit to how much weight they can stand to gain. This means if you’re taking bipolar medication you need to be watching your weight carefully – believe me when I tell you weight gain can creep up on you without you noticing if you’re not purposefully paying attention. And while your psychiatrist should be ensuring that your weight is monitored, in my experience, they rarely do. If you do reach a limit when you feel like you just can’t live with any more weight, be open with your doctor about it. There are many bipolar medications out there and it may be worth you switching and trying something else.
- It also may not be worth it. It’s a very individual decision. Sometimes it’s not worth the possible relapse. Truly consider your options and take control of your treatment, but understand that switching just isn’t always smart (or effective).
- Sometimes you just have to accept the fat in order to be happy. Yes, I know this isn’t what anyone wants, but sometimes it’s your only choice. Sometimes you just have to accept weight gain in bipolar disorder. I’m sorry, but it’s true.
I’m also not saying that losing weight on bipolar medication is impossible. People have done it but it tends to be very, very hard – much harder than for the average person. Nevertheless, if that is your goal, work with your doctor to find a weight loss program that is best for you.
For most people, I would say that you have to work on the being “happy” part if you have no choice about the “fat” part. But this is possible, too. Try therapy, for example, to help. Try changing your perspective. Try being grateful for what the medication does give you. Yes, I know it gives you gifts with purchase that no one wants, but it can also give you a life – and that’s worth it.
~ For myself, it’s just too, too upsetting and very scary to get off a medication (that works well) because of something like weight gain. For me, to be as mentally/emotionally as good as possible is my priority. Nothing else works unless my brain is motoring along as well as possible. And weight loss is possible. Tough but possible. My goals for a weight loss and excercise are tiny (baby steps). It’s something I feel good about working on. Because (like all of you) my brain misfires so little accomplishments are blessings to me. I do feel better (and have more strength) when I am on a healthy diet and excercise daily ~
Yes I totally agree and understand. I was a size 5 or 7 most of my teen and adult life. That is until I was medicated with an antipsychotic as a mood stabilizer. I am now a size 2x -3x. I am the highest and largest size I have ever been. It does not make me happy but it effects my self esteem. Yesterday I saw a picture of myself with friends and I was horrified at how fat I am. I am not stable. My psychiatrist is working with me. But because of the weight gain I am now a diabetic and I also have high blood pressure. And I have fibromyalgia and found out I have arthritis all in my lower back. The extra weight makes my pain worse. I can barely walk 10 minutes. I used to power walk and 5 years ago I was a Zumba instructor. And I did yoga regularly. I have to have pain injections and hopefully they will make pain liveable so I can start exercising again and get my life back. I HATE this weight gain!!! And I am not Happy!!
Not yet. Still trying and not giving up.
I actually gained weight on Abilify. I was lucky enough to take the weight off, but i initially gained on it. My pdoc said if i gained more than 10% then we would consider switching meds because of diabetes risk. So, I was lucky to lose it because it is a med that does wonders for me.
Yeah. This is a huge problem for me (not bipolar, but major depressive disorder and OCD) because I’m also a recovering anorexic/bulimic and the gain of a couple pounds is likely to cause a relapse for me. (At one point I had a BMI of 13 and was hospitalized being fed through a tube, so not a good thing.) Because of this I’m now on more weight friendly varieties of depression medications, which simply don’t work.
An addendum of sorts:
last Fall I went with my older sister to a Macy’s department store to look for a bra. They were having a sale and with some brands; they would donate a portion of the proceeds to a local charity (one, of which, I’ve received help from most recently). So, with much trepidation, I went with her to search for a bra or 2 cause I did actually need one, or 2.
NOT A SINGLE BRA was my size. It’s not only the bosom itself you must account for but also the size of your torso. If you are barrel sized (bloated abdomen) or, as I call myself, “Penguin shaped”…. your actual bosom may be one size but the band size that circles your torso may be another… NOT A SINGLE BRA was my size.
My older sis could not believe me. She found 2 different size bras and told me to go try them on cause she didn’t believe that I couldn’t just go in and buy one. With tears being fought back, knowing I couldn’t wear the bras, I went into the dressing room and tried them on because my older sister told me to and I, I am a people pleaser. NOPE, both bras felt as though they cut me in half.
This trip to the lingerie department of a major retailer reminded me of a trip, not long before that one, to a Victoria’s Secret with my daughter (she is 21) and my niece (she is 19). They, young ones, talked non-stop of these bras and these panties and this and that and at one time.. I too could speak of them, but, that was long ago. However, off we went to a local VS store.
ABSOLUTELY NOTHING was my size… NOTHING. I actually got angry and being in a manicky soaring that I was in, not to mention having a state of anxiety (malls do that to me)…. I took hold of the store’s manager and basically ripped her and her store to shreds… right there, in front of employees and customers… over the fact that VS has nothing FOR FAT WOMEN!
The manager, oddly, was as round as she was high and she acknowledged that even she couldn’t shop within her own store that she managed. She had to order online and hope that the materials actually fit. She encouraged that we, the PLUS SIZE population, complain to the VS corporation and see if they’d put more PLUS SIZE items in the stores.
Now… what does this have to do with having Bipolar?
When you have Bipolar, it is 24/7/365 for years… and years… and years…. and years…. and even more years. You are ALWAYS symptomatic in some sort or function. You take your meds and you blow up likened to a pregnant whale with docs who mock “better to be fat and happy than skinny and insane.” or “benefits will outweigh the risks and adverse reactions” (while you try yet the umpteenth med or cocktail)…. and also be told by non-caring professionals “you will just have to work that much harder, restrict that much further, and exercise that much longer.”
While you also go to the medical docs that now tell you that you have high blood, high lipids, high sugar, etc. and must now need to take x and y and z and AA meds for those….
and you go into a department store, as a woman, and try to find something to fit you and cover you and shield you… cause you have to go out into public from time to time
you join a gym where many women, and men, are buff and running and lifting… and you are in your sweats and too large T, trying to get through 30 minutes of something….
yeah… lifelong mental illness requiring life long pharma meds and weight gained seemingly at a drop of a pill….
“settling” is one thing
Happy? Oh no no no no…
Thing with gaining weight.. be it lifestyle, too much eating, not enough moving OR medication induced… gaining weight can and does cause other medical issues to appear.. which depending on which ones… also fuels the psych symptoms you or i may also feel.
Also.. society is a demon when it comes to belittling, judging and cruelty to those it deems inferior & lazy. There is no acceptable “body image” but that of a pre-adolescent teen… wonder why so many eating disorders? Few can honestly say that they are Fat and Happy… not truthfully.
I took Seroquel in 2006 and in 6 months, I gained 30lbs. I’ve taken Lithium, time and time again, and each time.. I’ve gained 15-30lbs.
The chemicals seep into your cells and metabolism and alters them. Some meds cause carbohydrate/sugar cravings so maddening or the “hunger” button gets pushed and just will not un-stick itself (some anti-depressants).
To lose the weight is nearly impossible… I said “nearly”. There is always bariatric surgery for those who cannot lose weight on their own and the constant “trial and error” of psych meds… doesn’t help for something – Bipolar – that is literally LIFE LONG and in some need of something all the days of our lives.
No, Sug… you can become “settled” with being obese due to the meds…
but, not happy.
Thank you for your empathy & understanding,Patricia.
Not everyone sees this as I do.
I was also raised to look as nice as possible thus adding fuel to the fire.
As an adult,being a perfectionist in many areas of life too
Annoying esp when I need to go out @ times putting on makeup ( 1 hr)
Trying to draw attention away from my weight gain…..
Stay well ?Sandra in BP cyber land.
As females in today’s society,I feel ( or am I imagining this?) I’m being compared to other women still.
At age 56?
I know in some shops you go to,women definitely give you the once over.
Including the brand of your purse)
Not false reality. I think we are still expected to be reasonably thin,even @ my age.
Truthfully,I hate leaving my house due to my weight,as everything is tight.
So,other than needed medical appts I generally do not.
My friend is same height but size 0!
I actually hate her for looking like a model,& me a pig
Lately she’s been ignoring me,
So I don’t think we’re going to stay friends
Plus she’s very materialistic,I am too but nooo way to her status,annoying
Another thing in women these days money & high end items.
The lowest size I’ve been is a 4 & im 5 feet 8 -1/2 inches
That was rt after my Dad passed
Still,GOT COMPLIMENTS
But my blood pressure that day went as high as it would register……
I’m so conflicted !!!!
Part of my logical mind was what I composed above,I did mean it
This is my perfectionistic,& sick mind speaking currently.
They clash.
Sometimes I feel ok about the weight,
Other days I hate it & cry & stay in bed all day
I look @ pics of models knowing I used to look that good & never will again.
Depressed,crying.
I really don’t know what to say.
Irionically,due to weight only,even though this med has been a godsend…
I went off it once 2 weeks,did look thinner.
But don’t own scales,clothes were looser.
However,beast returned,much more emotional.
Whereas,on this pill I’m not.
I don’t get manic ( but still triggers) or depressed ( same) weight is a HUGE trigger
Been since I was a teenager,I was very thin,but obsessed staying thin like a model.
Anyways
Feeling really depressed now so going to sign off
In a hole
Sandra
Yo-yo’d with weight like so many others. Years ago, the docs wouldn’t listen, but now, they have been hit with the reality of weight gain so much that, if they deny it any more, they are just being ridiculous. My doctors (pdoc and PCP) acknowledge that the weight gain side effect of these meds is real, and have done everything they can to help, but the simple fact is, the only way I can lose the weight is by taking a stimulant. Stimulants cause me to become manic, so I’m stuck taking Naltrexone and Wellbutrin, which keep me from bingeing, but do not help me lose weight. I have to be happy that I’m staying at 50 pounds overweight, rather than continuing to gain 5-10 pounds a month like I was doing before the Naltrexone. I’m not happy but I am realizing that I have to start being happy, since there is literally nothing more I can do. If anyone could lose the weight, it would be me. I love to exercise and it doesn’t do anything for me as far as losing weight. I’m done trying, all it does is get me upset and make me hate myself. I will exercise for health and nothing more.
Abilify (noted in this article as weight neutral) made my daughter gain 30 lbs in a month. She only took it for that long; never lost the weight, and had been a dancer. The p-docs were totally unsympathetic, wouldn’t even liisten. They simply parrot back, “The brochure says it’s weight neutral!” But that’s a load of you know what.
Everyone is different, but AP drugs really cause massive cravings in many people. The medical professionals need to acknowledge this issue and help patients with it.
Yup, I hear you – we are completely on our own trying to figure out the weight gain angle of so many of these meds. Too many PDoc’s are incognizant about this issue.
I was on Abilify for 4-5 months a few years ago and didn’t gain weight. My son was always a skinny kid growing up, but he gained about 60 lbs. on Zyprexa, gradually lost much of that weight when he came off of it, only to gain 80 lbs on Geodon after another hospitalization a year later. It feels like a crap shoot as to which of us will gain weight on any given AP med. I do credit those drugs with saving my son’s life however – those, and Lithium. Overall he’s doing much better as he’s matured and taken more command over this illness, the weight issue included.
One thing people need to bear in mind sometimes with this illness…the weight gain can naturally follow the bizarre rapid weight loss prevalent in manic psychosis. I recall losing 30 lbs. in a matter of weeks when in its throes – everything speeds up, including speech, thoughts and metabolism. Add intractable insomnia, pacing, and the delusional belief that one has reached some kind of plateau where food is unnecessary.
My son went through the same experience, so those weight gains I posted about him include regaining the 30 lbs. he lost before those hospitalizations. Like your daughter with dance, my son was in the great shape of the young athlete he once was. It takes a lot of time and perseverance for them to get fit again. It’s unfair, but it’s a harsh reality of living with this illness and these meds. I wish your daughter the best and hope she’s doing okay mentally as well as physically.
Just to end on a lighthearted note, the manic psychotic diet was the most successful diet I never expected to go on. It is only rivaled by the onset of diabetes diet. I do not recommend either.
Hi Patricia,
I’m definitely agreeing with your assessment of the ” manic diet”
I’d lose a lot of weight / sleep as well.
I’d take selfies during these times.
Wow! My face looked drawn & sick,I could feel my hip bones & ribs.
Just like yrs ago when I used speed,though drug free.
This was pure mania.
Irionically I’d get complimented how skinny I was,messed up society!!!
Hi Sandra, You’re absolutely right about how “messed up” society is re weight gain & weight loss issues. I too received many compliments about weight loss after two episodes of manic psychosis years ago – no one seemed to comprehend how ill I had been. I also lost weight after breast cancer treatment a decade ago, yet people were sensitive enough not to compliment me that time. I received visitors, cards and empathy for breast cancer – I didn’t get a card or a phone call for hospitalizations for manic psychosis – not during nor afterwards. Neither did my son. And I’ve always been one of those people who brings friends & relatives full course turkey dinners for their entire families if they had fractured an ankle or undergone a hysterectomy, etc.
Why such a dramatic differences between brain disorders and all other organ systems? I always treasured my brain far more than my breasts – after all, it is the organ I relied upon to get through every facet of life. The human brain is the quintessential organ that actually makes us human – it is the supreme command center of the human body. Yet people act like it’s no big deal for one’s brain to go awry. We cannot even lift our little pinky or cross a street safely without our brain functioning properly. But I digress…
Re: weight loss and gain – I’ve been up and down the scales like a grand pianist since the onset of this illness. What always strikes me is how differently strangers treat people who are normal weight vs. overweight.
People who are normal weight are treated with far more respect, whether you’re at a restaurant, shopping for clothing with your girlfriends, or bringing your car to the mechanic. When overweight, people are treated to eye-rolls, vacuous glances and snickers to denigrate them. Overweight people are treated as though they have a personal weakness or yet another character defect, just like with bipolar d/o. Little credence is given to the reality of dramatic weight shifts due to medications, metabolic changes or illnesses themselves. Our society prefers to view weight gain as a personal failure, and overweight people are therefore judged harshly.
I suppose it’s no different than when people judge others in grocery lines by what they have in their carts, or tsk, tsk about a person who appears to be able bodied when he/she pays with an EBT card – as if all disabling illnesses are visible. The empathy deficit out there is quite real and very, very toxic.
Yet, people wonder why those of us with SMI have a tendency to self isolate at times…Seriously?
I love this topic,it effects females & males equally.
It does suck,is a reality.
But,for me it’s not quite as hard as ex for Christmas) I’m vegetarian…..So,I still put on weight ( love Starbucks treats here & there…1- close to my Drs….)
When I grocery shop for example my treat is non dairy ice cream ( ❤️❤️) or I hit the bakery section and get one
Cookie or one cupcake.
That satisfies my cravings.
It doesn’t work for me,esp in winter,snowy & cold here to deny my cravings I simply moderate……yes,it takes practice not everyone can do it.
But I’m not about to buy an entire new wardrobe at the prices today nooooo!!!!
Yes,I’ve put on weight but I was very thin previously so I’m slightly above normal as I’m tall ( helps too)
Another thing helps I do is stay hydrated,with water!
No diet drinks,studies show they actually cause weight gain,as they leave you unsatisfied plus aspartame
Provokes migraines)
I’m pissed about the weight,yes….but like Natasha I’m in a better place w my illness so give or take.
Plus every winter I used to gain a bit of weight before meds b/c of the cold,so you need to nourish your body.
Wasn’t always vegetarian (3 yrs I think) now it’s not a diet that’s why it works.
Easiest way I feel to control this…….but not everyone is into it I know.
Just hate to think of ppl going on fad dangerous diets when it’s not necessary!!
Oh well.
Just trying to help others lose weight cos it’s a shitty thing that adds to a depressed mood already.
Sux
Of course Drs aren’t saying anything re weight for fear we would be non compliant.
My psych outright lied to me about the AP that super- helped me most)
When I asked to his face” will it cause any weight gain?” He replied ” oh no””
See?
I’d said before if it made me fat I’d refuse it…..sneaky bastards!
Guess the old theory holds true weigh the pros & cons ….if you’ve put on more weight than your comfortable w
Have that appt w your Dr. perhaps he’d change the drug or lower the dose of what your on.
Only you know how much weight is too much,or if someone ( hopefully not) makes a comment about it.
Realizing I have hips Sandra in bipolar Cyberspace.???
I both gained weight and developed diabetes. But I am happier.
just my $0.02 here — i’m fairly skinny — as a teenage boy it was a self-esteem downer, but even then it was how i wanted to be. my wife and other heavy women are sexy to me, but i feel that this is the kind of animal i’m meant to be. even when i’m out of shape i can do pull ups and run moderate distances, which is important to me. the downside is that i get cold quite easily… hypothermia’s a danger. anyhow, if a med made me heavy, that would be a deal-breaker.
just an anecdote — having been in many hospitals and known and loved many mentally ill people, the most miraculous recovery story i know was a friend who had just about doubled his body weight on closeril. he seemed an utterly hopeless, extremely tragic case, the kind of person i figured would never get well. i discharged before him, but then ran into him a year later at an alumni event (yes, some high-end hospitals have alumni…. because they cost as much as college, they figure they should act that way.)
when my friend and i saw him we both started crying…. we could believe our eyes. he was a handsome young man, back at college, sailing and playing chess at competitive levels. they had switched him to abilify, which was a new drug then. i get tears in my eyes just thinking about him — it was as if he had come back from the dead.
Great article! Thank you for your honesty. I have gained and lost, gained and lost , gained and lost too many times to count. Currently I am at gained. I hate eating. Nothing sounds good and I lack motivation to exercise. I know I can be healthier, I just need that motivation.
None of my psychiatrists over the years have shown much interest in my weight problems, but I *will* give them all credit for checking blood levels for signs of diabetes – a possible side effect of some medications. (They could have done so a little more frequently, but that’s a quibble.)
For me, the elephant in the room (sorry, pun unintended) is the *other* effects of obesity – heart disease and high blood pressure, for example. Whilst I agree that being alive and stable is more important in the short term, in my opinion the accompanying weight gain contributes to the shorter average lifespan of bipolar patients. I don’t *like* having a shorter lifespan.
I have gained weight BECAUSE of bipolar medications. I have no doubts that bipolar medications can be responsible for weight gain and metabolic effects. I will say that the weight gain I had because of the bipolar medications was made worse by the fact that those particular medications did not make me stable. In fact, that cocktail did nothing but exacerbate the depression I was in. Though I can’t be sure, I think that if that lousy weight unfriendly cocktail had actually helped me become stable instead of stay depressed, my weight gain would not have been quite as severe.
I successfully lost almost 40 lbs about 7 years ago when the above-mentioned medication cocktail was replaced with a much more weight friendly cocktail. However, before that weight loss was possible, I had to first become stabilized on the new replacement cocktail, which thankfully I did. Without the stability, I would surely not have been successful losing the weight. Please note that the new “weight friendly” cocktail did not MAKE me lose the weight. I made myself lose the weight by the most common weight-loss method in the book – diet and exercise. Without the diet and exercise, I might have lost a little bit of the weight, but not the almost 40 lbs.
Right now I’m still on some of the more weight friendly replacement medications that finally brought me stability. I’m also stable right now, but I wasn’t at times since the weight loss happened. Another medication, Seroquel XR, was added after the weight loss. Seroquel XR was weight neutral for me for a few years because I took only a small dose of 350 mg or less. During those few years I maintained almost all of my 40 lb weight loss. However, med changes were made (for various reasons) and my Seroquel XR was increased. When I reached doses of that med of 450-600 mg, I did put on some weight again. Some of that weight was clearly from the increased hunger I experienced, despite being mostly stable. But some was likely also from aging.
Aging? Yes, I think aging and normal weight gain. Think about it this way, a huge percentage of Americans are overweight and they do NOT take bipolar medications. They can’t pass all of the blame on bipolar medications, so I don’t pass 100% of the blame on them either. Thinking back, at 30 years old I was only 5 lbs lighter than I am now. I did not even take medications (of any kind) at that age. Certainly I can’t blame bipolar meds for that 30 year old weight. I do, however, think I was depressed or in mixed episodes at times back then. I also drank too much alcohol to self-medicate. So, I’m now only 5 lbs more than when I took zero bipolar meds, despite being on 450 mg (and recently up to 600 mg) of Seroquel XR for well over a year. I’m now 46 and not 30 years old. Hmm? Maybe Seroquel XR is not that bad after all.
Agreed. I wish more pdocs would treat their patients as intelligent and actually discuss risks and benefits rather than deciding for them “what’s best”. In any case, monitoring should be not only weight, but also metabolic factors associated with weight gain – lipid profile (cholesterol etc.) and glucose/HbA1c (diabetes). Guidelines aren’t set in stone but the general recommendation is measuring these at baseline (before starting a drug), 3 months in (to get an early sense if the drug is going to have an extreme effect), and annually after that. The person prescribing the drugs should be responsible for making sure this is being done, and that appropriate followup actions are taken if needed.