Q. My 14 year old son has been diagnosed with the above plus conduct disorder and poly substance dependence. Was being treated with depakote, gained weight, doctors felt something else needed. Switched to lithium. Immediate additional weight gain. He feels better on the lithium, but very depressed about weight gain. Leading to detrimental to treatment. Is currently in residential care and treatment facility. Can change of diet (ie: protein shakes) be beneficial or change of medication Topamax?

A. With such scant data it is tough to tell you very much. There is some pretty good emerging data that for some people, not all, Topamax will give all the benefits of Depakote or lithium without weight gain. No controlled trials to the best of my knowledge, just reports and collection of individual cases. Ask your doctor about switching to Topamax, and see what he/she thinks. Weight gain is not pleasant, but if your son is feeling better and doing better, it may be a side effect that needs to be tolerated until something better comes along.