Weight Gain Struggles

One of the enduring effects of my psychiatric medication side effects is the weight gain.

Side effects can occur when one starts a new medicine or when there is a dose change in a medicine one is already taking. I had a medicine dose change, an increase, in 2013, shortly after the picture on the left was taken to control a manic episode. In 2013 I gained 52 pounds over the span of a three- or four-month window of time.

In 2015, while manic again, I managed to lose about 25 pounds or so. I wasn't consciously trying to lose weight, I wasn't exercising, but when I'm manic I eat less. I wrote about my weight fluctuations last year. But since then I've gained all the weight back. I think it partly had to do with my birth control.

I used to avoid taking pictures after I initially gained the weight. I was used to being thin my entire life and to all of a sudden put on so much weight... I didn't like the way I looked in clothes. I felt frumpy.

Now, I make an effort to buy clothes that flatter my shape. And it doesn't hurt that my boyfriend likes my current body. It's a great boost to my self-esteem and body image.

I'd still like to lose some of this weight. I don't need to get back down to 128 pounds (I'm currently 169 pounds), but I want to be smaller. I haven't been exercising consistently. To change that, I signed up for a fitness class held at my town's recreation center. The first class is next week. I'm hoping to attend regularly.

Wish me luck!

Weight Loss and Weight Gain Update

In June 2013, my Seroquel dose was increased from 600mg to 800mg. Seroquel is notorious for weight gain as a side effect. Mind you, I had been on Seroquel for 6 years on a low dose of 100mg and had never had weight gain issues.

 

But at 800mg, the uppermost dosage I believe, I didn't stand a chance. I couldn't control my hunger urges. I was eating everything in sight. Literally. I was eating all the time. And the pounds packed on. I gained 52 pounds in three to four months. In my first 29 years, I had never weighed more than 128 pounds. In fact, it took me forever to break 125 pounds. I was so happy when I finally weighed that much. But after the Seroquel weight gain, I got up to 171 pounds. The weight gain coincided with a 12-month depression. I'm sure the body image issues I gained did nothing to help the depression.

 

I became manic during the summer of 2014 and the weight just started to fall off. I wasn't exercising, but I was consciously eating less (as a tactic and as a side effect of the mania). And I've heard weight loss is more about diet than exercise. Well, they work together, but portion control goes a long way.

 

After this recent manic hospitalization (March 2015), I lost a few pounds as I always do when I'm having an episode (whether manic or depressive; I don't eat much during either). But since getting discharged, I've gained about 11 pounds. I'm currently hovering between 140 and 142 pounds. I don't think I'll see 128 pounds again, but I also don't want to be more than 150.

 

I'll be going back to watching my portion sizes and I'm going to get back into a consistent exercise routine. I haven't exercised consistently since before the third mania (summer 2014). A year ago I was exercising three to four times per week. That is my goal again.

 

What a difference a year makes!

Left: February 2014

Right: February 2015

Weight Loss

As I've written before, I gained 52 pounds in about a three or four month window last year. I normally weigh between 125 and 128 pounds. I've never been heavier than 128. At my heaviest last year I weighed 171.

I can proudly report that I have lost a total of 17 pounds! I now weigh 154. I exercise two to four days per week. And since I got out of the hospital two weeks ago, I've been making a conscious effort to eat less. The IOP (Intensive Outpatient Therapy) nurse also told me that the new medicines I'm on (Latuda and Lithium) respond better to exercise, so I'll have an easier time losing weight.

I'm hoping to lose another 14 to 19 pounds. So my new ideal weight is 135 to 140. I don't know if I'll ever see 128 again. My primary care doctor told me that I was too thin before. But it's the only weight I've known. I'm naturally thin. I didn't hit 125 until my mid-20s; I'm only 30 now. And I'd like to fit into my old clothes. I can't fit about 75% of my wardrobe. And I love clothes!

I hope I lose another five pounds this summer. I joined the YMCA for the summer. My goal is to take three fitness classes per week for the summer: spinning, cardio, yoga, water aerobics, and zumba. During the school year my job subsidizes a personal trainer to work out with the faculty and staff. We only have to pay $5 per class! (Side note: I teach at a great school.)

What are your fitness goals? What do you do to stay motivated? Do you have any tips or suggestions for me to lose the last 14 to 19 pounds? Thanks in advance!

Medicine Side Effects

I've been on a number of medications. I'm currently on Lithium (the only drug specifically for mania) and Latuda (an atypical antipsychotic). I take Temazepam and Lunesta for sleep. This is my third time on Lithium. It works very fast and is my favorite medicine.

During my first hospitalization in 2007, I tried the following drugs before I found a combination I responded to: Depakote, Risperadal, Lithium, and Seroquel. In fact, I was on 2500mg of Depakote, the highest dose possible but it did nothing for me. That's how psychotic and manic I was.

I left the hospital on Lithium and Seroquel. I respond to very low doses of Lithium. After my 17-day hospital stay, I did 6 weeks of IOP (intensive outpatient therapy, for 3 days per week, from 10:30am to 2pm). While in IOP, you continue to see either a nurse practitioner or a psychiatrist and a therapist. I've found IOP to be incredibly helpful. I'm looking forward to going back on Wednesday, June 11th.

With Lithium you have to get frequent blood work done to check the therapeutic level of the medicine in your system and to make sure the medicine isn't toxic. It gets toxic rather easily. "Lithium acts on a person's central nervous system (brain and spinal cord). Doctors don't know exactly how lithium works to stabilize a person's mood, but it is thought to help strengthen nerve cell connections in brain regions that are involved in regulating mood, thinking and behavior" (WebMD). Lithium side effects can: affect kidney function; hand tremor (If tremors are particularly bothersome, an additional medication can help); increased thirst; increased urination; diarrhea; vomiting; weight gain; impaired memory; poor concentration; drowsiness; muscle weakness; hair loss; acne; decreased thyroid function (which can be treated with thyroid hormone) (WebMD). The Lithium has exacerbated my cystic acne and psoriasis. 

Side effects occur when you begin a new medicine or when the dose is increased. In 2007, the IOP psychiatrist increased my Lithium from 600mg to 900mg. Within a week I had a severe skin reaction. My face swelled up with about a half a dozen cysts. My cheeks were so swollen that my eyes were almost shut tight. I looked like the elephant man (see below). Needless to say I was taken off the Lithium and I had to go to my dermatologist to receive painful cortisone injections directly into the cysts. The Lithium has also caused my psoriasis to flare up; I have psoriasis on my scalp, palms of my hands, and on my legs.

I was on Tegretol from 2007 to 2013. I believe I was on 300mg. I didn't have any side effects on the Tegretol. But side effects can include: feeling dizzy, drowsy, or unsteady; nausea, vomiting, diarrhea, constipation, stomach pain; headache, ringing in your ears; dry mouth, swollen tongue; or joint or muscle pain and leg cramp (Rx List). I also had to get routine blood work on the Tegretol. And all of a sudden in February 2013, my liver function test came back toxic. I don't know how sick my liver was, but it was enough that both my primary care doctor and psychiatrist were concerned. I stopped the Tegretol immediately. Since I had been stable for six years, my psychiatrist did not replace the Tegretol with another medicine. So at this point I was only on 100mg of Seroquel. I spoke to my colleague/acupuncturist and she suggested I increase my water intake, start drinking Yogi detox tea, and add chia seeds or flax seed to my diet. At this point I was also exercising three days per week with a trainer. After two months, my liver healed itself; the liver can do that.

In 2013, they also tried to put me on Trileptal as it is a derivative of Tegretol, the medicine I had been on for 6 years. However, my roommate or one of her guests smoked in our room. No smoking is allowed on the floor. When I came back to the room after visiting hours, I smelled the smoke. When I am manic I am highly allergic to cigarette smoke. Within minutes a severe rash broke out across my face. It felt like a sunburn and I was screaming and crying hysterically. I had a blowout argument with my roommate who insisted that she wasn't smoking. I don't care who was smoking. The point was that somebody did. I was taken off after only 3 or 4 days.

The Seroquel made me gain 52 pounds in about 3 months! From 2008 to 2013, I was only on 100mg of Seroquel. I told you I can function on a really low dose. Well, after my 2013 hospitalization, the Seroquel was increased to 600mg. After I got out of IOP I started to have sleep problems, so my personal psychiatrist increased my dose to 800mg, the highest dose possible. Seroquel is heavily sedating; if I had a lot of grading to do, I would skip my dose. But if I didn't take it, I wouldn't sleep. I was definitely dependent. I didn't have any weight gain for the 6 years I was on 100mg, but as soon as the dose was increased I starting putting on weight. Seroquel makes you insatiably hungry. It makes you crave carbs and sugar. And it screws with your metabolism so your body processes the food differently. Seroquel side effects include: dizziness, drowsiness, tired feeling; dry mouth, sore throat, nasal congestion; stomach pain, upset stomach, nausea, vomiting, constipation; breast swelling or discharge; missed menstrual periods; and/or increased appetite and weight gain (Rx List). Despite the weight gain, I had to wait 6 months (and gain even more weight) because I was in a 6 month relapse window. I was tapered off the Seroquel in November 2013.

The picture on the left is from April 19, 2013 (the day I was hospitalized); the picture on the right is from Memorial Day 2013. I would go on to gain 20 more pounds after Memorial Day.

 This picture is from April 2013; a few days before I was hospitalized.

This picture is from June 2014, the night of the Janelle Monae concert; a day before I was hospitalized.

I say all this to say, every medication has side effects. If you need to take medicine, you have to make sure to do your homework and ask your providers lots of questions. For me, the possible risk of more skin reactions is worth it because I cannot function without the meds. Well, I could. But it wouldn't be ideal. I specifically asked to be put back on the Lithium. The psychiatrist was impressed that I came with my own treatment plan. He said but "unfortunately, he still had to charge me the full price even though I did his job for him!"