Do You Gain Or Lose Weight On Lithium

One of my patients asked me about the effect of lithium on weight and, while I was explaining my experience with many hundreds of patients treated with lithium (not a significant cause of weight gain except in the obese and those who develop hypothyroidism), she went on the internet and found this information…

“There’s no question that lithium leads to weight gain… A variety of different medical studies have reported that people typically gain between nine and 14 pounds when placed on lithium.”

In an article by Vendsborg, et al, the results of a retrospective review of weight changes (over 2 – 10 years of treatment) is summarized. This article appears to be the basis for many statements about lithium and weight gain. The article looks at weight changes in 70 patients receiving outpatient treatment with lithium in the late 1960’s and early 1970’s. There is no control group. There is no mention of tests for hypothyroidism. The mean change in weight in this study was 6.0 kg (13 pounds) over an average of 5 years follow up.

Understanding The Differences Between Lithium And Lithium Orotate

One article that reviewed literature on various medications (Garland) offered the view that lithium was associated with marked weight gain, “Lithium maintenance therapy stimulates weight gains of over 10 kg in 20% of patients.”  This article appears to base the statement on the Vendsborg article which it misquotes.

In a very small pilot study looking at the effects of lithium on weight in normal subjects given lithium for a month no change in weight was noted (Chen).

Since this was in such startling contrast to my experience, and the experience of the other attending psychiatrists working in the Bipolar Clinic at UCSF, I decided to see what information I could find by doing a comprehensive review of the available literature…

Lithium Side Effects: Long Term And Short Term

One problem with answering this question is that lithium is a generic medication and so there have been relatively few studies that comprehensively evaluated side effects. Most of the studies (and there are many studies) of lithium focus almost entirely on benefits.

However, I was able to find a few studies that looked at lithium and compared it to other standard treatments of bipolar.

The best of these studies, a randomized prospective long term trial of lamotrigine versus lithium treatment over 52 weeks by Bowden, et al, had reassuring data for most people contemplating whether or not to take lithium.

How Do Different Medications Affect Your Weight

The chart below shows weight change over one year in those treated with lithium and those treated with placebo (weight change is in kgs) (the red line is lamotrigine) and shows that there was clearly no difference in weight between lithium and placebo treated patients in those who

Average weight change in that group was 6 kgs (13 pounds) – although the good news is that after 36 weeks the weight change reached its maximum. In

We do not know why lithium is associated with weight gain in those who are obese. It does not have clear effects on appetite. Perhaps by eliminating periods of hyperactivity (mania or hypomania) the lithium is leading to weight gain that is not caused by increased appetite.

Lithium Weight Gain

The EMBOLDEN I study (Young) of bipolar patients with depression treated for up to 8 weeks with lithium or placebo found that there was no difference between lithium and placebo, which could be compatible with lithium causing weight gain in non-depressed patients with bipolar by reducing mania…

There is also some evidence that it may be possible to prevent the increase in weight in those who are obese and need to start lithium by treatment with metformin (Praharaj).

Bowden CL, Calabrese JR, Ketter TA, Sachs GS, White RL, Thompson TR. Impact of lamotrigine and lithium on weight in obese and nonobese patients with bipolar I disorder. Am J Psychiatry. 2006 Jul;163(7):1199-201. PubMed PMID: 16816224.

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Chen Y, Goodall E, Silverstone T. The effects of lithium on body weight and food intake in normal subjects–a pilot study. Int Clin Psychopharmacol. 1992 Spring;7(1):51-4. PubMed PMID: 1624757.

Praharaj SK. Metformin for Lithium-induced Weight Gain: A Case Report. Clin Psychopharmacol Neurosci. 2016 Feb 29;14(1):101-3. doi: 10.9758/cpn.2016.14.1.101. PubMed PMID: 26792047; PubMed Central PMCID: PMC4730928.

Young AH, McElroy SL, Bauer M, Philips N, Chang W, Olausson B, Paulsson B, Brecher M; EMBOLDEN I (Trial 001) Investigators.. A double-blind, placebo-controlled study of quetiapine and lithium monotherapy in adults in the acute phase of bipolar depression (EMBOLDEN I). J Clin Psychiatry. 2010 Feb;71(2):150-62. doi: 10.4088/JCP.08m04995gre. PubMed PMID: 20122369.

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