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31-03-2010 | Mental health | Article

Obesity is possible marker of bipolar disorder severity

Abstract

Free abstract

MedWire News: Obesity appears to be associated with a history of suicide attempts in patients with bipolar disorder, study findings show.

The researchers point out that this association remained significant even after taking into account well-established risk factors for suicide attempt such as lifetime comorbid anxiety, alcohol use disorders, and depressive symptoms.

“Clinicians must be aware that obesity may be a severity feature relevant not only to pharmacological treatment decisions but also to the comprehensive management of bipolar disorder,” say Flávio Kapczinski, from Hospital de Clínicas de Porto Alegre in Brazil, and colleagues.

The team examined the association between suicide attempts and obesity in 250 outpatients with bipolar disorder, of whom 133 (52.2%) had a history of suicide attempt and 80 (31.4%) were obese (body mass index [BMI]≥30). The majority (87.8%) of the patients were taking mood stabilizers alone or in combination, 20.4% were taking atypical antipsychotics, and 23.5% were receiving antidepressants.

As reported in the journal Acta Neuropsychiatrica, bipolar disorder patients who were obese were nearly twice as likely to have a history of suicide attempts as patients of normal weight.

The suggest that depression may be a possible link between obesity and suicide in bipolar disorder patients. Depressive episodes are related to changes in appetite and eating behavior that contribute to obesity, and bipolar disorder with predominant depressive polarity is strongly related to suicidal behavior.

Alternatively, recent data have suggested common features in the underlying pathophysiology of obesity and bipolar disorder.

Specifically, leptin, a key hormone in the regulation of adiposity, has been shown to be positively associated with the risk for depression. Also, disturbances in metabolic pathways such as insulin-mediated glucose homeostasis, overactivation of the hypothalamic–pituitary–adrenal axis, dysregulated immune and inflammatory processes, and adipocytokine profiles are present in both adiposity and depression.

Obesity may therefore be a correlate of allostatic load in bipolar disorder, the researchers suggest.

They caution about generalizing their findings, noting that most of their patients were recruited from the Bipolar Disorder Program and so were considered difficult to treat.

Kapczinski and team conclude: “It is plausible to speculate that therapeutic interventions targeted to obesity may be of potential benefit in the course of bipolar disorder.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

By Lucy Piper

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