Abstract
BackgroundBipolar disorders (BD) are associated with increased prevalence of obesity and metabolic syndrome (MetS). Nevertheless, there is a wide range in prevalence estimates, with little known about the contributions of pharmacotherapy. It has been suggested that lithium might have a more favorable metabolic profile. We hypothesized that lithium use is associated with less increased body mass index (BMI), MetS, and type II diabetes, when compared with non-lithium users (those on anticonvulsants, second-generation antipsychotics).MethodsCross-sectional study of 129 patients aged 18–85 with bipolar disorder, followed at tertiary care clinics in Montreal. Patients using lithium were compared with those not on lithium, for body mass index and metabolic syndrome.ResultsThe prevalence of obesity and metabolic syndrome in the sample of lithium-using patients with BD was 42.4 and 35.7% respectively, with an average BMI of 29.10 (+/− 6.70). Lithium and non-lithium groups did not differ in BMI or prevalence of MetS. However, compared to the non-lithium group, lithium users had lower hemoglobin A1C (5.24 +/− 0.53 versus 6.01 +/− 1.83, U = 753.5, p = 0.006) and lower triglycerides (1.46 +/− 0.88 versus 2.01 +/− 1.25, U = 947, p = 0.020).ConclusionsThere is a high prevalence of obesity and metabolic syndrome among patients with bipolar disorder. However, this did not appear to be associated with lithium use, when compared to those not on lithium. The lithium subgroup was also associated with lower prevalence of type II diabetes. Future prospective and intervention studies with larger sample sizes are necessary to further explore the association between lithium and insulin resistance, as well as its underlying mechanisms.
Highlights
Stats Statistics (Lithium) remains a first-line therapy in Bipolar disorders (BD), with indications in acute mania, depression, and maintenance treatment [1]
The majority (n = 50, 76.9%) of lithium users had an age of onset of psychiatric symptoms < 30 years of age, with on average more than four mood episodes in the course of their illness
A higher proportion of non-lithium users were on antipsychotic medications and anticonvulsants, as well as antidepressants
Summary
Lithium remains a first-line therapy in BD, with indications in acute mania, depression, and maintenance treatment [1] It is associated with unique anti-suicidal properties [2]. Lithium is often avoided for its adverse physical effects including reduced renal function, hypothyroidism, hyperparathyroidism and weight gain [3]. Among these adverse physical effects, weight gain is especially concerning, as it can lead to obesity. This is a constituent of MetS, a constellation of risk factors notably associated with cardiovascular disease and stroke [4]. We hypothesized that lithium use is associated with less increased body mass index (BMI), MetS, and type II diabetes, when compared with non-lithium users (those on anticonvulsants, second-generation antipsychotics)
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