Metabolic syndrome in bipolar disorder: a review with a focus on bipolar depression

To perform a detailed, qualitative review of existing literature on the co-occurrence of bipolar disorder and metabolic syndrome, the impact of metabolic dysregulation on patients with bipolar disorder, and treatment considerations, with a focus on bipolar depression.

Searches of the PubMed database (October 23, 2012) and Cochrane Library (September 20, 2013) were conducted for English-language articles published from January 1980 onward containing the keywords bipolar AND metabolic, weight, obesity, diabetes, dyslipidemia, OR hypertension in the title or abstract. The searches yielded 1,817 citations from which case reports, conference abstracts, and pediatric studies were excluded.

Abstracts and titles were evaluated for relevance to the stated objectives. Full texts of 176 articles were obtained for further evaluation; additional articles were identified from reference lists.

Metabolic risk factors are highly prevalent yet undertreated in patients with bipolar disorder. Putative factors accounting for the link between bipolar disorder and metabolic syndrome include behavioral/phenomenological features, shared neurobiologic abnormalities, and adverse effects of psychotropic medications. A comprehensive assessment of metabolic risk and regular monitoring of body mass index, waist circumference, lipid profile, and plasma glucose are important for patients with bipolar disorder. Management strategies for the bipolar patient with metabolic risk factors include use of bipolar disorder medications with better metabolic profiles, lifestyle interventions, and adjunctive pharmacotherapy for dyslipidemia, hypertension, and/or hyperglycemia.

Adequate management of metabolic syndrome may improve clinical outcomes in patients with bipolar disorder, as well as prevent adverse cardiovascular events and the development of diabetes.