Dear Liz --
You have a smart psychiatrist: those are good questions I'd hope a doctor would ask. My sample size remains small, so I'd be interested in your results if you try this. Frankly, after about 10 patients, only two of whom have lost a significant amount of weight, and one or two who appear to perhaps have ceased gaining, I've started using amantadine more often. There too we have only one open study with less than 20 people to go by. And I'd held off using it because it affects the neurotransmitter dopamine, which in some versions of bipolar disorder would seem like working against one's own medications, some of which affect dopamine in somewhat opposite way. But darn if the first 4 people I tried it on didn't start losing weight. On the other hand, all four also got a tremor and had to reduce the dose from 300 to 200 mg, and the long term consequences of using amantadine this way are basically completely unknown (as well as amantidine's somewhat higher risk profile in first place).

However, I haven't changed the metformin story to match what you're reading here; in part because my sample is also too small to say "it doesn't work"; and in part because of the case report from Dr. Rasgon I posted as part of the metabolic syndrome story, in which metformin was used effectively to treat depression. There's still something more appealing to me to try to treat the problem, which it seems metformin has the capacity to do, though admittedly not every time; as opposed to amantadine, which as far as we know is just adding another medication with some sort of funny side effect of weight control (rather like the Topiramate strategy).

Another similar "report from the fringe" would be to look at using T3/T4 thyroid, which has no clear data supporting its use (not even the less-than-20 open trial data), but again some metabolic rationale as discussed in Thyroid and Bipolar. Careful not to freak out your doc' with too many of these reports! Good luck to you.

Dr. Phelps