Insulin resistance and hyperlipidemia in women with bipolar disorder

Stemmle, Pascale G.; Kenna, Heather A.; Wang, Po; Hill, Shelley J.; Ketter, Terence A.; Rasgon, Natalie

doi:10.1016/j.jpsychires.2008.04.003

Cited by 8 publications

(7 citation statements)

References 18 publications

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“…In the present study, women with BD exhibited worse metabolic biomarkers than age‐matched controls, which is consistent with our previous findings (5–9). The observed preponderance of overweight/obesity and IR among women with BD in comparison with controls is not surprising.…”

Section: Discussionsupporting

confidence: 93%

“…With respect to its prevalence in mood disorders, IR is hypothesized to be (i) an underlying state predisposing toward both mood disorders and metabolic disorders, (ii) a side effect of the psychotropic medications used to treat mood disorders, and/or (iii) a consequence of mood disorders themselves (e.g., lifestyle changes or stress). While our group and others have previously reported high rates of overweight/obesity and surrogate biomarkers of IR in samples of women with bipolar disorder (BD) (5–9), there are no controlled studies utilizing direct measures of insulin sensitivity and glucose utilization in BD patients. The question of trait versus state vulnerability remains unanswered, as the effects of illness per se on glucose handling in these patients are difficult to disentangle from the effects of medications used to treat the illness.…”

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confidence: 97%

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Metabolic dysfunction in women with bipolar disorder: the potential influence of family history of type 2 diabetes mellitus

Rasgon¹,

Kenna²,

Reynolds-May³

et al. 2010

Bipolar Disorders

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Objective-Overweight/obesity, insulin resistance (IR), and other types of metabolic dysfunction are common in patients with bipolar disorder (BD); however, the pathophysiological underpinnings of metabolic dysfunction in BD are not fully understood. Family history of type 2 diabetes mellitus (FamHxDM2), which has been shown to have deleterious effects on metabolic function in the general population, may play a role in the metabolic dysfunction observed in BD.Methods-Using multivariate analysis of variance, the effects of BD illness and/or FamHxDM2 were examined relative to metabolic biomarkers in 103 women with BD and 36 healthy, agematched control women.Results-As a group, women with BD had higher levels of fasting plasma insulin (FPI) and fasting plasma glucose (FPG), higher homeostatic assessment of IR (HOMA-IR) scores, body mass index (BMI), waist circumference (WC), and hip circumference (HC) compared to control women. FamHxDM2 was associated with significantly worse metabolic biomarkers among women with BD but not among healthy control women. Among women with BD, there was a significant main effect of FamHxDM2 on FPI, HOMA-IR, BMI, WC, and HC, even after controlling for type of BD illness, duration of medication exposure, and depression severity. Metabolic biomarkers were not influenced by use of weight-liable psychotropic medication (WLM), even after controlling for type of BD illness, duration of medication exposure, and depression severity.Conclusions-Women with BD have overall worse metabolic biomarkers than age-matched control women. The use of WLM, duration of medication use, type of BD illness, and depression severity did not appear to be associated with more pronounced metabolic dysfunction. FamHxDM2 may represent a risk factor for the development of IR in women with BD. Further, focused studies of the endocrine profiles of families of BD patients are needed. Over the last decade, metabolic dysfunction [i.e., overweight/obesity, insulin resistance (IR), and dyslipidemia] has become increasingly important in clinical medicine in general and in psychiatry in particular (1,2). Despite intense scientific focus on this topic, risk factors for developing metabolic dysfunction as well as its pathophysiology among patients with mental illness remain to be elucidated. KeywordsIR is recognized as central to the pathophysiology of many metabolic abnormalities and is a known precursor condition for type 2 diabetes mellitus (DM2), obesity, cardiovascular illness (3), and neurocognitive disorders (4). With respect to its prevalence in mood disorders, IR is hypothesized to be (i) an underlying state predisposing toward both mood disorders and metabolic disorders, (ii) a side effect of the psychotropic medications used to treat mood disorders, and/or (iii) a consequence of mood disorders themselves (e.g., lifestyle changes or stress). While our group and others have previously reported high rates of overweight/obesity and surrogate biomarkers of IR in samples of women with bipolar disorder (BD) (5-9), ther...

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Section: Discussionsupporting

confidence: 93%

mentioning

confidence: 97%

Metabolic dysfunction in women with bipolar disorder: the potential influence of family history of type 2 diabetes mellitus

Rasgon¹,

Kenna²,

Reynolds-May³

et al. 2010

Bipolar Disorders

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“…In turn, depression has a lifetime prevalence of over 23% (Okamura et al, 2000), and patients with a history of depressive disorders have high prevalence of IR and glucose dysregulation (Heninger et al, 1975; Okamura et al, 2000; Rasgon et al, 2002; Stemmle et al, 2009) and DM2 (Okamura et al, 2000). …”

Section: Discussionmentioning

confidence: 99%

Adjuvant pioglitazone for unremitted depression: Clinical correlates of treatment response

Lin

Wroolie

Robakis

et al. 2015

Psychiatry Research

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Previous studies suggest that insulin-sensitizing agents could play a significant role in the treatment of major depression, particularly depression in patients with documented insulin resistance or those who are resistant to standard psychopharmacological approaches. This study aimed to assess the effects on depressive symptoms with adjuvant treatment with the PPARγ-agonist pioglitazone. Patients (N=37) with non-psychotic, non-remitting depression receiving standard psychiatric regimens for depression were randomized across an insulin sensitivity spectrum in a 12-week double blind, randomized controlled trial of pioglitazone or placebo. Improvement in depression was associated with improvement in glucose metabolism but only in patients with insulin resistance. An age effect was also shown in that response to pioglitazone was more beneficial in younger aged patients. Study findings suggest differential improvement in depression severity according to both glucose metabolic status and level of depression at baseline. A greater understanding of the reciprocal links between depression and IR may lead to a dramatic shift in the way in which depression is conceptualized and treated, with a greater focus on treating and/or preventing metabolic dysfunction.

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“…Insulin sensitivity was significantly lower and acute insulin response to intravenous glucose was significantly higher in this population and there was an inverse correlation of depressive symptoms and insulin sensitivity. Stemmle et al 17 studied a small sample of unmedicated depressed women with BD. They found increased rates of IR (estimated by the HOMA-IR), obesity and hyperlipidemia in untreated patients and suggested that the metabolic dysfunctions may, at least in part, be attributable to the disorder itself.…”

Section: Discussionmentioning

confidence: 99%

“…Hung et al 16 studied a small sample of non-obese young males and found an inverse relationship between the severity of unipolar and bipolar depressive symptoms and insulin resistance. In the same vein, Stemmle et al 17 found high rates of hyperlipidemia and IR in untreated women with bipolar II disorder. Although preliminary, these data have added some insights into the underlying pathophysiology of previous findings of increased IR and metabolic disturbances in patients with bipolar disorder 18,19 .…”

Section: Introductionmentioning

confidence: 91%

Resistência à insulina e síndrome metabólica em pacientes ambulatoriais com transtorno do humor bipolar

Gomes¹,

Magalhães²,

Kunz³

et al. 2010

Rev. psiquiatr. clín.

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Background: Bipolar disorder (BD) is associated with significant morbidity and mortality from metabolic diseases. There is a paucity of data regarding insulin resistance (IR) and its relationship with the metabolic syndrome (MS) in bipolar patients. Objective: To evaluate the prevalence of both IR and MS in BD outpatients and to assess clinical criteria associated with IR. Method: Cross-sectional study in 65 DSM-IV-TR BD patients consecutively assessed at the Bipolar Disorder Program at Hospital de Clínicas de Porto Alegre, Brazil. IR was diagnosed by the homeostatic model assessment -insulin resistance (HOMA-IR) and MS was diagnosed using three different definitions: National Cholesterol Educational Program -Adult Treatment Panel III (NCEP-ATP III); NCEP-ATP III modified criteria and International Diabetes Federation. Results: IR was present in 43.1% of the sample (women 40%, men 44.4%). The prevalence of MS defined by the NCEP-ATP III criteria was 32.3%, NCEP-ATP III modified was 40% and IDF was 41.5%. NCEP-ATP III modified criteria showed the best tradeoff between sensitivity (78.6%) and specificity (89.2%) to detect insulin resistance. Waist circumference was the clinical parameter most associated with IR. Discussion: Current MS criteria may provide reasonable sensitivity and specificity for the detection of IR in BD patients. Abdominal obesity is closely related to IR in this patient population.

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Insulin resistance and hyperlipidemia in women with bipolar disorder

Cited by 8 publications

References 18 publications

Metabolic dysfunction in women with bipolar disorder: the potential influence of family history of type 2 diabetes mellitus

Metabolic dysfunction in women with bipolar disorder: the potential influence of family history of type 2 diabetes mellitus

Adjuvant pioglitazone for unremitted depression: Clinical correlates of treatment response

Resistência à insulina e síndrome metabólica em pacientes ambulatoriais com transtorno do humor bipolar

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