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What causes weight gain post Zyprexa intake?

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Posted on Wed, 2 Dec 2015
Question: Hello, My son took zyprexa for acute psychosis for 6 weeks Dec 14-Jan 15. He gained 25lbs in that short time and developed a folliculitis of his scalp as well. He stopped taking it due to weight gain and uncontrolled hunger. (He was previously a lean, healthy weight 20 year old with great eating habits.) After a brief period off zyprexa, his appetite decreased significantly and his weight gain slowed down. However, it has now been 10+ months off the zyprexa and he appears to have permanent changes to his metabolism. He has fat pockets on his outer abdomen / hips, a belly, and multiple large stretch marks. He is exercising 5 days a week, eating very healthy, and has been taking metformin to see if that would help with appetite and/or weight loss. He has only lost 10 pounds after 6 months of serious diet and exercise. He is still much hungrier then he ever had been pre-zyprexa. Of note, he also took lithium for a period of 4-5 months from 4/15 to 9/15. This seemed to cause thyroid issues, which had been hovering in the 3-4.5 range (tsh) He started taking synthroid 12/14 in an attempt to maintain "optimal" thyroid function in light of his psychological issues. Over time, and with the insult of lithium, the tsp worsened and got as high as 10.1 with synthroid treatment. It finally is down to 2.1 on a daily dose of 75 mcg of synthroid. He still sleeps a lot and has poor sleep quality (dream state with little deep sleep. He just stopped taking the metformin (was on 1500 mg/day) because he is tired of taking so many pills and wasn't sure it was helping his appetite or weight.

My questions -

Do you think my son has permanent metabolic changes? Why is he still so hungry and having such a hard time losing weight? He seems to have the metabolism of an 80 year old female.

Is there anything else we can do to try to normalize his metabolism and help him lose weight, have more energy or be less hungry? Basically reverse the effects of the zyprexa?

Do you expect his thyroid might improve since he is no longer taking lithium?

Thank you so much!
doctor
Answered by Dr. Seikhoo Bishnoi (1 hour later)
Brief Answer:
His weight will become normal

Detailed Answer:
Hello, thanks for asking from HCM

I can understand your concern for your son. First of all I'd like to tell you that metabolic changes caused by Zyprexa don't remain permanently. The drug cause increase in hunger and cause fat deposition. This results in increased weight. The gained weight takes time to decrease because of associated symptoms of psychosis. After psychosis dietary habits changes and this is probably the reason of his persistent increased hunger.

If the issues related to metabolism are causing problems the drugs like Topiramate can be tried. The drug is a mood stabiliser and helps in reducing the weight. This will reverse the side effects related to metabolism caused by Olanzapine.

Yes since he has discontinued the Lithium his thyroid will improve definitely. In most cases improvement is seen with in 6 months of stopping drug.

So remain assured, his weight will come in normal range in some time.

Thanks, Hope this helps you, if you have more doubts you can ask again.

Take care
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Seikhoo Bishnoi (19 hours later)
Thank you very much. His doctor thought topiramate may make college studies difficult due to memory and brain fog issues that topiramate would likely cause. What do you think? I wonder if a small dose would help? Does this medication control hunger or improve metabolism? Thanks again!
doctor
Answered by Dr. Seikhoo Bishnoi (35 minutes later)
Brief Answer:
Topiramate if started with low dose will definitely help.

Detailed Answer:
Hello thanks for asking a follow up question

Yes Topiramate is known to cause brain fog like symptoms in some individuals but this doesn't occur in every individual. The drug can be given a try. In my opinion if patient start with low dose and doses are increased gradually then the risk of brain fog reduces significantly.

The drug helps to reduce weight and improve metabolism if taken regularly.

Thanks. Still have doubts please ask again. Take care
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Seikhoo Bishnoi (4 minutes later)
Thanks very much!
doctor
Answered by Dr. Seikhoo Bishnoi (0 minute later)
Brief Answer:
Thanks and Take care

Detailed Answer:
Thanks and take care.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Seikhoo Bishnoi (2 days later)
Thank you very much. I'm wondering if I can ask you a couple more questions. We are struggling to understand why my son is still having some symptoms of psychosis. His symptoms involve very mild dilusions and also not feeling right, brain fatigue, headachy, and other complaints in this regard. My son has been treated for 15 months now. The psychosis started after my son used ecstasy. At that time, symptoms were related to a ghost being out to get my son and getting in his spine and hurting him while he slept...also sensations of feeling the ghost and an intense fear. My son was put on seroquel (in addition to Effexor that he was already taking) and the psychosis went away mostly but my son slept for about 16-20 hours per day. His dose was lowered and lowered over the next few months and psychosis came back in the form of paranoid dilusions about the government. My son was put on zyprexa and things got better in terms of psychosis, but he gained a ton of weight and stopped taking it. We discovered trilifon, which didn't give my son akathesia like three of the 2nd gen APs did. He also started taking g lithium. Things were pretty good for a short time, although excessive sleep continued. 12-15hra/day. The lithium started to damage an already volatile thyroid and tsh got as high as 10 despite thyroid replacement for 6 months and a dose of 75 mcg. My son went off the lithium and we thought maybe he wasn't bipolar since he didn't become manic off lithium. He did develop his old personality that was a little quirky and mildly manicy, but this was his usual self since teenage hood. Things were good for a couple weeks it seemed, then we decided my son wasn't functioning well bc of all the sleep. Doctor decreased trilifon from 6mg to 4mg. This was a few weeks ago and psychosis is returning. It was very low level before stopping the lithium and decreasing trilifon. Now becoming bothersome and making my son feel hopeless. He also has a cold right now and he has noticed whenever he gets sick with a virus or head cold, his psychosis returns and flares up. Do you know why this would happen and what does it mean when a cold worsens psychosis?

Finally, my question is...We don't underatand why the psychosis is continuing to be a problem. My son quit marijuana successfully for the last 6 -8 months. Before that, he struggled off and on for about 6 months after original psychosis.

Do you think he has bipolar or another diagnosis? He had anxiety from 14 on (untreated) then a severe neck injury resulting in chronic muscular pain from age 16 on, and intermittent symptoms of depression/anxiety during early college that we tried to treat with an SSRI unsuccessfully. My son smoked marijuana from age 17 until 6-8 months ago.

Mood is good currently when the psychosis is very mild. Right now, he feels like there is no hope to get better.

How do we stop the psychosis? Why won't it stop despite seeming to do everything right?

Would it help to take a one time dose of zyprexa?

Is it a bad sign that this is all going on so long?

Any insight you have would be appreciated. Thank you very much!
doctor
Answered by Dr. Seikhoo Bishnoi (20 hours later)
Brief Answer:
ATPD symptoms might persist in some individuals try to ignore the symptoms

Detailed Answer:
Hello thanks for asking a follow up question

A lot of individuals who abuse ecstasy or marijuana develop acute psychosis as complication. This psychosis usually doesn't complicate into full blown psychosis. The psychosis is called Acute Transient Psychotic Disorder. In most cases full recovery is seen so no need to worry.

The symptoms might persist in some individuals but in most individuals with in 6-12 months symptoms remit. If his symptoms are persisting the continue with his antipsychotic drugs and the symptoms will decrease. Second generation antipsychotic drugs usually cause increase in weight so should be avoided. First generation antipsychotics like Haloperidol can be tried. The drug doesn't cause metabolic side effects and is safe in low doses.

I don't think its bipolar disorder. As he had anxiety disorder prior to his psychotic episode and this could be the reason his symptoms are persisting.

Try to ignore the mild symptoms he is having. A lot of individuals with anxiety have mild paranoid like ideas but these are not full blown delusions and are not the symptoms of psychosis.

So continue to give him medicines and his psychosis will improve. As Zyprexa caused weight gain so no need to give him this drug. The symptoms will remit in some days.

No its not bad sign. No need to worry. The symptoms will remit by self in some days.

Thanks. Still have doubts please ask again. Please excuse me for late reply.

Take care
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Seikhoo Bishnoi (21 hours later)
Thank you so much! Your answer helps me so much. Do you think he should take a medication for anxiety? I wonder if his anxiety was treated then perhaps he could wean off the antipsychotic? it makes him very tired. Thank you for sharing your knowledge!
doctor
Answered by Dr. Seikhoo Bishnoi (8 hours later)
Brief Answer:
Anti anxiety drugs will definitely help in reducing the symptoms.

Detailed Answer:
Hello again and thanks for asking a follow up

Low doses of anti anxiety drugs might help and he would come out of his symptoms. No need to worry. Once his symptoms are under control then antipsychotics can be weaned off gradually without any risk.

Thanks, still have doubts please don't hesitate to ask again.

TAKE CARE
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Seikhoo Bishnoi

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What causes weight gain post Zyprexa intake?

Brief Answer: His weight will become normal Detailed Answer: Hello, thanks for asking from HCM I can understand your concern for your son. First of all I'd like to tell you that metabolic changes caused by Zyprexa don't remain permanently. The drug cause increase in hunger and cause fat deposition. This results in increased weight. The gained weight takes time to decrease because of associated symptoms of psychosis. After psychosis dietary habits changes and this is probably the reason of his persistent increased hunger. If the issues related to metabolism are causing problems the drugs like Topiramate can be tried. The drug is a mood stabiliser and helps in reducing the weight. This will reverse the side effects related to metabolism caused by Olanzapine. Yes since he has discontinued the Lithium his thyroid will improve definitely. In most cases improvement is seen with in 6 months of stopping drug. So remain assured, his weight will come in normal range in some time. Thanks, Hope this helps you, if you have more doubts you can ask again. Take care