Far more common, however, is weight gain associated with the introduction of medications to treat comorbid illnesses (50). These include antidiabetic medications (sulfonylureas, thiazolidinediones, insulin) as well as a wide range of psychotropic medications. The antipsychotic drugs clozapine, olanzepine, risperidone, and quetiapine have all been associated with weight gain, as well as abnormalities in glucose homeo-stasis (51). A number of antidepressant medications, incuding amitriptyline, mirtazapine, and some serotonin reuptake inhibitors, may promote weight gain in some patients. Other drugs that are used as mood stabilizers—including lithium, valproic acid, and carbamazepine—can cause weight gain. Finally, the antiepileptic drugs valproate, carbamazepine, and gabapentin can promote weight gain. Historically, psychiatrists and neurologists may have paid little attention to the weight-gaining properties of some of the medications that they prescribed. This is fortunately changing, but it is still common for a patient to be placed on a psychotropic medication or an antiepileptic medication and experience substantial weight gain without the knowledge of the provider who initially prescribed the medication.
Fortunately there are alternatives for each of these medications that could be considered if drug-associated weight gain is a serious problem. Metformin and newer GLP-1 analogs offer people with diabetes the benefits of glucose-lowering without weight gain and, in some patients, even mild weight loss. Bupropion is an antidepressant medication that has some weight-loss properties, although it does not have an FDA indication for weight loss (52). Topiramate is a medication that is FDA-approved as an antiepileptic medication and also for use in the treatment of migraines. It has some utility as a mood stabilizer and in the treatment of neuropathic pain. It has moderate weight-loss promoting properties (53,54). Topiramate has a number of side effects that limit its usefulness as a weight-loss drug and it is not FDA-approved for weight loss. However, if a patient has a seizure disorder or migraines, especially if weight gain has resulted from the use of other medications for these conditions, topiramate may be a reasonable alternative.
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