Q:  Questions re: Lithium & Weight Gain & Thyroid

Dear Dr. Phelps,

Apologize for this poorly written e-mail, hope you can still understand me. I am not in a good mood at the moment.

I hope you can provide me with some expertise in my situation. Prior to getting the diagnoses of Bipolar Affective Disorder (type 1 I beleive is the term) about 9 years ago (but was left untreated for 4 years prior to that which caused me great stress/etc...) but stabilized after the hospital figured out lithum was working but difficult for me to take. I think it has to do with the way the capsule itself and the fact I had to mush it into food because I couldn't swallow the pill of that size for some reason (not used to it) 

Anyways, I take a high dosage of lithium, been taking a consistant amount of 1200 mg daily for most of my diagnoses (difficult but usually keep at least 900mg). I am told that I require the "salt" aspect of lithium because I do not produce it as told by my other doctor (my mom who told  me what the doctors told her) I notice a symptom that when I sweat (prior to lithium) I lost the salty effect that most people have when they prespire now with lithium I hav  e it back but its more acidic. I put on weight with lithium over the years, not too much but enough to make me worry because I don't like and yet I don't think doing excercise would help much because I am retaining water as it feels like it. 

I also want to know what lithium has been doing to my thyroid, because I have developed a case of dry eyes which I never had since the past year or so. Right now I'm thinking I need a Thyroid test, but wonder what would my GP do if I take lithium which I read blocks the  way the thyroid works. I'm confused and seriously need professional help to save lithium from destroying my thyroid, liver, kidney etc..as long term treatmen may cause not sure. Lithium has shown to be effective among anything else out there. I hope you understand this e-mail as I want answers but in Canada, it's hard to get doctors that specializes in treating BP disorder unless you prepared to get druged with Seroquel, Respritol, Zyprexa (all by the way don't work for m  e but overall made me feel slow and sleepy) I don't get why they would prescribe something that doesn't work!!! That is why I use a GP and not a specialist in mood disorder. Anyways, I hope to hear back.

Sorry about this hastly worded e-mail to you but I am sure you can skim through it and figure out what I am trying to say. If you don't want to read this one I can write another but right now I am upset because I know more facts after reading your website. Know more about bipolar is beneficial and worrysome because all what treats it is bad if not deadly short/long term.

Sincerely,
 

Dear E' -- 
No problem, your questions are clear ( I added a few paragraph separations).  So, first before I forget, you may know there's a liquid form of lithium that works as well (lithium citrate) and should cost about the same, in case that makes it any easier to swallow, so to speak. 

Second, will exercise help manage lithium weight gain?   You're right, lithium causes people to hang on to some extra water, as much as a few pounds -- but that effect stops there, whereas the "weight gain" from lithium can go on, so we presume it's fat accumulation at that point.  Could exercise help manage that?  We have little reason to suspect otherwise, actually.  And since exercise has all those other benefits, and very little risks as long as you don't overdo it (ask your GP how much is okay, if in doubt), it certainly is worth trying.  Try this essay on Exercise: not the Usual Rap. 

Third, can lithium have interfered with thyroid hormone production, leaving you hypothyroid? (dry eyes might be a symptom; dry skin certainly is)  Definitely possible.  Getting a thyroid test is standard while on lithium so if you haven't had one in a year (some people even say 6 months), you're due for that test anyway.   

Fourth, uh, don't get me started on why doctors use then new-generation antipsychotics at great expense and risk of diabetes, not to mention sedation and can't-think effects, when we have lithium, Depakote, carbamazepine, and lamotrigine (and maybe even fish-oil works).  I understand your frustration there (although should point out that those medications work beautifully for some people and should definitely not be stopped by anyone without discussing it with her/his doctor, etc.). 

Dr. Phelps

Published November, 2004