Q:  Binge Eating and Cycling

I have two questions. Firstly, when delving through the onset of depressive symptoms of soft BP, does onset of SAD at the age of 14 count? Secondly, when binge eating is a part of my mood spectrum disorder (BPII?) how can it be dealt with? I was initially taking topomax for it, which worked beautifully for two years and then stopped working. In the meantime I was diagnosed with BP and put on depakote which did nothing for the bingeing, although it did even me out (the wellbutrin gave me some energy, but I had to stop it due to the anxiety). The bingeing is unbearable during the winter months and is anxiety and/or impulse driven during the rest of the year. It also comes and goes in cycles. I'm currently back on topomax as a mood stabilizer. It's helping the bingeing slightly, but nothing like the first time. I'm not quite sure about the mood stabilization yet. Do you know of any medications that would be helpful? I know of a few other BP people who also experience bingeing, but I still feel hopeless and ingnored by the medical community as if "control" is all that's needed. I've lost and gained the same 70 lbs. over and over again and it's hurt my self esteem, my body image and causes depression. My depressions are worse.  My "ups" are never the problem. The worst they can be is that I become engrossed in a subject that I'm interested in and learn as much as I can before I burn out.

I appreciate any feedback. Thank-you.
 

Dear Ms. C' -- 
Carbohydrate craving is a recognized symptom of seasonal affective disorder, as you know; but I see it go along with mood shifts throughout the year in some people.  The good news that might apply to you is that if we can stop the cycling , and thereby prevent the depressive episodes, sometimes there is no need for additional treatment for the craving and resultant bingeing. So one approach you can try is to focus on the cycling. 

In addition to lamotrigine, which is an obvious candidate in this circumstance because it is most effective against depression -- though not without risk (you have to learn about the rash and how to try to lower that risk) -- I think there is suggestive evidence for a non-medication approach that may be rather dramatically underutilized, namely darkness. In two essays on my website I've presented the dramatic improvement in rapid cycling experienced by one patient treated at the NIMH, and then the "big picture" behind why that approach might work for some people, concluding with a way to "have your darkness and eat it too", meaning that you don't have to undergo the complete darkness they used at the NIMH, perhaps. Instead it may be possible to use "virtual darkness" in which you can still read and perhaps even watch TV, although the latter may have to stop for some people in order for this approach to work. This is explained in my essay on Light and Darkness and the treatment implications thereof. 

Finally, for your discussions with your doctor, you might also look at another antiseizure medication called zonisamide (Zonegran in the US) that is a bit like Topomax in that it can suppress appetite. It has risks too of course. But it's nice to know there's another medication out there besides Topomax. I've had some limited success with it re: weight control, and less success re: cycling control (but not zero success...). 

Dr. Phelps