instruction: hi doctor I am a 30 year old male and I have been on cipralex 20 my for my depression for more than a year now when I started cipralex 10 my I was fine however when my depression worsened I was given mirtazapine 30 my and my weight increased like hell I gained 15 keg in three months mostly around my belly and hip I consulted you and my medicine was changed from mirtazapine 30 my to topomax 100 my I lost 10 keg in three months with topomax and stopped it eventually nevertheless my weight has started increasing drastically around the belly and hips I feel bulky and the tummy is growing out it is so embarrassing as I am a lean guy and with a belly protruding out I am going low on confidence I cannot leave my depression tablets but I cannot ignore my increasing weight either could you please let me know what should I do to lose this excess weight and get back to shape I cannot walk as I have a slipped disc problem I cannot go to the gym either as it is not recommended by doctors if on leaving topomax I am going to gain weight again then it is only a temporary solution further in spite of taking cipralex 20 my at night I am extremely sleepy and feeling tired all day I fall asleep unconsciously even while driving and working on the computer I have disturbed sleep at nite and the weight gain is another trouble I still feel I am depressed and cipralex is not doing all it can I need your help to tackle my depression sleepiness tiredness and my increasing weight please help
output: hello stopping topiramate is not the reason for weight gain in your case topiramate resulted in weight loss and the drug is also a good mood stabilizer drug this helps in stabilizing the mood and supplements the antidepressants so stopping topiramate probably result in worsening of depressive symptoms and thus altered food intake which consequently resulted in weight gain in my opinion you can start topirmate again and this will help in controlling the weight gain the drug will help in improving the depressive symptoms too so there is no harm in restarting the drug apart from this please change your dietary intake avoid any foods with refined sugars and high fat take high protein diets rich like meat and animal food avoid fried food totally lime juice in an empty stomach daily without sugar should be included in the diet please take at least a cup of green tea which will help to dissolve the belly fat this will help in making you fit again if you are feeling sleepy and tired then drugs like modafinil can be added to your prescription modafinil will help in improving alertness and will reduce your tiredness this will help in improving the depressive symptoms too so you can make these changes and you will definitely come out of depression