DEAR DR. GOTT: My diagnosis is clinical depression and schizo-affective disorder. I have been taking clozapine since 1990 and Mirapex, levothyroxine, omeprazole, Cymbalta and bupropion for about six years. I am severely overweight now – 270 pounds. I used to be no more than 150.
I have been unable to work steadily, except as a retail shop clerk. I’ve had a college degree since 1981. My family (brothers, nieces, nephew and cousins) are all very successful. My parents are 88 and 90 years old and have been helping financially. When they are gone I don’t know what I’ll do.
Do you have any advice for me?
DEAR READER: Clinical depression is a medical illness that affects how a person feels, thinks and acts. He or she has likely lost interest in things that were once enjoyable. This condition cannot be taken lightly. It is a serious illness that can last from weeks to years. Sadness and depression can be a normal reaction to a rather stressful situation for all of us on occasion. We feel bad one day and, to a degree, feel better shortly thereafter. For the individual who is clinically depressed, he or she becomes unable to cope, sleep is interrupted, irritability sets in and the person finds him or herself withdrawing from life. Each person may have reasons to feel this way – problems with finances, work, loss of a loved one, every day demands, family, etc., or there may be no obvious source for the depression such as in the case of pure medical depression or secondary to certain health problems such as hypothyroidism.
Schizo-affective disorder is a mental condition that causes a loss of contact with reality as well as mood problems. Symptoms vary from person to person. The disorder may manifest with cycles of severe symptoms, improvement, and ultimately reverts back to severe symptoms. A person may have difficulties sleeping, may have hallucinations, delusions, be paranoid, and more. The paranoia and mood swings can result when an individual abuses cocaine and other drugs, has a seizure disorder, takes steroid medications and for other reasons. Control begins through psychotherapy and drugs to include anti-psychotics and antidepressants.
The clozapine you have been prescribed treats severe schizophrenia. Cymbalta treats depression plus anxiety. Bupropion is an anti-depressant. Levothyroxine is a replacement for a hormone ordinarily produced by the thyroid gland. Omeprazole treats gastroesophageal reflux disease (GERD). Mirapex treats the symptoms of Parkinson’s disease, restless legs syndrome and for other conditions as determined by a physician. Therefore, in summation, you are on three drugs for your disorder but also appear to have hypothyroidism, GERD and perhaps RLS or tardive dyskinesia (from your clozapine). So, you are dealing with several issues that can be rather debilitating. Clozapine has a specific side effect of weight gain, as does bupropion; however, I do not feel your 120 pound weight gain can all be attributed to the meds you are on. Rather, I believe it is in part, a manifestation of your disorder. Because a therapist cannot prescribe medication, I recommend you speak with your psychiatrist or prescribing doctor to determine if there are other satisfactory drugs that don’t have weight gain as a side effect. Another interesting fact is that Cymbalta can cause hallucinations. If your depression came first, perhaps the treatment is the cause of your schizo-affective disorder. If this is the case, you may be able to switch to another medication and discontinue the clozapine. And, while it is easy for me to say and perhaps extremely difficult for you to tackle, you are a college graduate. I must, therefore, urge you to get your drugs stabilized, join a support group and take the initial steps necessary to get your life back on track. I wish you well and know you can improve your life. Good luck.
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