Lithium weight gain

Lithium augmentation of antidepressants, carbamazepine, lamotrigine, and valproate can improve response, but it may increase the risk of sedation, weight gain, GI complaints, and tremor. 

Other late-appearing lithium side effects include benign reversible leukocytosis, acne, alopecia, exacerbation of psoriasis, pruritic dermatitis, mac-ulopapular rash, folliculitis, and weight gain. 

Despite the widespread use of neuroleptics in maintenance treatment of bipolar disorder, there have not been any systematic studies of their suitability for this role. Through clinical experience it has been widely accepted that neuroleptics are useful adjunctive treatments to lithium and related drugs. Treatment refractory patients frequently respond to atypical antipsychotics such as clozapine or risperidone. Such adverse effects as EPS, cognitive dysfunction and weight gain frequently limit the long-term use of classical neuroleptics. For this reason, the atypical neuroleptics such as olanzapine and risperidone should now be considered as alternatives for maintenance treatment. 

Polyuria, polydipsia, tremor, ataxia, nausea, diarrhea, weight gain, drowsiness, acne, hair loss Possible effects on thyroid and renal functioning with longterm administration Children prone to dehydration are at higher risk for acute lithium toxicity... 

Weight gain is a frequent side effect of lithium treatment. Dermatological Effects... 

Lithium Neurological tremor, ataxia, seizures Endocrine hypothyroidism Cardiovascular T wave changes, sinus node dysfunction Renal polyuria, nephrogenic diabetic insipidus Dermatological hair loss, acne, psoriasis, rash Gastrointestinal nausea, diarrhea Miscellaneous fluid retention, weight gain, weakness... 

Like some other antidepressants and lithium, the MAOIs can also cause weight gain. Because they do not affect cholinergic receptors, they produce less constipation, dry mouth, and blurred vision, typically associated with the tricyclics. MAOIs do produce some similar adverse effects, particularly urinary hesitancy, possibly because... 

Vestergaard P, Poulstrup I, Schou M. Prospective studies on a lithium cohort. 3. Tremor, weight gain, diarrhea, psychological complaints. Acta Psychlatr Scand 1988 78 434-441. 

Garland EJ, Remick RA, Zis AP. Weight gain with antidepressants and lithium. J Clin Psychopharmacol 1988 8 323-330. 

Edema is a common adverse effect of lithium treatment and may be related to some effect of lithium on sodium retention. Although weight gain may be expected in patients who become edematous, water retention does not account for the weight gain observed in up to 30% of patients taking lithium. 

Aripiprazole Blockade of 5HT2A receptors > blockade of D2 receptors Some a blockade (clozapine, risperidone, ziprasidone) and M-receptor blockade (clozapine, olanzapine) variable receptor blockade (all) Schizophrenia—improve both positive and negative symptoms bipolar disorder (olanzapine or risperidone adjunctive with lithium) agitation in Alzheimer s and Parkinson s (low doses) major depression (aripiprazole) Toxicity Agranulocytosis (clozapine), diabetes (clozapine, olanzapine), hypercholesterolemia (clozapine, olanzapine), hyperprolactinemia (risperidone), QT prolongation (ziprasidone), weight gain (clozapine, olanzapine)... 

Long-term side effects of lithium treatment include weight gain. The treatment is associated with development of hypothyroidism in about 10-15% of cases. There is an association with kidney disease. Birch has expressed the general view that Li may interact with magnesium-dependent processes, and theoretical chemistry supports this view. Despite the widespread clinical significance of Li, there is presently no consensus on its mode of action. One postulate for the mechanism is termed hyperpolarization . Li affects the conductivity in cell transport channels. Other explanations include modulation of neurotransmitter concentrations and inhibition of Na+/K+/Mg2+/ Ca2+ ATPases. 

Weight gain, a well-recognized adverse effect of lithium, occurs in one-third to two-thirds of patients (687). It is... 

In a 12-month maintenance study, weight gain was an adverse event in 21% of patients taking divalproex, 13% of those taking lithium, and 7% of those taking placebo (697). The divalproex/placebo difference was statistically significant, but the lithium/placebo difference was not. 

In 15 consecutive patients, serum leptin concentrations were measured at baseline and after 8 weeks of lithium treatment. There was a significant mean increase of 3.5 ng/ml and serum leptin correlated positively with weight gain (5.9 kg), increased BMI (24-27), and clinical efficacy (699). The authors suggested that leptin might play a role in lithium-induced weight gain. 

Atmaca M, Kuloglu M, Tezcan E, Ustundag B. Weight gain and serum leptin levels in patients on lithium treatment. Neuropsychobiology 2002 46(2) 67-9. 

When 60 patients (22 men, 38 women) who had taken lithium for 1 year or more (mean 6.9 years mean serum concentration 0.74 mmol/1) were interviewed about adverse effects, 60% complained of polyuria-polydipsia syndrome (serum creatinine concentrations were normal) and 27% had hypothyroidism requiring treatment (108). Weight gain was more common in women (47 versus 18%) as were hypothyroidism (37 versus 9%) and skin problems (16 versus 9%), while tremor was more common in men (54 versus 26%). Weight gain of over 5 kg in the first year of treatment was the only independent variable predictive of hypothyroidism. 

Long-term use of lithium is sometimes associated with weight gain, polyuria and polydipsia, and thyroid dysfunction (see below), but many patients have been treated successfully for several decades without developing treatment-limiting adverse effects. However, long-term success should not breed complacency, since there is an ever-present risk of recurrence (if concentrations are too low) and toxicity (if concentrations are too high). 

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