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Have IBS, borderline personality disorder, depression and anxiety. Weight loss medicine?

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Practicing since : 2004
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Hi. I am a 26yr old female who has been recently diagnosed with Borderline Personality Disorder. For the past 6-8yrs i have been suffering from Depression & anxiety. It wasn't until about 3-4yrs later that i felt there was something else. Something else additional to what is going on. I would self harm and still do today, i bite the top of my right hand, grip down so hard and pull away tearing my skin and i also punch walls. My moods fluxtuate often, sometimes several times a day. I am very angry, can be aggressive, hostile and potentially violent in the way i behave. I was seeing a Psychiatrist who didn't think i had Bipolar but Borderline Personality Disorder. I am no longer seeing this person due to conflict of interest and i didnt think he was helpful. I was just paying him to tell me things i already knew. I have started to see a DBT (Dialetical Behavioural Therapist) who has decided to pit me into a DBT program for 20wks starting in January but also seeing her individually. I am taking 250mg Seroquel at night time daily. While the dose doesn't exactly feel like it is working 100% it is helping a little. As it is i very rarely sleep at night and if i do it isn't for long... I am yet to see another Psychiatrist just awaiting a reply from them. I am having a really hard time with not only my moods, my life, trying not to let relationships break away like they are with my partner, but my weight gain is a huge issue and i know the medication i am taking is not helping this issue. I remember being on my way to 100kg which was 2yrs ago. But now ive just seen them rising. 119kg, 137kg, 152kg and now i am 168kg. I don't have the motivation to want to get up and get active.. I do not feel comfortable in my own skin and i try not to leave the house if i can help it.
I guess my question is.. Is there any weightloss medication i can take with the seroquel? Or anything that can help? What are my options?
Posted Thu, 20 Dec 2012 in Mental Health
Answered by Dr. Ashish Mittal 3 hours later
Thanks for your query.

I appreciate your efforts for medical consultation in so much distress.

Important aspects of your query are:
•     26 year old female
•     Known case of IBS, Borderline Personality Disorder, Depression, anxiety, paranoia
•     Currently on seroquel
•     Concern related to weight (168kg).

In your case, you have gained around 68 kg in last 2 year, which is around 3kg every month. We need to find out cause of so much weight gain and same time start working to reduce it.

I would like to consider multiple possibilities for weight gain in your case:
•     Depression: it may lead to increase eating or binge eating.
•     Thyroid related problem: get thyroid hormonal assay done. Thyroid dysfunction is associated with frequent mood change and weight gain.
•     Sedentary life style
•     Side effect of medicines

In your case it is better to restart visit with psychiatrist. In discussion weight should also be issue, so that psychiatrist can change your medicine, which cause no or minimal weight gain. Apart from that depression need to be manage. There are some medicine (like topiramate) which can be added in your treatment to reduce weight, for which you can discus with your psychiatrist.

Following steps will be helpful to reduce weight:
•     Buy one weighing machine preferably digital and measure weight every week, on a fixed day and on empty stomach in morning. Write weight in front of date in calendar or diary.
•     Most important thing to lose weight is to remain motivated towards your goal. So fix your goal in form of target weight like start with target of 8kg in 4 month. Target around 2 kg weight reduction in every month as it will not disturb physiological functioning of body.

•     Inform your family members about your plan to reduce weight as it will help to continue your motivation towards your goal.

•     It is better to maintain diet chart by simply daily food intake items in diary. Also calculate your calorie (take help of net to calculate calorie of individual food article) intake from that diary and restrict it 2000 k cal per day.

•     Eliminate food items containing sugar and fat from your diet. Increase consumption of salad and fruits in your diet as it will mobilise your fat. Using these principle and according to your dietary habits prepare your own diet chart and stick to that plan.

•     Do not try to reduce weight very fast as it is harmful to health.

•     In exercise plan: Incorporate aerobics and brisk walk in your exercise plan at least for 30 min a day. It is better to follow exercise program daily, rather than alternate day for more benefit. I can understand that you have difficulty in that because of depression, but try as much as you can. It will lift your mood too.

I hope this information has been both informative and helpful for you. In case of any doubt, I will be available for follow ups.

Wish you good health.
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