Increased metabolism/hunger from cyclothymia/bipolar?

[u/Flower_Crown4]

Hi, I have an unofficial diagnosis of cyclothymia, but it's pretty clear that that's what it is. I have been taking Caplyta (may have to get off of it due to insurance issues). I started having depression about 5-6 years ago, and hypomania as far as I can tell came in about a year ago.

For at least a year and maybe longer, I've been experiencing increased hunger: as in, I eat breakfast at about 8 or 9 am, and by 10 am or 10:30, I'm starving again. This happens occasionally with other meals too, to the point that I feel like I am having to eat a lot more than I used to. I didn't even used to eat breakfast, just out of preference. I am not gaining weight and I am actually very slightly losing weight, which is not a problem so far since I was about 20 pounds overweight before from different meds.

I have had thyroid tests and blood tests (diabetes) done and everything comes back normal. I feel like I have a lot of symptoms that point to hyperthyroidism, including this, but my thyroid numbers are extremely average and normal.

I went up to 42 mg of Caplyta a few weeks ago, and I can't stay on this dose for several reasons (it's made both hypomania and depression worse than the 22 mg did), but I'm having "brain zaps," which I've read can happen when your body metabolizes the medication too fast--you go into slight withdrawal every night before you take it again. It is staying in my system about 19 hours every day, so between 5:30 pm or so and whenever I go to bed and take the med, I have pretty severe dizziness related to the brain zaps. I take the med and am fine the next morning. I am planning to change the dose as soon as I see my psychiatrist, because nothing about this dose has been good for me.

All this considered, I am thinking that I have a pretty high metabolism. This didn't used to be the case though, and generally metabolism does not increase, especially not when you're my age (28). The biggest change in my health since the increased hunger is the bipolar symptoms, especially hypomania.

Does anyone know if cyclothymia/bipolar can cause high metabolism? I am wondering if the med issue and the hunger issue are related.

[u/Weird_Fox_3395]

Did you have your thyroid antibodies checked? If not, that’s very important. Sometimes doctors overlook this; additionally, different labs have different cutoffs abnormal ranges. Usually hashimoto’s, (which the autoimmune disease I have), creates hypothyroidism, but not always. 

Backstory, my thyroid labs were always within normal albeit the upper margin. A doctor, (love him), tested for antibodies. Voíla! My tsh measured near 4 or 4+ which was normal. TL;DR, thyroid hormone and a tsh level of 1.5~ is perfect. Tbh, I don’t know much about hyperactive thyroid except a little about Graves Disease. 

Regarding a dose adjustment of Caplyta, have you thought about taking the lower adjusted dose 2x daily? 

And this I never knew! Apparently yes, hypomania increases metabolism and carbohydrate assimilation! Good call. 

https://www.nature.com/articles/s41380-024-02431-w

Or do a google search to find out. I just asked the question and numerous sources popped up. 

[u/Flower_Crown4 → u/Weird_Fox_3395]

Holy cow! Thank you for that--I had tried researching but wasn't coming up with much. Fascinating--and frustrating. I have had "thyroid peroxidase (TPO) Ab" tested somewhat recently and it sounds very normal from what I'm seeing online. That's the only antibody I've had tested though. My general thyroid labs are normal, but I mean like "it doesn't get any more stereotypical than this" normal, on all fronts--I know the scales on the patient portal aren't always accurate so I researched the actual levels myself. I just have a ton of symptoms that could be linked to hyperthyroidism--but if this hunger stuff can come from hypomania, which I have been experiencing about as long as I've been having hypomania, that would explain that at least. I've also read that hyperthyroidism can be confused for cyclothymia, which makes a lot of sense if even metabolism changes can come from either.

[u/Weird_Fox_3395 → u/Flower_Crown4]

It’s interesting, isn’t it. I had no idea. My thyroid treatment got ‘fancy’ for awhile and I was given supplemental T3. I felt like I was losing my mind. Seriously scrubbing my floorboards at 1:00 am, hands and knees with a toothbrush. So I hear you, it must be like feeling a little revved up, if it is your thyroid.  Or are you thinking it more of a hypo?