Medical Edge Newspaper Column

Controlling Paranoia, Reducing Overweight

Dec. 11, 2006
DEAR MAYO CLINIC:
My son is 50 years old, 6 ft. 1 inch, and weighs 343 pounds. He has suffered from paranoia for 30 years and is taking Depakote and Navane. I don't see any improvement in his condition. He claims the medication has made him gain too much weight. Is there any medication that could actually help him, and without weight gain as a side effect? -- Valley Stream, N.Y.

ANSWER:
Your son's height and weight translate to a body-mass index of 45. Comparing this figure with the normal BMI range of 20 to 25, it's clear that he is obese. The question is, given that a good fraction of the American public also is obese, how much of his being overweight can be attributed to his medications alone?

Thiothixene (Navane) is a long-established antipsychotic drug, generally effective in reducing paranoia and other psychotic symptoms, that is less likely than many similar agents to produce appreciable weight gain. On the other hand, divalproex sodium (Depakote) -- a mood stabilizer -- is often associated with weight gain. Thus if your son's paranoid symptoms were under control, it would make sense to consider replacing the Depakote first.

On the other hand, you say that you "don't see any improvement in his condition." If he is still manifesting significant paranoid symptoms, he and his doctor might consider an alternative to Navane.

Substitutes are available. For example, either of two new antipsychotic drugs -- aripiprazole (Abilify) or ziprasidone (Geodon) -- are potential substitutes for Navane, and they are weight-neutral. Similarly, a relatively new mood stabilizer called topiramate (Topamax), though it may not be as good as Depakote in all psychiatric conditions, is often effective and also may promote weight loss.

Please note that only one drug should be replaced at a time. If the main concern is obesity, switch the Depakote first. If the motivation is drug effectiveness, switch the Navane first.

In any event, don't expect weight loss to come from drug substitution alone. Proper diet and exercise -- ideally, as part of a group behavioral-therapy process such as Weight Watchers -- could help produce significant reduction as well. In severe cases, gastric bypass is also a possibility.

-- Mark R. Hansen, M.D., Psychiatry and Psychology, Mayo Clinic, Rochester, Minn.