I can definitely relate to the constant weight struggle that is taking meds for bipolar disorder. I had some success with managing that from following a ketogenic diet (which some may say is a fad diet, I disagree as it's actually prescribed for epileptics either in lieu of or along side anticonvulsants to help manage epilepsy that is refractory to anticonvulsant monotherapy/multi-anticonvulsant polypharmacy; it is also being researched in being used to treat cancer, Alzheimer's disease, and a number of other things, so there is some medicinal value to it besides just its ability to promote rapid weight loss) as well as switching meds (I had gained 22.2 lb after switching from Latuda to Geodon, but after beginning the ketogenic diet, I wasn't able to make the scale budge a single bit until I switched to Abilify, after which I was able to lose 38 lb following the ketogenic diet over a period of about 4 months).
To say the ketogenic diet wasn't a pain in the neck would be a flat out lie, but in some ways, it was kind of fun meeting the challenges it brought. You have to get creative with it when it comes to managing your carb cravings and what to eat instead of them, which I kinda found interesting.
Anyway... The benefits of Abilify were short-lived, as once I reached 15 mg, I developed akathisia from hell!! That was towards the end of last summer, and the same company who made Abilify (Otsuka) had just come out of Rexulti, touting it as "Abilify 2.0," so I decided to give it a try, thinking it would be better for me therapeutically and with less side effects. I had no idea how mistaken I was... Not only did Rexulti not help me, it made me worse, so I got demotivated and got off my diet, spiraled into a deep depression again, and just within the up-titration period, I gained 20 lb in just under 4 weeks, from getting off my diet I'm sure, but weight gain that rapid had to have been aided by the medicine.
I promptly discontinued that medicine at my next pdoc appointment, but discussed starting an older med, an antipsychotic of the typical class called "Stelazine," (trifluoperazine) which is supposed to be weight neutral part, much like Haldol. I started it mainly for anxiety, as it's FDA-approved for the short-term therapy of anxiety management after other options have failed (I tried literally all other benzos except Versed and Onfi with little to no success and was rapidly becoming a shut-in on account of my anxiety).
I responded better to Stelazine than I had to any medicine I have yet to take, I'd be willing to say. But unfortunately I started ballooning in size and weight with no change in appetite or diet... I was in denial that it could be the Stelazine because of how well I was responding to it, but after two months and 30+ lbs of weight gain (making a grand total of 50 lb weight gain within 2-3 months, which has never happened to me before...), I had to call it quits on the Stelazine, which meant all the progress I had made with my anxiety and bipolar depression came tumbling back down all over me again as I tapered off of it. Bear in mind that I was on Adderall XR 60-90 mg at the time of this weight gain occurring, and I wasn't eating any amount of what would be considered "excessive."
It's been 4 months since I quit Stelazine, and have lost very minimal weight since quitting. I've only recently gotten motivated to getting blood work to get to the bottom of it and see if there have been some major changes in any aspects of my metabolism or anything. Since my depression hasn't responded to any of the commonly-used SSRIs/SNRIs/SARIs (trazodone & nefazodone)/NaSSA (Remeron) along with many of the commonly used augmenters like Buspar (that was a disaster), several atypical antipsychotics, several anticonvulsant mood stabilizers, etc., my pdoc and I finally decided that it was the appropriate time to make the transition to an MAOI, so she chose Emsam, a transdermal MAOI, and supposedly one of the safest to take, and have been having quite a bit of success from it. She has been augmenting it with Dexedrine ER (which some doctors/psychiatrists may be hesitant to do due to the potential pharmacological interaction of hypertensive crisis) and, until recently, the tricyclic antidepressant nortriptyline (Pamelor) (until she raised my Emsam dosage, which is when she decided to take away the Pamelor), and have actually started losing the weight. She also augments it with the thyroid hormone Cytomel, and gave me Saphris 10 mg samples to take as needed as a "tune up" med. When I took Saphris the first time, it caused an immediate 10 lb weight gain, then I immediately lost it and kept losing weight (it was during my ketogenic diet weight-loss period). So I'm not so afraid of it causing any weight gain, and I'm not going to be taking it regularly anyway, mostly just to help for sleep (wow does it ever help with sleep! Restoril, Belsomra, and Rozerem can't hold a candle to it...)
My reason for posting all this is to let you and others know that where there are troubles, there are alternatives, even if the alternatives initially lead to success eventually turn out to lead to more troubles... lol. There's plenty of meds out there, and therefore plenty of alternatives. Of course I'm not advocating that one should just switch meds like one changes underwear, but I'm under the belief that one shouldn't become a slave to the side effects of their meds. Also, while it might not sound like an attractive option to take another pill to manage one pill's side effects, there are also plenty of meds that can help manage the weight gain... Topamax and Zonegran for instance (the latter of which is my mood stabilizer) can be used as mood stabilizers or adjunct mood stabilizers, and are known to cause weight loss in most people who take them. Some pdocs may use a small dose of a stimulant or anorexigen along with your mood stabilizer(s) to counteract the weight gain as long as they believe you're stable enough to handle it. As long as it won't destabilize your mood, a switch in antipsychotic or anticonvulsant meds can also help. If you're taking lithium, I've read that drinking plenty of water can help keep off the water weight with lithium, and if need be, the diuretic amiloride (Midamor) can be used without as much concern for raising lithium levels like with hydrochlorothiazide; furosamide (Lasix) has also been used and not shown to raise lithium levels.
Anyway, I wish you and everyone else all the best of luck in all your endeavors in taking care of both your mental health as well as all other aspects of your health!
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