Treatment-related weight gain prevalent in pediatric bipolar disorder
MedWire News: Children and adolescents with bipolar disorder experience metabolic problems as early as 3 months after starting treatment with second-generation antipsychotics (SGAs), study results show.
“Given the potential risk for physical health, close monitoring of weight and metabolic indices should be implemented during treatment initiation and continuation,” Carmen Moreno (Hospital General Universitario Gregorio Marañón, Madrid, Spain) and colleagues comment.
SGAs are increasingly used to treat psychiatric conditions in children and adolescents, especially manic phases in bipolar disorder.
Although treatment-associated metabolic disturbances have been studied mostly in schizophrenia, there is mounting evidence of an increased risk in patients with bipolar disorder.
To investigate, the researchers assessed metabolic parameters in youth with bipolar disorder (n=31), psychotic disorders (n=29), and nonpsychotic disorders (n=30) before and 3 months after starting treatment with SGAs.
The main outcome measures were significant weight gain (weight increase ≥5% at three months or increase ≥0.5 in body mass index [BMI] z-score) and risk for adverse health outcome (≥95th BMI percentile, or ≥85th BMI percentile plus presence of another obesity-related complication).
Significant weight gain at 3 months was found in 71.1% of the sample; 75% of patients with bipolar disorder, 76.9% with psychotic disorders, and 62.1% with nonpsychotic disorders, with no significant differences between the groups.
In all, 21.4% of the sample was at risk for adverse health outcomes at 3 months; 33.3% with bipolar disorder, 14.8% with psychotic disorders, and 16.7% with nonpsychotic disorders, again with no differences between groups.
Total cholesterol was elevated in the bipolar disorder and psychotic groups relative to the nonpsychotic group, while low-density lipoprotein cholesterol was increased in the bipolar disorder group relative to the other groups, and free thyroxine decreased in the psychotic disorder group versus the other groups.
Moreno et al comment: “Although side effects of SGAs were seen at the same degree of severity in children and adolescents as in adult populations, higher impact would be expected on a developing system than on a mature system.
“This is particularly important in the case of children and adolescents with bipolar disorder, given the usual need for multiple drug classes and their need for long-term treatment due to the chronic nature of the illness and likelihood of relapses.”
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By Andrew Czyzewski