Lithium or Valproate Adjunctive Therapy to Second-generation Antipsychotics and Metabolic Variables in Patients With Schizophrenia or Schizoaffective Disorder

Abstract

Objective People with schizophrenia are at greater risk for cardiovascular disease and their overallmortality rate is elevated compared to the general population. The metabolic side effects of antipsychotic medications have been widely studied; however, the effect of adding conventional mood stabilizers, such as lithium and valproate, to antipsychotic medication has not been assessed in terms of metabolic risk. The primary purpose of this secondary analysis was to examine whether treatment with lithium or valproate in addition to a second-generation antipsychotic is associated with poorer metabolic outcomes than treatment with a second-generation antipsychotic without lithium or depakote. Methods Baseline data from 3 studies, which included measurement of body mass index, waist circumference, fasting glucose, insulin, homeostatic model assessment of insulin resistance, insulin sensitivity index, glucose utilization, and acute insulin response to glucose, were included in the analysis. Results No differences were found between those taking lithium or valproate and those who were not in terms of fasting glucose, fasting insulin, and homeostatic model assessment of insulin resistance. Insulin sensitivity was lower among participants taking lithium or valproate. Participants taking lithium or valproate had a higher body mass index than those not taking conventional mood stabilizers, although the difference did not reach statistical significance. Conclusions These cross-sectional findings suggest it may be beneficial to monitor insulin sensitivity and body mass index in patients taking lithium or valproate in combination with a second-generation antipsychotic.

Obesity and metabolic comorbidity in bipolar disorder: Do patients on lithium comprise a subgroup? A naturalistic study.

“…MetS and its constituents) of pharmacotherapy combinations. Previous studies are limited by their focus on individual antipsychotics or mood stabilizers and modest sample sizes (23). Overall, lithium and non-lithium combinations seem to emerge as comparable in this study.…”

Obesity and Metabolic Comorbidity in Bipolar Disorder: Do Patients on Lithium Comprise A Subgroup? A Naturalistic Study.

“…metabolic syndrome and its constituents) of pharmacotherapy combinations. Previous studies are limited by their focus on individual antipsychotics or mood stabilizers and modest sample sizes 21 . Overall, the present study seems to suggest that lithium and nonlithium combinations emerge as comparable.…”

Depresión Y Obesidad: Una Relación Bidireccional

“…Algunos principios farmacodinámicos útiles para orientar estas modificaciones en la medicación incluyen evitar el uso de fármacos antagonistas de los receptores D2 (todos los fármacos antipsicóticos), H1 (algunos antipsicóticos, mirtazapina, hidroxizina, antidepresivos tricíclicos, y 5HT 2C (mirtazapina, mianserina, trazodona, algunos antipsicóticos de segunda generación), todos los cuales se asocian con aumento de peso y apetito (Foley & Morley, 2011). Estabilizadores del humor como el valproato y las sales de litio se asocian con aumento de peso a través de mecanismos heterogéneos y poco claros, pero probablemente relacionados con empeoramiento de la RI (Vincenzi et al, 2016). En contraparte, algunos psicofármacos, como el bupropion y topiramato, se han asociado a pérdida de peso (Fujioka, 2015).…”