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Medical Edge Newspaper Column from Mayo Clinic
CONTROLLING PARANOIA, REDUCING OVERWEIGHT
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
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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.
Additional Resources:
Psychiatry and Psychology
Readers: Guilt isn’t all bad. A healthy sense of guilt can motivate you to do what’s right and to consider the consequences of your actions.
On the other hand, guilt can be harmful. If feeling bad about your actions has progressed to feeling bad about your entire person — feeling shame, in other words — then guilt has taken a destructive turn. If guilt is causing you to feel unworthy, anxious or depressed, it’s a good idea to seek help from a mental health professional.
If you are bothered by guilt and unsure how to proceed, these five steps could help:
1. Assess the seriousness of the situation
Start by asking yourself some questions. Whom have I hurt and how has it affected that person? Were there other, better choices I could have made? How would I assess this situation for a friend?
2. Determine your level of responsibility
Were others involved in creating the events that led to your guilty feelings? Were some elements beyond human control? What can you do about the consequences?
3. Try to resolve matters
See whether you can resolve any negative consequences of your action. Doing something late may be better than doing nothing. Instead of feeling bad about yelling at your husband and neglecting the dog, take the dog for a long walk and leave your husband a note saying you don’t know what you’d do without him.
4. Seek forgiveness
If you’ve hurt someone, ask for forgiveness and then make amends as best you can.
5. Let go
Once you’ve done everything you can, move on. Learn your lesson, but let go of self-punishing thoughts. Reassess your standards and consider whether they help make you a better person or simply set you up for failure.
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Medical Edge from Mayo Clinic is an educational resource and doesn’t
replace regular medical care. To e-mail a question, go to www.mayoclinic.org,
or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave.,
Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.
© 2006 TRIBUNE MEDIA SERVICES, INC.
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