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Bipolar Disorder and the Metabolic Syndrome

Causal Factors, Psychiatric Outcomes and Economic Burden

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Abstract

Overweight and obesity are highly prevalent in patients with bipolar disorder, and metabolic disorders also affect a significant portion of this population. Obesity and metabolic disorders cause significant economic burden and impair quality of life in both the general population and patients with bipolar disorder. This review examines the relationship between bipolar disorder and the metabolic syndrome, and the associated economic impact.

The metabolic syndrome and bipolar disorder appear to share common risk factors, including endocrine disturbances, dysregulation of the sympathetic nervous system, and behaviour patterns, such as physical inactivity and overeating. In addition, many of the commonly used pharmacological treatments for bipolar disorder may intensify the medical burden in bipolar patients by causing weight gain and metabolic disturbances, including alterations in lipid and glucose metabolism, which can result in an increased risk for diabetes mellitus, hypertension, dyslipidaemia, cardiovascular disease and the metabolic syndrome. These medical co-morbidities and obesity have been associated with a worse disease course and likely contribute to the premature mortality observed in bipolar patients. Weight gain is also a major cause of treatment noncompliance, increased use of outpatient and inpatient services and, consequently, higher healthcare costs. Prevention of weight gain and metabolic disturbances or early intervention when these are present in bipolar disorder could result in significant health and economic benefits.

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Acknowledgements

Funding for this article was provided by Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, NJ 07936, USA. Editorial assistance for this article was provided by Strategic Implications International, a business of Advogent, 1800 Valley Rd, Wayne, NJ 07470, USA.

Dr Fagiolini is a consultant and/or speaker for Bristol-Myers Squibb, Eli Lilly Italy, Novartis Pharmaceuticals Corporation, Pfizer Inc. and Solvay Pharmaceuticals Inc.

Dr Chengappa is a consultant for AstraZeneca Pharmaceuticals LP, Janssen Pharmaceutical Inc., and Eli Lilly and Company; has received grant and/or research support from Janssen Pharmaceutical Inc.; is a speaker on advisory boards for AstraZeneca Pharmaceuticals LP, and Eli Lilly and Company; and has received honoraria from AstraZeneca Pharmaceuticals LP, and Eli Lilly and Company.

Dr Soreca has received honoraria from Novartis Pharmaceuticals Corporation.

During the preparation of this review, Ms Chang was an employee and owned stock options in Novartis Pharmaceuticals Corporation.

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Fagiolini, A., Chengappa, K.N.R., Soreca, I. et al. Bipolar Disorder and the Metabolic Syndrome. CNS Drugs 22, 655–669 (2008). https://doi.org/10.2165/00023210-200822080-00004

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