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

Abstract

Background: Bipolar disorders (BD) are associated with increased prevalence of obesity and metabolic syndrome (MetS). Nevertheless, there is a wide range in prevalence estimates, and little is known about the relative contributions of medications, especially lithium. We hypothesized that lithium use is not associated with increased body mass index (BMI), metabolic syndrome, and type II diabetes (DM II), when compared to non-lithium users (those on anticonvulsants (ACs) or second-generation antipsychotics (APs)). Methods: Cross-sectional study of 129 patients aged 18-85 with bipolar disorder, followed at tertiary care clinics in Montreal. Patients using lithium were compared with those not on lithium, for body mass index and metabolic syndrome. Results: The prevalence of obesity and MetS in the sample of lithium-using bipolar patients was 42.4% and 34.9%, respectively, with an average BMI of 29.10 (+/-6.70). Lithium and non-lithium groups did not differ in BMI or prevalence of MetS. However, compared to the non-lithium group, lithium users had lower hemoglobin A1C (5.24 +/- 0.53 versus 6.01 +/- 1.83, U=753.5, p=0.006) and lower triglycerides (1.46 +/- 0.88 versus 2.01 +/-1.25, U=947, p=0.020). Conclusions: There is a high prevalence of obesity and metabolic syndrome among bipolar disorder patients. However, this did not appear to be associated with lithium use, when compared to those not on lithium. The lithium subgroup was also associated with lower prevalence of type II diabetes. Future prospective and intervention studies with larger sample sizes are necessary to further explore the association between lithium and insulin resistance, as well as its underlying mechanisms.