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Lithium & Weight Gain: How Much? (And Why It Happens)

Lithium is a naturally occurring element that’s commonly prescribed in the format of “lithium carbonate” for the prophylaxis and/or management of bipolar disorder.  Additionally, lithium is sometimes prescribed as an adjunct to treat refractory cases of major depressive disorder and schizophrenia.  Throughout treatment, lithium is understood to modulate numerous aspects of a user’s neurophysiology to help control his/her neuropsychiatric symptoms.

Specifically, pharmacodynamic research reveals that lithium: modulates NMDA receptors, GABA receptors and nitric oxide (NO) signaling; increases serotonin synthesis and secretion; decreases norepinephrine release; and inhibits pAp-phosphatase.  It is through the aforementioned mechanisms that lithium stabilizes mood in persons with bipolar disorder – and alleviates depression plus suicidality among individuals with major depressive disorder.

Although many patients find lithium effective for the management of neuropsychiatric symptoms, some will struggle to cope with the side effects.  One of the most distressing side effects associated with lithium treatment is weight gain.  It is estimated that over 20% of all lithium users will gain weight as a result of treatment.

Lithium & Weight Gain (Potential & Hypothetical Causes)

If you end up gaining weight while using lithium, listed below are some potential and hypothetical causes.  Most available literature suggests that common causes of lithium-induced weight gain include: increased thirst; increased appetite; and sodium retention.  Other potential causes of lithium-mediated weight gain might include: altered metabolism; hormonal fluctuations; fatigue; and constipation.

Nonetheless, the exact cause(s) of weight gain among lithium users is likely subject to interindividual variation.  In other words, weight gain for one lithium user may be mostly attributable to increased thirst and/or water retention, whereas weight gain for another user might be more attributable to increased appetite and/or slowed resting metabolic rate.  In short, the underlying causative mechanism(s) for weight gain on lithium may slightly vary among users.

  • Appetite increase: It is understood that approximately one-third of lithium users experience increased appetite as a side effect of treatment. Though increased appetite doesn’t guarantee weight gain, it’s generally difficult to consistently exercise self-restraint around foods when appetite remains high.  If you cannot discipline yourself around food due to a skyrocketing appetite on lithium – you may end up consuming more calories than your body expends, ultimately yielding weight gain.  That said, some experts believe that increased appetite is a very weak influencer of weight gain on lithium.
  • Bloating or edema: Lithium is understood to cause increased thirst (polydipsia) as a side effect – which can lead users to consume more fluids than usual.  Increased consumption of fluids causes greater water storage within the body, making it easier to bloat or exhibit edema – ultimately accounting for “water” weight gain.  In fact, many medical doctors and researchers believe that a majority of the weight gain on lithium is “water” weight from increased water retention and storage (rather than fat gain).
  • Cognitive deficits: Cognitive deficits such as confusion and decreased memory are considered frequent side effects of lithium treatment – occurring in over 10% of users. Though cognitive deficits cannot directly cause weight gain, they might indirectly lead to weight gain.  For example, if you experience such significant “brain fog” or disorganized thinking that you have trouble planning low-calorie, nutrient-dense meals – it might become easier to gain weight.  Moreover, cognitive deficits could make it challenging to self-regulate (or stay disciplined) around food – leading to greater calorie intake and weight gain.
  • Constipation: Constipation is a side effect of lithium that occurs in over 10% of users. Although constipation is generally a transient side effect that abates with long-term or ongoing lithium use, constipation could account for some temporary weight gain among lithium users.  If you experience frequent constipation as a result of lithium, body weight will appear greater than usual because digested food hasn’t been excreted.
  • Cravings: A subset of lithium users may experience cravings for certain foods and/or beverages as a side effect. While some individuals might crave carbohydrates or sugary foods, others might crave salty, fatty, or savory items.  Although cravings for foods and/or beverages can be resisted, some individuals may find the cravings to be overwhelming and/or difficult to manage.  If you’re unable to resist the food cravings – you may end up consuming a greater number of calories than you did prior to using lithium – leading to weight gain.
  • Fatigue or lethargy: Lithium can cause fatigue or lethargy as side effects in a subset of users. If lithium decreases your energy level, this might cause you to exercise less frequently during treatment (compared to pre-treatment).  Less exercise or physical activity throughout treatment will result in: fewer calories being burned; slowed metabolic rate; and increased fat storage – compared to pre-treatment, making it easier to gain weight.
  • Fat storage: Another possible means by which lithium might induce weight gain for a subset of users is via increasing fat storage.  Increased fat storage may be caused by lithium-mediated: hormone changes, decreased metabolic rate, and/or altered carbohydrate and/or fat metabolism.  In other words, the body may end up retaining more fat throughout lithium treatment than it did prior to lithium use.  Though there’s no evidence to suggest that lithium directly induces increased fat storage, enhanced fat storage might explain weight gain in certain lithium users.
  • Gut bacteria changes: It’s unknown as to whether lithium treatment modulates concentrations of gut bacteria. Because many neuropsychiatric drugs alter gut bacteria in ways that cause weight gain – it’s fair to hypothesize that lithium could do something similar.  If lithium upregulates populations of gut bacteria that increase appetite, water retention, and/or fat storage – then gut bacteria could be implicated in weight gain.  Gut bacteria changes from lithium could negatively alter hormone levels and/or cause bloating and/or constipation-related weight gain.
  • Hormone modulation: Weight gain on lithium may be partly caused by modulation of hormone levels. Research suggests that lithium substantially modulates signaling of numerous hormones including: leptin, ghrelin, testosterone, estrogen, insulin, thyroxine (T4), and cortisol.  Fluctuations in these hormones might slow resting metabolic rate, increase adipose (fat) storage, and/or increase appetite (leading to increased caloric intake) – all of which could yield weight gain.
  • Increased thirst (polydipsia): One of the most common side effects of lithium is polydipsia, a medical term used to describe “excessive thirst.” If you experience thirstiness or increased thirst while using lithium, it makes sense that you’ll end up drinking more fluids than usual in attempt to quench it.  Consuming more fluids than usual can lead to increased water retention and “water weight” throughout the body.  Increased water weight can account for some of the weight that you gain while using lithium.  If you drink calorically-dense beverages such as sodas, juices, sports drinks, etc. to quench your thirst – the calories within these drinks may also lead to fat gain.
  • Slower metabolism: Lithium may significantly slow the resting metabolic rate (RMR) in a subset of persons. A slower resting metabolic rate means that the body is burning (i.e. expending) fewer calories at rest than prior to treatment.  Possible reasons for slower metabolic rate while using lithium include: decreased exercise (due to fatigue); hormone fluctuations (particularly decreased thyroid function); and shifts in neurotransmitter levels.  If lithium slows your metabolism, this could account for some of the weight that you gain in treatment.
  • Social eating: Untreated bipolar disorder and/or major depressive disorder can sometimes lead to social isolation. If you derive significant benefit from lithium treatment and it leads to increased socialization and/or sociability – you may end up pursuing more social events, a common one of which is dining out.  In the event that you dine out more often while using lithium (than before treatment), this behavior might account for some weight gain.  Though going out to eat doesn’t always cause weight gain – it may increase likelihood of gain due to the calorie-dense foods and large portion sizes served at most restaurants.
  • Sodium & water retention: It is widely known that lithium increases sodium retention, which in turn, leads to increased water retention throughout the body. Increased water retention throughout the body causes bloating or edema and weight gain (in the form of water weight).  Though cutting back on sodium may be helpful for minimizing edema-related weight gain on lithium, some weight gain as a result of sodium retention and corresponding water retention is likely inevitable.
  • Taste changes: Some individuals will notice that lithium alters their perception of taste – such that foods taste differently during treatment than they did prior to treatment. Taste alterations may lead you to develop a preference for consuming foods that were never preferred before treatment.  For example, certain lithium users claim that the medication makes them crave salty, fatty, and/or savory foods.  If the taste changes are causing you to consume more foods that are calorically-dense OR foods that increase water retention (due to high salt) – this might account for some weight gain.

Lithium & Weight Gain (The Research)

Included below is a summary of trials and/or scientific research in which the effect of lithium on body weight was documented.  As you’ll read below, most evidence suggests that weight gain is a common side effect of lithium treatment.  Though most patients are likely to gain weight with long-term lithium maintenance therapy, only a small percentage will exhibit clinically-significant weight gain (characterized by +7% body weight increase from baseline).

2006: Effects of lamotrigine and lithium on body weight during maintenance treatment of bipolar I disorder.

Sachs, Bowden, Calabrese, et al. conducted a retrospective analysis to compare the effect of lamotrigine (Lamictal) maintenance therapy on body weight to that of lithium, as well as that of a placebo.  Researchers retrospectively analyzed data from multiple randomized, double-blind, controlled trials, which in total, were comprised of 583 patients with bipolar 1 disorder.  Of the 583 participants, it was noted that: 227 received lamotrigine; 166 received lithium; and 190 received a placebo – for an 18-month duration.

Researchers specifically evaluated average body weight change of participants, the percentage of individuals with clinically significant weight change, and the percentage of persons with weight-related adverse effects.  Results indicated that average weight changes over the span of 1 year among participants were: +2.2 kg with lithium; +0.2 kg with placebo; and -1.2 kg with lamotrigine.  Moreover, the percentages of participants with clinically significant weight gain were as follows: 11.8% of lithium recipients; 10.9% of lamotrigine recipients; and 7.6% of placebo recipients.

Conversely, the percentages of participants with clinically significant weight loss were: 5.1% of lithium recipients; 12.1% of lamotrigine recipients; and 11.5% of placebo recipients.  It was concluded that long-term lithium maintenance therapy is associated with weight gain.  This retrospective analysis clearly supports the idea that lithium can cause weight gain in over 10% of users.

  • Source: https://www.ncbi.nlm.nih.gov/pubmed/16542188

1995: Lithium and body weight gain.

Baptista, Teneud, Contreras, et al. noted that weight gain is an unwanted side effect associated with long-term lithium therapy.  Because the specific causes of lithium-induced weight gain aren’t fully elucidated, researchers suggest that it’s often challenging to manage in patients.

Researchers reference one study reporting weight gain of at least 10 kg in 20% of lithium users, and another study reporting weight gain of 6.3 kg among lithium users.  Animal model studies reviewed by researchers indicate that chronic lithium treatment yields excessive weight gain only in female rats – but not males.

Though weight gain occurs in both male and female humans treated with lithium, studying an animal model was thought to potentially reveal mechanisms behind the weight gain.  In this paper, researchers discuss how lithium interacts with the endocrine system, neurotransmitters, metabolism, electrolyte levels, feeding behavior, and gonadal steroid function – each of which might help explain its propensity to cause weight gain.

  • Source: https://www.ncbi.nlm.nih.gov/pubmed/7624385

1992: Carbamazepine versus lithium in the prophylaxis of bipolar affective disorder.

Coxhead, Silverstone, and Cookson conducted a double-blind, randomized, controlled trial investigating the effects of lithium and carbamazepine on body weight.  A total of 31 patients with bipolar affective disorder participated in this trial for a 12-month duration.  It was noted that prior to this trial, all 31 patients had been using lithium as a bipolar prophylactic.

Upon initiation of the trial, 15 patients were transitioned to carbamazepine treatment.  Through the 12-month trial period, it was noted that relapse rates were similar between the 2 groups.  While more side effects were observed in early phases of carbamazepine treatment, lithium recipients exhibited an average weight gain of ~4 kg – whereas carbamazepine recipients exhibited an average weight loss of ~3.1 kg.

  • Source: https://www.ncbi.nlm.nih.gov/pubmed/1543034

1989: Weight gain secondary to treatment with lithium carbonate.

Iglesias, Arrillaga, and Ruiz studied the effect of lithium carbonate maintenance therapy on body weight.  The aforementioned researchers assessed weight changes exhibited by 80 patients receiving lithium maintenance therapy – over a 1-year duration.  Results indicated that nearly every patient exhibited weight gain lesser than 10% of his/her baseline body weight.

Based on results of their study, researchers concluded that there was no connection between lithium-related weight gain and side effects like increased thirst or edema.  Moreover, it was stated that weight gain was not a cause of lithium discontinuation.

  • Source: https://www.ncbi.nlm.nih.gov/pubmed/2497625

1988: Weight gain with antidepressants and lithium.

Garland, Remick, and Zis researched the effects of various neuropsychiatric medications on body weight.  It was stated that unwanted weight gain is a frequent complaint among patients using neuropsychiatric medications.

Because weight gain can interfere with treatment adherence and compromise health, it is important to understand which medications are likely to provoke substantial weight changes.  Researchers reviewed the literature on the relationship between weight gain and tricyclic antidepressants, monoamine oxidase inhibitors, and lithium.

Data indicated that tricyclic antidepressants induced dose-dependent ongoing weight gain of ~0.57 kg to ~1.37 kg – per month of treatment.  This was hypothesized as being due to increased appetite, carbohydrate cravings, inhibition of satiety, and reduced metabolic rate.

While atypical serotonergic and dopaminergic antidepressants were reported to suppress appetite, monoamine oxidase inhibitors were suggested to stimulate appetite and augment insulin-induced hypoglycemia.

Moreover, lithium maintenance therapy was documented as inducing weight gain exceeding 10 kg in ~20% of recipients.  Mechanisms for the induction of lithium-induced weight gain were stated as: alterations in carbohydrate and fat metabolism; polydipsia; and increased sodium retention.

  • Source: https://www.ncbi.nlm.nih.gov/pubmed/3053797

1988: Prospective studies on a lithium cohort. 3. Tremor, weight gain, diarrhea, psychological complaints.

Vestergaard, Poulstrup, and Schou sought to determine the side effects of lithium among long-term users.  Researchers assessed a group of individuals diagnosed with manic depression who received lithium as a prophylactic agent.  All individuals were assessed prior to lithium prophylaxis therapy, as well as at various intervals over the span of long-term treatment (up to 7 years).

The average dose of lithium administered was ~23.2 mmol/d and the average serum lithium levels were 0.68 mmol/l.  It was discovered that ~40% of lithium recipients exhibited zero significant side effects.  However, only around ~10% of persons receiving higher doses of lithium and/or exhibiting higher-than-average serum lithium levels exhibited zero side effects.

Researchers discovered that weight gain was positively associated with baseline body weight, as well as adjunct antidepressant use.  In other words, the greater a person’s baseline (pre-treatment) body weight, the higher the odds of weight gain during treatment.  Overall, this study supports the idea that lithium can cause weight gain in a subset of users when administered for a long-term.

  • Source: https://www.ncbi.nlm.nih.gov/pubmed/3227963

1980: Lithium carbonate and weight gain.

Peselow, Dunner, Fieve, and Lautin sought to assess the effect of lithium carbonate on the body weights of patients with bipolar disorder.  Researchers monitored 33 patients with bipolar disorder over a 1-year duration – 21 received lithium and 12 received a placebo.  It was noted that during trial initiation, all patients exhibited euthymic mood.

Of the 21 lithium recipients, 11 gained more than 10 lbs. and 13 exhibited weight gain of at least 5% initial body weight – over the 1-year duration.  Comparatively, only 1 placebo recipient gained more than 10 lbs. and 2 exhibited weight gain of at least 5% initial body weight – over the 1-year duration.  The findings from this study clearly support the idea that weight gain is a side effect of lithium.

  • Source: https://www.ncbi.nlm.nih.gov/pubmed/6450789

1976: Lithium treatment and weight gain.

Vendsborg, Bech, and Rafaelsen were among the earliest of researchers to report upon lithium-related weight gain.  The researchers assessed the case records of 70 manic depressive patients who had received lithium maintenance therapy for 2 to 10 years.  In addition to assessing case records, the 70 long-term lithium users received questionnaires.

It was noted that 45 of the 70 patients (50%) exhibited long-term weight gain, with an average gain of +10 kg.  Among those who gained weight while using lithium, all were overweight prior to using lithium.  With long-term lithium administration, the 45 patients who gained weight ended up 20% higher than a medically-ideal weight.

There were no associations between infant obesity and weight gain among those who exhibited lithium-induced weight gain.  The causes of lithium-induced weight gain were suggested to be: increased appetite (one-third of weight gainers) and increased thirst.  Researchers stated that increased thirst or intake of fluids, particularly calorically-dense fluids, might be one of the biggest reasons for weight gain while using lithium.

  • Source: https://www.ncbi.nlm.nih.gov/pubmed/1251759

1974: Drugs Causing Weight Gain.

Kerry responded to an article entitled “Drugs Causing Weight Gain” in which lithium carbonate was discussed as a prophylactic intervention for bipolar disorder.  Kerry stated that while many patients use lithium carbonate long-term, its long-term effect on body weight warranted discussion.

It was specifically noted that weight gain from lithium typically occurs within the first 6 months of treatment, followed by weight stabilization (or no significant change in weight) for years thereafter.  Furthermore, Kerry suggests that the initial weight increase among lithium users may be mostly water weight – and/or is likely a reversal of weight loss attributable to untreated neuropsychiatric conditions (e.g. bipolar disorder).

Moreover, it was mentioned that due to lithium’s side effect of increased thirst, weight gain might occur in a subset of individuals as a result of drinking calorically-dense beverages.  Kerry advises anyone prescribing prophylactic lithium to regularly monitor the weight of their patients.  Overall, Kerry believes that the long-term therapeutic effect of lithium prophylaxis substantially outweighs any short-term weight gain.

  • Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1610476/

Based on the research, how much weight gain is Lithium likely to cause?

A modest-to-significant amount.  Research indicates that 20% to 50% of lithium users are likely to gain a modest-to-significant amount of weight as a result of treatment.  The average weight gain associated with lithium treatment falls within the range of 4.85 lbs. and 22 lbs; some studies reported lower average weight gain than others.

  • Study #1: Sachs, Bowden, Calabrese, et al. (2006) examined body weights of 166 lithium users over an 18-month duration and reported an average weight gain of 85 lbs. (2.2 kg).
  • Study #2: Baptista, Teneud, Contreras, et al. (1995) referenced multiple studies in which weight gain occurred in lithium users. The first study reported weight gain of 22 lbs. (10 kg) in 20% of lithium users, and the second reported weight gain of 88 lbs. (6.3 kg).
  • Study #3: Coxhead, Silverstone, and Cookson (1992) documented an average weight gain of 81 lbs. (4 kg) among 16 patients receiving lithium for a 1-year span.
  • Garland, Remick, and Zis (1988) noted that approximately 20% of lithium users exhibit weight gain in excess of 22 lbs. (10 kg).
  • Study #4: Peselow, Dunner, Fieve, and Lautin (1980) recorded weight gain of more than 10 lbs. and at least 5% initial body weight in 11 and 13 of 21 lithium recipients, respectively, over a 1-year period.
  • Study #5: Iglesias, Arrillaga, and Ruiz (1989) reported weight gains lesser than 10% of baseline body weight among 80 patients receiving lithium maintenance therapy for 1 year.
  • Study #6: Vendsborg, Bech, and Rafaelsen (1976) reported that long-term lithium administration caused weight gain in 45 of 70 recipients (50%), with an average weight gain of 22 lbs. (10 kg).

While a significant percentage of individuals will gain weight from lithium treatment, only a small subset of these individuals exhibit clinically significant weight gain (defined as an increase in body weight of at least 7% from baseline).  Risk factors associated with clinically significant weight from lithium include: being overweight at baseline (prior to using lithium), adjunct antidepressant use, and intake of calorically-dense beverages (as opposed to water).

Can lithium ever cause weight loss?

Although many lithium users gain weight from treatment, research suggests that a subset of lithium users can actually lose weight.  A retrospective analysis by Sachs, Bowden, Calabrese, et al. (2006) reported 5.1% of 166 individuals [taking lithium for bipolar disorder] exhibited clinically significant weight loss (defined as at least 7% body weight reduction from baseline) over the span of 18 months.  This clearly supports the idea that some individuals will lose weight while undergoing long-term lithium maintenance therapy.

What about the effect of lithium orotate on weight?

While lithium carbonate is the most popular format of lithium utilized for the management and/or prophylaxis of bipolar disorder, some individuals might prefer to use another format of lithium known as “lithium orotate.”  Lithium orotate is similar to lithium carbonate in that it is a simple chemical salt containing lithium, however, unlike lithium carbonate, it is hypothesized to exhibit greater bioavailability.

If lithium orotate is more bioavailable than lithium carbonate, this means that it would be absorbed more efficiently by the body and uptaken more efficiently within the brain.  More efficient absorption and/or uptake of lithium orotate (compared to lithium carbonate) as a result of increased bioavailability could yield fewer side effects – and possibly decreased incidence of treatment-related weight gain.

Proponents of lithium orotate suggest that the supplement is unlikely to cause weight gain and report that it could even augment preexisting weight loss efforts.  Nevertheless, because the effect of lithium orotate on body weight hasn’t been extensively researched – it’s unclear as to how it might affect one’s weight.

Variables that influence weight gain on Lithium

There are a multitude of variables that may determine whether someone gains weight on lithium, and if so, its significance.  Variables that likely influence the significance of weight change on lithium include: baseline weight; adjunct substance use; and lithium dosage.  Other variables such as: the user’s lifestyle and genetics; duration of lithium administration; and prior medication use – might also impact the significance of lithium-induced weight change.

  1. Baseline weight: Multiple reports suggest that being overweight prior to using lithium increases likelihood of clinically significant weight gain during treatment. For this reason, if you are already overweight before initiating lithium treatment, you may pack on more pounds throughout treatment than someone who isn’t. That said, being underweight at baseline due to untreated bipolar disorder or major depressive disorder, might also increase odds of weight gain during lithium treatment (assuming lithium effectively attenuates neuropsychiatric symptoms causing low body weight).
  2. Adjunct substance use: It is known that many antidepressants, antipsychotics, and mood stabilizers can cause weight gain as side effects. Assuming you’re using lithium along with another neuropsychiatric medication, there’s a chance that the other medication is more culpable for your weight gain than lithium. Furthermore, there may be neurotransmitter-mediated, hormone-mediated, and/or metabolically-mediated interactions between lithium and another medication – possibly facilitating synergistic effects that yield weight gain.  It is known that lithium plus an SSRI, TCA, antipsychotic, or mood stabilizer can cause weight gain.
  3. Lithium dosage: Evidence suggests that the dosage of lithium administered could impact body weight. Low-dose lithium use is associated with decreased likelihood of weight gain – compared to moderate-dose or high-dose lithium. This is partly due to the fact that higher doses of lithium exert more substantial neurophysiologic modulation than lower doses, thereby amplifying the underlying mechanisms of lithium-induced weight gain.
  4. Lifestyle: It is thought that a person’s lifestyle could influence the significance of weight gain during lithium maintenance therapy. Someone who purchases “junk” food and/or beverages (i.e. calorically-dense items lacking in nutritional value) and lives a sedentary lifestyle may be at increased risk of weight gain throughout treatment – compared to an individual who consumes low-calorie foods and zero-calorie drinks (e.g. water) and exercises on a daily basis.
  5. Genetics: It’s possible that gene and epigenetic expression might influence who gains weight on lithium, as well as the significance of the gain. Perhaps expressing or lacking certain genes protects against or decreases the significance of lithium-induced weight gain – whereas expressing or lacking other genes might increase the likelihood or significance of lithium-induced weight gain. Though the interactions between lithium and genes aren’t fully understood, it should be considered that drug-gene interactions might affect body weight.
  6. Duration of lithium use: In some cases, total duration of lithium treatment might influence weight change. Certain individuals may experience substantial weight gain in the early months of treatment followed by weight stabilization or weight loss in later months. Others might experience some weight loss in the early stages of treatment followed by weight gain with longer-term use.  For this reason, consider that the cumulative length of your lithium treatment might determine your weight gain.
  7. Prior medication use: Anyone who used medications prior to lithium should reflect upon the effect that those agents had on body weight. For example, if you used a medication associated with weight loss prior to taking lithium, you may have been underweight – or under your true homeostatic weight. If you transitioned from the other medication to lithium, you may have gained some weight simply because you’re no longer getting the weight loss effect from the formerly-administered medication.  Oppositely, if you used a medication that caused significant weight gain (e.g. Zyprexa), and then transitioned from that medication to lithium, you might lose significant weight during treatment because you were already well-above your homeostatic weight.

Possible ways to minimize weight gain on lithium

It is understood that between 20% and 50% of lithium users will gain weight.  Assuming you want to keep weight gain to a minimum throughout treatment, you may want to implement some of the weight management strategies listed below.  Understand that you should always confirm the safety of these weight management strategies with a medical doctor prior to implementation.

  1. Avoid calorie-dense fluids: Lithium is a medication that causes polydipsia or excessive thirst. As a result of this excessive thirst, most individuals being treated with lithium end up consuming more fluids than they did pre-treatment.  While drinking more fluids can cause weight gain due to increased water retention and bloating, increased fluid intake might lead to weight gain as a result of drinking more calories.  To minimize weight gain from fluid intake, it is recommended to drink only water or “zero calorie” beverages; no soda or juices.
  2. Track calories & exercise: Many individuals taking lithium do not track calories and/or record exercise. As a result, it’s difficult to know whether lithium actually caused weight gain – or if weight gain during treatment was due to increased caloric intake and/or decreased physical activity.  Tracking calories and exercise each day should help you get a better understanding of whether your weight gain is more attributable to your choices and/or behavior – rather than lithium.  Reducing your caloric intake and/or increasing your exercise may aid in weight loss or help offset lithium-induced weight gain.
  3. Dosage modification: Some individuals may find that modifying the dosage of lithium used in treatment can help reverse weight gain. Research suggests that using lower doses of lithium yield less significant weight gain than higher doses.  For this reason, it is recommended to work with your psychiatrist to find the “minimal effective dose” of lithium – or lowest possible quantity necessary to manage neuropsychiatric symptoms; this should decrease odds of weight gain.
  4. Evaluate thyroid function: Lithium administration can negatively alter thyroid function, causing hypothyroidism. Hypothyroidism is a medical condition associated with slower metabolic rate and fatigue – each of which could lead to weight gain.  Testing for abnormal thyroid function – and treating any abnormalities could help offset lithium-related weight gain.
  5. Manage side effects: It is understood that certain side effects of lithium such as: increased thirst, dry mouth, constipation, bloating, fatigue, and increased appetite can cause weight gain. If you’re experiencing side effects that are directly contributing to your weight gain on lithium, it is recommended to treat these side effects.  Work with your doctor to pinpoint the most problematic side effects (in terms of impact on weight) and follow his/her recommendations for getting them under control.  If you are able to manage or reduce the severities of side effects that lead to weight gain – this might improve your weight.
  6. Consider concurrent medications: If you’ve gained weight while taking lithium, it is recommended to evaluate concurrently administered medications and/or supplements. In some cases, it may help to discontinue all concurrently-administered substances that are medically-unnecessary – particularly if those substances are linked to weight gain.  Oppositely, it may help to initiate treatment with an adjunct medication for weight management.  Using certain prescription medications (e.g. metformin) may help decrease odds of lithium-mediated weight gain.
  7. Use lithium for a longer-term: Though weight gain from lithium can be alarming in the first 6 months of treatment, some doctors suggest that body weight usually stabilizes within the first year. In other words, once you’re through the initial “weight gain phase” of lithium treatment, you shouldn’t experience much fluctuation in body weight thereafter – even if used for years.  Although the initial weight gain may be disappointing, the good news is that additional significant weight gain probably won’t occur.

Note: In the event that you’ve experienced significant weight gain on lithium, and no weight management strategies have improved your body composition, you may want to talk to your doctor about lithium withdrawal and/or transitioning to a different mood stabilizer associated with less weight change.

Have you experienced weight gain on lithium?

If you ended up gaining weight while using lithium, document the amount of weight that you gained in the comments section below.  To help others get a better understanding of your situation, provide additional details in your comment such as: how long you’ve been using lithium; the dosage of lithium that you take; and whether you use other medications or supplements along with lithium.

After initiating lithium treatment, how long did it take for you to notice weight gain?  If you’re a long-term lithium user, did weight gain peak over a short-term and eventually stop – or has the weight gain gradually continued even over a long-term?  If you use other medications and/or supplements with lithium, have you considered that those other agents might also be culpable for some of your observed weight gain?

Have you tracked calories and exercise throughout treatment to ensure that the weight gain from lithium wasn’t simply due to greater caloric intake or reduced energy expenditure versus pre-treatment (i.e. baseline)?  Moreover, if you gained weight while using lithium, have you tested any of the weight management strategies included within this article?  In your experience, do the therapeutic effects of lithium “outweigh” the side effect of weight gain?

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