Q. I've recently started with a new psychiatrist and continue with 60 mg Celexa that was started with the previous psychiatrist. I've been suffering with debilitating depressions for 7+ years now, most of which occur every winter. There has always been the issue of a Bipolar component (type II or III - unsure as yet)) and I've tried lithium and depekene and haven't had much success with either and had problems with side effects. This new doctor is wanting to start me on Lamictal but I'm a little hesitant. I've had serious weight gains with all the meds I've tried except Effexor (lost weight). I recently gained 10 lbs rather quickly on Celexa and I had not lost weight from before. I have heard about Topomax being good for avoiding weight gain. I asked this psychiatrist about trying Topomax instead but he says he knows very little about it and seemed to make light of my concerns about weight gain (told me I can "control" my weight). I am wondering what Lamictal is like with respect to weight gain and what Topomax is like for Bipolar (type II or III) conditions where depressions are the more disruptive component.

  A. Topomax is probably a good medication for Bipolar disease. Trials are underway to get it FDA approved for type I illness. There are published trials in the literature that show it works for type IIs also. As far as weight gain, it looks to be the best at this time, but again, there are no definitive trials to prove this. Anecdotally, it is the best.

As far as weight gain on Lamictal, it tends to cause it in most, but not all patients. If your physician is more comfortable with Lamictal, give it a try to see if it helps. You may not get weight gain. If it does not help and/or you gain weight, revisit the idea of using Topomax with him.