Psychopharmacology Tips

Goodwin and Goldstein (2003) advocate the following measures to prevent weight gain in patients on lithium carbonate:

Dietary/lifestyle measures

• Encourage daily physical exercise
• Restrict fluid intake to non-sugary liquids (e.g., water, diet soft drinks)
• Avoid intake of simple carbohydrates, particularly early in the day (lithium may induce mild hypoglycemia, causing patients to increase caloric intake as they “chase” their blood sugar through the day)

Medical/pharmacological measures

• Measure free T4 and supplement thyroid hormone if necessary (T4 at or below the lower quartile of normal may indicate hypothyroidism, another cause of weight gain
• If possible, avoid concurrent medications with additive weight gain effect
• Consult with primary care physician about other options if weight gain exceeds 5 lbs despite preventive measures

Ref: - Goodwin, F.K. & Goldstein, M.A. (2003) Optimizing lithium treatment in bipolar disorder: a review of the literature and clinical recommendations. Journal of Psychiatric Practice, 9, 5, 333-343.

After a detailed review of the literature, Allen and Hollander (2000) concludes that SSRIs are the first-line therapy for body dysmorphic disorder, with the dosage and length of trial similar to those used for OCD. In refractory cases, especially if delusional conviction is present, augmentation with low doses of atypical antipsychotics might be effective. Other augmentation strategies that are clinically used include adding bupropion, gabapentin, or stimulants such as dexamphetamine to the SSRI therapy.

Ref: - Allen, A. & Hollander, E. (2000) Body dysmorphic disorder. The Psychiatric Clinics of North America, 23 (3), 617 – 628.