1
|
Arniotis-Streat S, Fonte A, Ziauddeen H. Psychotropic drugs, eating behaviour and weight gain. Curr Opin Psychiatry 2024; 37:331-336. [PMID: 38994802 DOI: 10.1097/yco.0000000000000953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
PURPOSE OF REVIEW Psychotropic drug related weight gain is a common side-effect of significant concern to both clinicians and patients. Recent studies and treatment guidelines strongly support taking preventive and early treatment approaches to psychotropic drug-related weight gain (PDWG). Arguably the main pathway that PDWG occurs is via changes in eating behaviour leading to increased caloric intake. RECENT FINDINGS Systematic reviews and meta-analyses have provided good data on the nature and prevalence of alterations in eating behaviour with psychotropic treatment including increased hunger, night eating and binge eating. These changes are unsurprisingly more prominent with agents like olanzapine and clozapine that have high propensity to cause weight gain. SUMMARY Altered eating behaviour can serve as an earlier measure of the risk of weight gain and can be examined easily in clinical practice. Detecting these changes can enable earlier action in terms of switching treatments and starting pharmacological and nonpharmacological preventive strategies.
Collapse
Affiliation(s)
| | - Anthony Fonte
- Mental Health service, Fiona Stanley Fremantle Hospitals Group, Murdoch, WA, Australia
| | - Hisham Ziauddeen
- Mental Health service, Fiona Stanley Fremantle Hospitals Group, Murdoch, WA, Australia
- Dept of Psychiatry, University of Cambridge, Cambridge, UK
| |
Collapse
|
2
|
Ishii H, Yamada H, Sato R, Hayashi W, Nakamura D, Sugita S, Tazaki T, Takashio O, Inamoto A, Iwanami A. Obesity-associated factors in psychiatric outpatients: A multicenter questionnaire survey. Neuropsychopharmacol Rep 2024. [PMID: 39010283 DOI: 10.1002/npr2.12465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 06/11/2024] [Accepted: 06/15/2024] [Indexed: 07/17/2024] Open
Abstract
The prevalence of obesity is increasing worldwide, resulting in various health issues such as hypertension, dyslipidemia, diabetes mellitus, heart disease, and a lower life expectancy. Importantly, several psychiatric disorders and the use of psychotropic medications have been linked to obesity, and the possible risk factors need further investigation. This study examined the prevalence of obesity and its associated factors using a self-administered questionnaire. Participants were recruited from three outpatient clinics and individuals who met one or more of the ICD-10 F0-F9, G4 diagnoses were included. In total, 1384 participants completed the questionnaire about their lifestyle. Statistical analysis compared the demographic and clinical characteristics of the individuals who were obese (Body Mass Index: BMI ≥25) and those who were non-obese (BMI <25). The results revealed that the factors associated with obesity in psychiatric outpatients were being male, prolonged treatment duration, eating out frequently, and use of both second- and first-generation antipsychotics. The study emphasized the importance of closely monitoring BMI in individuals with multiple obesity-related factors.
Collapse
Affiliation(s)
- Hiroki Ishii
- Department of Psychiatry, Graduate School of Medicine, Showa University, Shinagawa-ku, Tokyo, Japan
- Department of Psychiatry, School of Medicine, Showa University, Shinagawa-ku, Tokyo, Japan
- Department of Psychiatry, East Hospital, Showa University Hospital, Shinagawa-ku, Tokyo, Japan
| | - Hiroki Yamada
- Department of Psychiatry, School of Medicine, Showa University, Shinagawa-ku, Tokyo, Japan
- Department of Psychiatry, Showa University Northern Yokohama Hospital, Tsuzuki-ku, Yokohama, Japan
- Shinrin Koen Mental Clinic, Namekawa-cho, Hiki-gun, Saitama, Japan
| | - Ryotaro Sato
- Department of Psychiatry, Graduate School of Medicine, Showa University, Shinagawa-ku, Tokyo, Japan
- Department of Psychiatry, School of Medicine, Showa University, Shinagawa-ku, Tokyo, Japan
- Department of Psychiatry, East Hospital, Showa University Hospital, Shinagawa-ku, Tokyo, Japan
| | - Wakaho Hayashi
- Department of Psychiatry, School of Medicine, Showa University, Shinagawa-ku, Tokyo, Japan
- Showa University Karasuyama Hospital, Setagaya-ku, Tokyo, Japan
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Dan Nakamura
- Department of Psychiatry, School of Medicine, Showa University, Shinagawa-ku, Tokyo, Japan
- Showa University Karasuyama Hospital, Setagaya-ku, Tokyo, Japan
| | - Shutaro Sugita
- Department of Psychiatry, School of Medicine, Showa University, Shinagawa-ku, Tokyo, Japan
- Showa University Karasuyama Hospital, Setagaya-ku, Tokyo, Japan
| | - Taro Tazaki
- Department of Psychiatry, Graduate School of Medicine, Showa University, Shinagawa-ku, Tokyo, Japan
- Department of Psychiatry, School of Medicine, Showa University, Shinagawa-ku, Tokyo, Japan
- Showa University Karasuyama Hospital, Setagaya-ku, Tokyo, Japan
| | - Osamu Takashio
- Department of Psychiatry, School of Medicine, Showa University, Shinagawa-ku, Tokyo, Japan
- Department of Psychiatry, East Hospital, Showa University Hospital, Shinagawa-ku, Tokyo, Japan
| | - Atsuko Inamoto
- Department of Psychiatry, School of Medicine, Showa University, Shinagawa-ku, Tokyo, Japan
- Department of Psychiatry, Showa University Northern Yokohama Hospital, Tsuzuki-ku, Yokohama, Japan
| | - Akira Iwanami
- Department of Psychiatry, School of Medicine, Showa University, Shinagawa-ku, Tokyo, Japan
- Showa University Karasuyama Hospital, Setagaya-ku, Tokyo, Japan
| |
Collapse
|
3
|
Urhan M, Cengisiz C, Türk M, Akanalçı C. Can mindful eating be a psycho-marker of obesity in bipolar disorder? NUTR HOSP 2024. [PMID: 39037191 DOI: 10.20960/nh.05084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND AND AIM obesity is a very important problem in individuals with bipolar disorder. The study was aimed to determine the prevalence of obesity in individuals with bipolar disorder and to evaluate the effects of factors affecting eating behavior such as mindful eating, impulsivity and eating disorders on the development of obesity in these individuals. METHODS this study is a cross-sectional study. A total of 109 individuals (52 female; 57 male) with bipolar disorder who were in a euthymic state at the time of the interview and underwent outpatient follow-up, treatment and monitorization, and 109 age- and sex-matched healthy individuals as the control group were included in the study. The Mindful Eating Questionnaire-30 (MEQ-30), Three-Factor Eating Questionnaire (TFEQ-21), Barratt Impulsiveness Scale 11-Short Form (BIS-11-SF), and Eating Attitude Test-26 (EAT-26) were used, and anthropometric measurements (height, bodyweight, etc.) were taken. RESULTS the obesity rate was 50.4 % among the cases and 24.8 % in the control group. Moreover, disinhibition (3.4 ± 0.93), emotional eating (3.5 ± 1.13), and mindfulness (2.6 ± 0.54) scores of individuals with BD were significantly lower than for healthy individuals (3.7 ± 0.82, 4.0 ± 0.93, 2.8 ± 0.55, respectively). The risk of obesity was 5.19 times higher in cases compared to the age- and gender-matched controls (OR = 5.19, 95 % CI (2.01-13.37), p = 0.001). The risk of obesity was 2.76 times higher in those with low mindful eating level (OR = 2.76, 95 % CI (1.07-5.47), p = 0.014) and 4.29 times higher in those using antipsyhotics/mood stabilizers (OR = 4.29, 95 % CI (1.12-12.24), p < 0.001). CONCLUSION A comprehensive education program on mindful eating and healthy eating would be helpful in elucidating the mechanisms of the possible relationships between bipolar disorder-specific risk factors and mindful eating.
Collapse
Affiliation(s)
- Murat Urhan
- Department of Nutriton and Dietetics. Faculty of Health Science. Ege University. Department of Nutriton and Dietetics
| | - Cengiz Cengisiz
- Department of Psychiatry. Manisa Mental Health and Diseases Hospital
| | - Melek Türk
- Department of Psychiatry. Manisa Mental Health and Diseases Hospital
| | - Ceren Akanalçı
- Department of Nutriton and Dietetics. Faculty of Health Science. Ege University. Department of Nutriton and Dietetics
| |
Collapse
|
4
|
McIntyre RS, Kwan ATH, Rosenblat JD, Teopiz KM, Mansur RB. Psychotropic Drug-Related Weight Gain and Its Treatment. Am J Psychiatry 2024; 181:26-38. [PMID: 38161305 DOI: 10.1176/appi.ajp.20230922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Psychotropic drug-related weight gain (PDWG) is a common occurrence and is highly associated with non-initiation, discontinuation, and dissatisfaction with psychiatric drugs. Moreover, PDWG intersects with the elevated risk for obesity and associated morbidity that has been amply reported in the psychiatric population. Evidence indicates that differential liability for PDWG exists for antipsychotics, antidepressants, and anticonvulsants. During the past two decades, agents within these classes have become available with significantly lower or no liability for PDWG and as such should be prioritized. Although lithium is associated with weight gain, the overall extent of weight gain is significantly lower than previously estimated. The benefit of lifestyle and behavioral modification for obesity and/or PDWG in psychiatric populations is established, with effectiveness similar to that in the general population. Metformin is the most studied pharmacological treatment in the prevention and treatment of PDWG, and promising data are emerging for glucagon-like peptide-1 (GLP-1) receptor agonists (e.g., liraglutide, exenatide, semaglutide). Most pharmacologic antidotes for PDWG are supported with low-confidence data (e.g., topiramate, histamine-2 receptor antagonists). Future vistas for pharmacologic treatment for PDWG include large, adequately controlled studies with GLP-1 receptor agonists and possibly GLP-1/glucose-dependent insulinotropic polypeptide co-agonists (e.g., tirzepatide) as well as specific dietary modifications.
Collapse
Affiliation(s)
- Roger S McIntyre
- Department of Psychiatry (McIntyre, Rosenblat, Mansur) and Department of Pharmacology and Toxicology (McIntyre, Rosenblat, Mansur), University of Toronto, Toronto; Brain and Cognition Discovery Foundation, Toronto (McIntyre, Kwan, Teopiz); Faculty of Medicine, University of Ottawa, Ottawa (Kwan)
| | - Angela T H Kwan
- Department of Psychiatry (McIntyre, Rosenblat, Mansur) and Department of Pharmacology and Toxicology (McIntyre, Rosenblat, Mansur), University of Toronto, Toronto; Brain and Cognition Discovery Foundation, Toronto (McIntyre, Kwan, Teopiz); Faculty of Medicine, University of Ottawa, Ottawa (Kwan)
| | - Joshua D Rosenblat
- Department of Psychiatry (McIntyre, Rosenblat, Mansur) and Department of Pharmacology and Toxicology (McIntyre, Rosenblat, Mansur), University of Toronto, Toronto; Brain and Cognition Discovery Foundation, Toronto (McIntyre, Kwan, Teopiz); Faculty of Medicine, University of Ottawa, Ottawa (Kwan)
| | - Kayla M Teopiz
- Department of Psychiatry (McIntyre, Rosenblat, Mansur) and Department of Pharmacology and Toxicology (McIntyre, Rosenblat, Mansur), University of Toronto, Toronto; Brain and Cognition Discovery Foundation, Toronto (McIntyre, Kwan, Teopiz); Faculty of Medicine, University of Ottawa, Ottawa (Kwan)
| | - Rodrigo B Mansur
- Department of Psychiatry (McIntyre, Rosenblat, Mansur) and Department of Pharmacology and Toxicology (McIntyre, Rosenblat, Mansur), University of Toronto, Toronto; Brain and Cognition Discovery Foundation, Toronto (McIntyre, Kwan, Teopiz); Faculty of Medicine, University of Ottawa, Ottawa (Kwan)
| |
Collapse
|
5
|
Vieta E, Ghorpade S, Biswas A, Sarkar A, Phansalkar A, Cooper J. Lamotrigine efficacy, safety, and tolerability for women of childbearing age with bipolar I disorder: Meta-analysis from four randomized, placebo-controlled maintenance studies. Eur Neuropsychopharmacol 2024; 78:81-92. [PMID: 37775363 DOI: 10.1016/j.euroneuro.2023.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 08/17/2023] [Accepted: 09/04/2023] [Indexed: 10/01/2023]
Abstract
This meta-analysis investigated the efficacy, safety, and tolerability of lamotrigine versus placebo in preventing relapse and recurrence of mood episodes in women of childbearing age with bipolar I disorder. Following up to 16 weeks' open-label lamotrigine treatment, responders were randomized to double-blind treatment, including lamotrigine 100-400 mg/day or placebo, in four trials of up to 76 weeks. Women aged 18-45 years who received ≥ 1 dose of study treatment and had ≥ 1 efficacy assessment in the double-blind phase were pooled for efficacy analysis. The primary outcome was median time to intervention for any mood episode (TIME). Of 717 eligible women in the open-label phase, 287 responded and were randomized to lamotrigine (n = 153) or placebo (n = 134). The randomized group had a mean (SD) of 2.0(2.02) manic and 2.5(2.02) depressive episodes in the 3 years before screening. Median TIME was 323 days with lamotrigine and 127 days with placebo (HR 0.69; 95% CI 0.49, 0.96; p = 0.030). Lamotrigine delayed time to intervention for any depressive episode (HR 0.59; 95% CI 0.39, 0.90; p = 0.014) with no treatment difference for manic episodes (HR 0.91; 95% CI 0.52, 1.58; p = 0.732). 2/717 (< 1%) participants experienced serious rash-related adverse events (AEs) during the open-label phase, and 52/717 (7%) had non-serious rash-related events leading to study withdrawal. Incidence of AEs and AEs leading to withdrawal were similar between lamotrigine and placebo groups. Lamotrigine delayed relapse and recurrence of mood episodes, largely by preventing depressive episodes, and was well tolerated in women of childbearing age.
Collapse
Affiliation(s)
- Eduard Vieta
- Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | | | | | | | | | | |
Collapse
|
6
|
Yocum AK, Friedman E, Bertram HS, Han P, McInnis MG. Comparative mortality risks in two independent bipolar cohorts. Psychiatry Res 2023; 330:115601. [PMID: 37976662 DOI: 10.1016/j.psychres.2023.115601] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 11/06/2023] [Accepted: 11/09/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES To compare mortality rates in bipolar disorder with common causes of mortality. METHODS Observational data from the Prechter Longitudinal Study of Bipolar Disorder (PLS-BD) of 1128 participants including 281 controls was analyzed using logistical regression to quantify mortality rates in comparison with common comorbidities and causes of death. Outcome and treatment measures, including ASRM, GAD-7, PHQ-9 and medication use were used to stratify those with bipolar disorder (BD) that are alive or deceased. A larger cohort of 10,735 existing BD patients with 7,826 controls (no psychiatric diagnosis) from the University of Michigan Health (U-M Health) clinics was used as replication, observational secondary data analysis. RESULTS The mortality rates are significantly different between those with BD and controls in both PLS-BD and U-M Health. Those with BD and are deceased have a higher percentage of elevated depression measures but show no difference in mania or anxiety measures nor medication use patterns. In both cohorts, a diagnosis of BD increases the odds of mortality greater than history of smoking or being older than ≥ 60-years of age. CONCLUSION BD was found to increase odds of mortality significantly and beyond that of a history of smoking. This finding was replicated in an independent sample.
Collapse
Affiliation(s)
- Anastasia K Yocum
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI 48109, USA.
| | - Emily Friedman
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Holli S Bertram
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI 48109, USA
| | - Peisong Han
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Melvin G McInnis
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI 48109, USA
| |
Collapse
|
7
|
Greil W, de Bardeci M, Müller-Oerlinghausen B, Nievergelt N, Stassen H, Hasler G, Erfurth A, Cattapan K, Rüther E, Seifert J, Toto S, Bleich S, Schoretsanitis G. Controversies regarding lithium-associated weight gain: case-control study of real-world drug safety data. Int J Bipolar Disord 2023; 11:34. [PMID: 37840048 PMCID: PMC10577117 DOI: 10.1186/s40345-023-00313-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/27/2023] [Indexed: 10/17/2023] Open
Abstract
BACKGROUND The impact of long-term lithium treatment on weight gain has been a controversial topic with conflicting evidence. We aim to assess reporting of weight gain associated with lithium and other mood stabilizers compared to lamotrigine which is considered free of metabolic adverse drug reactions (ADRs). METHODS We conducted a case/non-case pharmacovigilance study using data from the AMSP project (German: "Arzneimittelsicherheit in der Psychiatrie"; i.e., Drug Safety in Psychiatry), which collects data on ADRs from patients treated in psychiatric hospitals in Germany, Austria, and Switzerland. We performed a disproportionality analysis of reports of weight gain (> 10% of baseline body weight) calculating reporting odds ratio (ROR). We compared aripiprazole, carbamazepine, lithium, olanzapine, quetiapine, risperidone, and valproate to lamotrigine. Additional analyses related to different mood stabilizers as reference medication were performed. We also assessed sex and age distributions of weight-gain reports. RESULTS We identified a total of 527 cases of severe drug-induced weight gain representing 7.4% of all severe ADRs. The ROR for lithium was 2.1 (95%CI 0.9-5.1, p > 0.05), which did not reach statistical significance. Statistically significant disproportionate reporting of weight gain was reported for olanzapine (ROR: 11.5, 95%CI 4.7-28.3, p < 0.001), quetiapine (ROR: 3.4, 95%CI 1.3-8.4, p < 0.01), and valproate (ROR: 2.4, 95%CI 1.1-5.0, p = 0.03) compared to lamotrigine. Severe weight gain was more prevalent in non-elderly (< 65 years) than in elderly patients, with an ROR of 7.6 (p < 0.01) in those treated with lithium, and an ROR of 14.7 (p < 0.01) in those not treated with lithium. CONCLUSIONS Our findings suggest that lithium is associated with more reports of severe weight gain than lamotrigine, although this difference did not reach statistical significance. However, lithium use led to fewer reports of severe weight gain than some alternative drugs for long-term medication (olanzapine, quetiapine, and valproate), which is consistent with recent studies. Monitoring of weight gain and metabolic parameters remains essential with lithium and its alternatives.
Collapse
Affiliation(s)
- Waldemar Greil
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Nussbaumstr. 7, 80331, Munich, Germany.
- Psychiatric Private Hospital, Sanatorium Kilchberg, Zurich, Switzerland.
| | - Mateo de Bardeci
- Psychiatric Private Hospital, Sanatorium Kilchberg, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Bruno Müller-Oerlinghausen
- Charité Universitätsmedizin-Berlin, Berlin, Germany
- Medical Faculty Brandenburg Theodor Fontane, Neuruppin, Germany
- Drug Commission of the German Medical Association, Berlin, Germany
| | - Nadja Nievergelt
- Psychiatric Private Hospital, Sanatorium Kilchberg, Zurich, Switzerland
| | - Hans Stassen
- Psychiatric Private Hospital, Sanatorium Kilchberg, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
- IFMA Preventive Health Management Inc., 80 Pine Street, 24th Floor, New York, NY, 10005, USA
| | - Gregor Hasler
- Psychiatry Research Unit, University of Fribourg, Fribourg, Switzerland
| | - Andreas Erfurth
- Klinik Hietzing, 1st Department of Psychiatry and Psychotherapeutic Medicine, Vienna, Austria
| | - Katja Cattapan
- Psychiatric Private Hospital, Sanatorium Kilchberg, Zurich, Switzerland
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Eckart Rüther
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Nussbaumstr. 7, 80331, Munich, Germany
| | - Johanna Seifert
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Sermin Toto
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Georgios Schoretsanitis
- Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry at the Donald and Barbara Zucker School of Medicine at Northwell/Hofstra, Hempstead, NY, USA
| |
Collapse
|
8
|
De R, Prasad F, Stogios N, Burin L, Ebdrup BH, Knop FK, Hahn MK, Agarwal SM. Promising translatable pharmacological interventions for body weight management in individuals with severe mental illness - a narrative review. Expert Opin Pharmacother 2023; 24:1823-1832. [PMID: 37653675 DOI: 10.1080/14656566.2023.2254698] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/21/2023] [Accepted: 08/30/2023] [Indexed: 09/02/2023]
Abstract
INTRODUCTION Psychotropic medications, especially antipsychotics, have been consistently shown to cause weight gain in individuals with severe mental illness (SMI), a population inherently challenged by poor physical health. Consequently, compared to the general population, this contributes to an increased cardiometabolic burden, including the risk of type 2 diabetes, dyslipidemia, and hypertension. Furthermore, comorbid obesity leads to treatment nonadherence, decreased quality of life, and increased risk of relapse, posing a challenge in the management of mental health. To address this, emerging agents investigated in the general population with potential to mitigate weight gain were explored to assess translatability to the SMI population. AREAS COVERED A literature search was conducted including agents approved for the management of obesity in the general population, along with upcoming agents under investigation in phase III trials with weight loss properties. EXPERT OPINION Metformin and topiramate along with lifestyle interventions are commonly prescribed for weight gain in individuals with SMI; however, their weight loss potential is modest at best. This review identified tirzepatide and cagrilintide-semaglutide among others as promising agents for adjunctive pharmacological management of weight gain.
Collapse
Affiliation(s)
- Riddhita De
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Femin Prasad
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Nicolette Stogios
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Luisa Burin
- Center of Clinical Research and Center of Experimental Research, Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Post-Graduation Program in Psychiatry and Behavioral Sciences, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- I-QOL Innovations and Interventions for Quality-of-Life research group, Porto Alegre, Brazil
| | - Bjørn H Ebdrup
- Center for Neuropsychiatric Schizophrenia Research, Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Filip K Knop
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Margaret K Hahn
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Banting and Best Diabetes Centre, University of Toronto, Toronto, ON, Canada
| | - Sri Mahavir Agarwal
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Banting and Best Diabetes Centre, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
9
|
Eder J, Simon MS, Glocker C, Musil R. [Weight gain and treatment with psychotropic drugs : Background and management]. DER NERVENARZT 2023; 94:859-869. [PMID: 37672085 DOI: 10.1007/s00115-023-01534-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/21/2023] [Indexed: 09/07/2023]
Abstract
Psychotropic drug-induced weight gain (PIWG) is a well-known and frequent side effect which is relevant for the prognosis of patients. Individual medications have varying risks for the occurrence of PIWG, and at the same time there are individual risk factors on the part of patients, such as age, gender, metabolic and genetic factors. As the metabolic changes in the context of PIWG result in increased mortality in the long term, it is important to prevent PIWG by appropriate prevention and to intervene in a targeted manner if PIWG has already occurred. Appropriate monitoring is therefore essential. This article provides an overview of underlying mechanisms, risk constellations and possible countermeasures.
Collapse
Affiliation(s)
- J Eder
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität (LMU) München, Nußbaumstraße 7, 80336, München, Deutschland
| | - M S Simon
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität (LMU) München, Nußbaumstraße 7, 80336, München, Deutschland
| | - C Glocker
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität (LMU) München, Nußbaumstraße 7, 80336, München, Deutschland.
| | - R Musil
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität (LMU) München, Nußbaumstraße 7, 80336, München, Deutschland
- Oberberg Fachklinik Bad Tölz, Bad Tölz, Deutschland
| |
Collapse
|
10
|
Sachse T, Kanji S, Thabet P, Schmiedl S, Thürmann P, Guirguis F, Sajwani S, Gauthier MF, Lunny C, Mathes T, Pieper D. Clinical utility of overviews on adverse events of pharmacological interventions. Syst Rev 2023; 12:131. [PMID: 37525235 PMCID: PMC10388527 DOI: 10.1186/s13643-023-02289-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 07/14/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Overviews (i.e., systematic reviews of systematic reviews, meta-reviews, umbrella reviews) are a relatively new type of evidence synthesis. Among others, one reason to conduct an overview is to investigate adverse events (AEs) associated with a healthcare intervention. Overviews aim to provide easily accessible information for healthcare decision-makers including clinicians. We aimed to evaluate the clinical utility of overviews investigating AEs. METHODS We used a sample of 27 overviews exclusively investigating drug-related adverse events published until 2021 identified in a prior project. We defined clinical utility as the extent to which overviews are perceived to be useful in clinical practice. Each included overview was assigned to one of seven pharmacological experts with expertise on the topic of the overview. The clinical utility and value of these overviews were determined using a self-developed assessment tool. This included four open-ended questions and a ranking of three clinical utility statements completed by clinicians. We calculated frequencies for the ranked clinical utility statements and coded the answers to the open-ended questions using an inductive approach. RESULTS The overall agreement with the provided statements was high. According to the assessments, 67% of the included overviews generated new knowledge. In 93% of the assessments, the overviews were found to add value to the existing literature. The overviews were rated as more useful than the individual included systematic reviews (SRs) in 85% of the assessments. The answers to the open-ended questions revealed two key aspects of clinical utility in the included overviews. Firstly, it was considered useful that they provide a summary of available evidence (e.g., along with additional assessments, or across different populations, or in different settings that have not been evaluated together in the included SRs). Secondly, it was found useful if overviews conducted a new meta-analysis to answer specific research questions that had not been answered previously. CONCLUSIONS Overviews on drug-related AEs are considered valuable for clinical practice by clinicians. They can make available evidence on AEs more accessible and provide a comprehensive view of available evidence. As the role of overviews evolves, investigations such as this can identify areas of value.
Collapse
Affiliation(s)
- Thilo Sachse
- Faculty of Health, School of Medicine, Institute for Research in Operative Medicine, Witten/Herdecke University, 51109, Cologne, Germany.
| | - Salmaan Kanji
- The Ottawa Hospital and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Pierre Thabet
- Hôpital Montfort and University of Ottawa, Ottawa, Ontario, Canada
| | - Sven Schmiedl
- Philipp Klee-Institute of Clinical Pharmacology, Helios University Hospital Wuppertal, Witten/Herdecke University, Chair of Clinical Pharmacology, Wuppertal, Germany
| | - Petra Thürmann
- Philipp Klee-Institute of Clinical Pharmacology, Helios University Hospital Wuppertal, Witten/Herdecke University, Chair of Clinical Pharmacology, Wuppertal, Germany
| | | | | | | | - Carole Lunny
- Knowledge Translation Program, Unity Health Toronto and the Cochrane Hypertension Group, St. Michael's Hospital, University of British Columbia, Vancouver, Canada
| | - Tim Mathes
- Faculty of Health, School of Medicine, Institute for Research in Operative Medicine, Witten/Herdecke University, 51109, Cologne, Germany
- Institute for Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Dawid Pieper
- Faculty of Health, School of Medicine, Institute for Research in Operative Medicine, Witten/Herdecke University, 51109, Cologne, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School (Theodor Fontane), Institute for Health Services and Health System Research, Rüdersdorf, Germany
- Center for Health Services Research, Brandenburg Medical School (Theodor Fontane), Rüdersdorf, Germany
| |
Collapse
|
11
|
Kim HH, Goetz TG, Grieve V, Keuroghlian AS. Psychopharmacological Considerations for Gender-Affirming Hormone Therapy. Harv Rev Psychiatry 2023; 31:183-194. [PMID: 37437250 PMCID: PMC10348476 DOI: 10.1097/hrp.0000000000000373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
ABSTRACT The field of transgender health has grown exponentially since the early 2010s. While this increased visibility has not been without controversy, there is growing acknowledgement of the needs of transgender, nonbinary, and gender expansive (TNG) patients and the health disparities they experience compared to the cisgender population. There is also increased interest among clinicians and trainees in providing gender-affirming care in all medical specialties. This is particularly relevant in psychiatry as mental health disparities in TNG patients have been well-documented. TNG patients experience significant minority stress and higher rates of psychiatric illness, self-harm, suicidality, and psychiatric hospitalization compared to their cisgender peers. In this review, we will cover potential interactions and side effects relevant to psychiatric medication management for the three most common medication classes prescribed as part of gender-affirming hormone therapy (GAHT): gonadotropin-releasing hormone receptor agonists, estradiol, and testosterone. Although no studies directly examining the efficacy of psychiatric medications or their interactions with GAHT for TNG patients have been published yet, we have synthesized the existing literature from both cisgender and TNG patients to shed light on health care disparities seen in TNG patients. Since clinicians' lack of comfort and familiarity with gender-affirming care contributes significantly to these disparities, we hope this narrative review will help psychiatric prescribers provide TNG patients with the same quality of care that cisgender patients receive.
Collapse
Affiliation(s)
- Hyun-Hee Kim
- From Department of Psychiatry, Massachusetts General Hospital, Boston, MA (Drs. Kim and Keuroghlian); University of Pennsylvania Department of Psychiatry (Dr. Goetz); University of Pittsburgh Department of Pharmacy and Therapeutics (Dr. Grieve)
| | | | | | | |
Collapse
|
12
|
Sachse T, Mathes T, Dorando E, Heß S, Thürmann P, Schmiedl S, Kanji S, Lunny C, Thabet P, Pieper D. A review found heterogeneous approaches and insufficient reporting in overviews on adverse events. J Clin Epidemiol 2022; 151:104-112. [PMID: 35987405 DOI: 10.1016/j.jclinepi.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 07/19/2022] [Accepted: 08/10/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To investigate reporting and methodological characteristics of overviews on adverse (drug-associated) events (AEs) of pharmacological interventions. STUDY DESIGN AND SETTING We searched MEDLINE, Embase, Epistemonikos, and the Cochrane Database of Systematic Reviews from inception to May 17, 2021 for overviews exclusively investigating AEs of pharmacological interventions. We extracted general, reporting, and methodological characteristics and analyzed data descriptively. RESULTS We included 27 overviews, 70% of which were published in 2016 or later. The most common nomenclature in the title was "overview" (56%), followed by "umbrella review" (26%). The median number of included systematic reviews (SRs) in each overview was 15 (interquartile range 7-34). Study selection methods were reported in 52%, methods for data extraction in 67%, and methods for critical appraisal in 63% of overviews. An assessment of methodological quality of included SRs was performed in 70% of overviews. Only 22% of overviews reported strategies for dealing with overlapping SRs. An assessment of the certainty of the evidence was performed in 33% of overviews. CONCLUSION To ensure methodological rigor, authors of overviews on AEs should follow available guidance for the conduct and reporting of overviews.
Collapse
Affiliation(s)
- Thilo Sachse
- Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - Tim Mathes
- Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Ostmerheimer Str. 200, 51109, Cologne, Germany; Institute for Medical Statistics, University Medical Center Göttingen, Germany
| | - Elena Dorando
- Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - Simone Heß
- Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - Petra Thürmann
- Philipp Klee-Institute of Clinical Pharmacology, Helios University Hospital Wuppertal, University Witten/Herdecke, Wuppertal, Germany
| | - Sven Schmiedl
- Philipp Klee-Institute of Clinical Pharmacology, Helios University Hospital Wuppertal, University Witten/Herdecke, Wuppertal, Germany
| | - Salmaan Kanji
- The Ottawa Hospital and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Carole Lunny
- Knowledge Translation Program, St Michael's Hospital, Unity Health Toronto and the Cochrane Hypertension Group, University of British Columbia, Vancouver, Canada
| | - Pierre Thabet
- Hôpital Montfort and University of Ottawa, Ontario, Canada
| | - Dawid Pieper
- Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Ostmerheimer Str. 200, 51109, Cologne, Germany; Faculty of Health Sciences Brandenburg, Brandenburg Medical School (Theodor Fontane), Institute for Health Services and Health System Research, Rüdersdorf, Germany; Center for Health Services Research, Brandenburg Medical School (Theodor Fontane), Rüdersdorf, Germany.
| |
Collapse
|
13
|
Tunçel ÖK, Altunkaynak Z, Bilgici B, Karaustaoğlu A, Gümrükçüoğlu Tİ. Increased growth hormone secretagogue receptor-1a (GHSR-1a) in hypothalamus during olanzapine treatment in rats. Psychoneuroendocrinology 2022; 144:105862. [PMID: 35835020 DOI: 10.1016/j.psyneuen.2022.105862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 01/07/2022] [Accepted: 07/05/2022] [Indexed: 11/24/2022]
Abstract
Weight gain is the one of the most important factors which increases global burden of psychiatric disorder. Second-generation antipsychotics, olanzapine (Olz) and valproic acid (Vpa) in particular, are held responsible for weight gain. However, it is still uncertain how these drugs cause this. Thus, the rats selected for the experiment were randomly divided into 3 groups. The 1st group received only 0.5 ml saline solution intraperitoneally (n = 20, control group); the second group was given 200 mg / kg Vpa intraperitoneally (n = 20, Vpa group) and 2 mg / kg Olz was given intraperitoneally to the 3rd group (n = 20, Olz group) between 8 and 10 am for 30 days. We examined serum leptin, adiponectin, resistin, TNF-α, IL-6, ghrelin level and, the amount of ghrelin secreting cells in the stomach and growth hormone secretagogue receptor-1a (GHSR-1a, ghrelin receptor) expression in the hypothalamus. The hypothalamic GHS-1a receptor index was significantly higher in the Olz group compared with the control group and Vpa group (p = 0.036 and p = 0.016 respectively). Ghrelin immune positive cell index in stomach was statistically significantly lower in the Vpa group compared with the control and Olz groups (p = 0.028 and p = 0.013 respectively) There was no difference between the groups in terms of serum leptin, resistin, IL-6 and ghrelin levels. In the Vpa group, a statistically significant increase was found in serum adiponectin level compared with both the control group and the Olz group (p = 0009 and p = 0024 respectively) and, significant decrease was found in serum TNF-α level compared to Olz group (p = 0007). In conclusion, we found that the main cause of weight gain in Olz use was the increase in the number of hypothalamic ghrelin receptors. Investigating the mechanism by which Olz increases the number of ghrelin receptors may help to develop effective treatment strategies in preventing obesity in psychiatric patients.
Collapse
Affiliation(s)
- Özgür Korhan Tunçel
- Medical Biochemistry Department, Faculty of Medicine, Ondokuz Mayıs University, 55139 Samsun, Turkey.
| | - Zuhal Altunkaynak
- Histology and Embryology Department, Faculty of Medicine, Ondokuz Mayıs University, 55139 Samsun, Turkey
| | - Birşen Bilgici
- Medical Biochemistry Department, Faculty of Medicine, Ondokuz Mayıs University, 55139 Samsun, Turkey
| | - Arzu Karaustaoğlu
- Medical Biochemistry Department, Faculty of Medicine, Ondokuz Mayıs University, 55139 Samsun, Turkey
| | - Taner İlker Gümrükçüoğlu
- Medical Biochemistry Department, Faculty of Medicine, Ondokuz Mayıs University, 55139 Samsun, Turkey
| |
Collapse
|
14
|
Tickell AM, Rohleder C, Ho N, McHugh C, Jones G, Song YJC, Hickie IB, Scott EM. Identifying pathways to early-onset metabolic dysfunction, insulin resistance and inflammation in young adult inpatients with emerging affective and major mood disorders. Early Interv Psychiatry 2022; 16:1121-1129. [PMID: 34852406 DOI: 10.1111/eip.13260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 09/09/2021] [Accepted: 11/07/2021] [Indexed: 12/17/2022]
Abstract
AIM Young people with common mood disorders face the prospect of shortened life expectancy largely due to premature cardiovascular disease. Metabolic dysfunction is a risk factor for premature cardiovascular disease. There is an ongoing debate whether metabolic dysfunction can be simply explained by weight gain secondary to psychotropic medications or whether shared genetic vulnerability, intrinsic immune-metabolic disturbances or other system perturbations (e.g. dysregulated sympathetic nervous system, circadian dysfunction) are more relevant determinants of premature cardiovascular disease. Thus, we aimed to investigate underlying drivers of metabolic dysfunction and premature cardiovascular disease in young people in the early phases of common mood disorders. METHODS We evaluated the relationships between insulin resistance (assessed by HOMA2-IR) and body mass index (BMI), sex, diagnosis, medication, inflammatory markers and hormonal factors in 327 inpatients with emerging affective and major mood disorders admitted to the Young Adult Mental Health Unit, St Vincent's Private Hospital, Sydney. RESULTS While HOMA2-IR scores were positively associated with BMI (rs = 0.465, p < .001), they were also higher in those prescribed mood stabilizers (p = .044) but were not associated with specific diagnoses, other medication types or the number of prescribed medications. Further, high-sensitivity C-reactive protein levels (but not thyroid-stimulating hormone and ferritin levels) were positively associated with HOMA2-IR (rs = 0. 272, p < .001) and BMI (rs = . 409, p < .001). CONCLUSIONS In addition to BMI, other non-specific markers of inflammation are associated with early metabolic dysfunction in young people with emerging affective and major mood disorders.
Collapse
Affiliation(s)
| | - Cathrin Rohleder
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - Nicholas Ho
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - Catherine McHugh
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - Graham Jones
- SydPath, St Vincent's Hospital, Sydney, Australia.,St Vincent's Clinical School, University of NSW, Australia
| | | | - Ian B Hickie
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - Elizabeth M Scott
- Brain and Mind Centre, University of Sydney, Camperdown, Australia.,Young Adult Mental Health Unit, St Vincent's Private Hospital, Sydney, Australia
| |
Collapse
|
15
|
Ghusn W, Bouchard C, Frye MA, Acosta A. Weight-centric treatment of depression and chronic pain. OBESITY PILLARS (ONLINE) 2022; 3:100025. [PMID: 37990725 PMCID: PMC10661995 DOI: 10.1016/j.obpill.2022.100025] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/20/2022] [Accepted: 06/20/2022] [Indexed: 11/23/2023]
Abstract
Background Depression and chronic pain are two major chronic non-communicable diseases (CNCD). Considering the bidirectional relationship between obesity and CNCD, it is of the utmost importance to understand the effect of medications utilized to treat these diseases on body weight. Methods This is a clinical review on the effect of medications for depression and chronic pain on body weight. We searched PubMed, Scopus, MEDLINE, and Google Scholar databases for studies on the topic from January 1, 1950 to April 1, 2022 in English language. Additionally, we present expert opinions in the fields of obesity, depression and chronic pain, providing a weight-centric approach to treat depression and chronic pain. Results Several antidepressant and chronic pain medications are associated with weight gain. Selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, tricyclic antidepressants, monoamine oxidases, mirtazapine and trazodone are common antidepressants that can increase body weight while bupropion is significantly associated with weight loss. Gabapentin and pregabalin are common chronic pain medications that are linked to weight gain. On the other hand, topiramate is associated with significant weight loss. Obesity, depression and chronic pain experts recommend avoiding medications that can increase body weight if another effective alternative is available. Conclusion By shifting prescribing practices toward a weight-conscious approach (i.e., switching from weight gain medications to weight loss/neutral), it is possible to mitigate the incidence of drug-induced weight gain.
Collapse
Affiliation(s)
- Wissam Ghusn
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Mark A. Frye
- Department of Psychiatry, Mayo Clinic, Rochester, MN, USA
| | - Andres Acosta
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
16
|
Sun JW, Young JG, Sarvet AL, Bailey LC, Heerman WJ, Janicke DM, Lin PID, Toh S, Block JP. Comparison of Rates of Type 2 Diabetes in Adults and Children Treated With Anticonvulsant Mood Stabilizers. JAMA Netw Open 2022; 5:e226484. [PMID: 35385086 PMCID: PMC8987905 DOI: 10.1001/jamanetworkopen.2022.6484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Anticonvulsant mood stabilizer treatment is associated with an increased risk of weight gain, but little is known about the risk of developing type 2 diabetes (T2D). OBJECTIVE To evaluate the comparative safety of anticonvulsant mood stabilizers on risk of T2D in adults and children by emulating a target trial. DESIGN, SETTING, AND PARTICIPANTS This observational cohort study used data from IBM MarketScan (2010-2019), with a 5-year follow-up period. The nationwide sample of US commercially insured patients included children (aged 10-19 years) and adults (aged 20-65 years) who initiated anticonvulsant mood stabilizer treatment. Data were analyzed from August 2020 to May 2021. EXPOSURES Initiation and continuation of carbamazepine, lamotrigine, oxcarbazepine, or valproate. MAIN OUTCOMES AND MEASURES Onset of T2D during follow-up. Weighted pooled logistic regression was used to estimate the association of initiation and continuation of carbamazepine, lamotrigine, oxcarbazepine, or valproate with the risk of developing T2D. Inverse probability weights were used to control for confounding and loss to follow-up by measured baseline and time-varying covariates. RESULTS The analysis included 274 206 adults (159 428 women [58%]; mean [SD] age, 39.9 [13.2] years) and 74 005 children (38 672 girls [52%]; mean [SD] age, 15.6 [2.6] years) who initiated an anticonvulsant mood stabilizer. In adults, initiation of valproate was associated with an increased risk of developing T2D compared with initiation of lamotrigine (5-year risk difference [RD], 1.17%; 95% CI, 0.66% to 1.76%). The number needed to harm was 87 patients initiating valproate for 1 patient to develop T2D within 5 years compared with initiation of lamotrigine. Point estimates were similar when evaluating the association of treatment continuation (5-year RD, 1.99%; 95% CI, -0.64% to 5.31%). The estimated association was smaller and more variable comparing carbamazepine and oxcarbazepine to lamotrigine. In children, RDs were much smaller and more variable (5-year RD for initiation of oxcarbazepine vs lamotrigine, 0.29%; 95% CI, -0.12% to 0.69%; 5-year RD for initiation of valproate vs lamotrigine, 0.18%; 95% CI, -0.09% to 0.49%). CONCLUSIONS AND RELEVANCE In this cohort study, valproate was associated with the highest risk of developing T2D in adults. The comparative safety was generally similar in children, but estimates were small and variable. In the absence of randomized trials, emulating target trials within health care databases can generate the age-specific drug safety data needed to inform treatment decision-making.
Collapse
Affiliation(s)
- Jenny W. Sun
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Jessica G. Young
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Aaron L. Sarvet
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - L. Charles Bailey
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - William J. Heerman
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David M. Janicke
- Department of Clinical and Health Psychology, University of Florida, Gainesville
| | - Pi-I Debby Lin
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Sengwee Toh
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Jason P. Block
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| |
Collapse
|
17
|
Cabral Barata P. "Polypharmacy in neuroleptics side-effects comparison: a bias not to be overlooked". Early Interv Psychiatry 2022; 16:323-324. [PMID: 34041851 DOI: 10.1111/eip.13159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 03/16/2021] [Accepted: 04/20/2021] [Indexed: 11/29/2022]
|
18
|
Henriques F, Ferreira AR, Gonçalves-Pinho M, Freitas A, Fernandes L. Bipolar disorder and medical comorbidities: A Portuguese population-based observational retrospective study (2008-2015). J Affect Disord 2022; 298:232-238. [PMID: 34715188 DOI: 10.1016/j.jad.2021.10.090] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 09/13/2021] [Accepted: 10/23/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND This study aimed to use the Charlson Comorbidity Index (CCI) to assess the prevalence of medical comorbidities among hospitalization episodes with a primary Bipolar Disorder (BD) diagnosis, and to analyze its association with hospitalization outcomes. METHODS A population-based observational retrospective study was conducted using a Portuguese administrative database containing all mainland public hospitalizations. From 2008-2015, hospitalization episodes with a primary diagnosis of BD were analysed. Outcomes included: length of stay (LoS), in-hospital mortality and discharge destination. RESULTS Overall, 20807 hospitalization episodes were analysed. Mean±standard deviation age at admission was 47.9±14.3 years, and these episodes mostly refer to women's admissions (66.6%). Median (1st quartile; 3rd quartile) LoS was 16.0 (9.0; 25.0) days. A total of 2145 (10.3%) episodes had ≥1 CCI comorbidities registered, being diabetes the most prevalent. LoS was significantly higher for episodes with secondary diagnoses of congestive heart failure, cerebrovascular disease, dementia, diabetes, renal disease and malignancy (all p<0.05). Episodes with a registry of myocardial infarction, peripheral vascular disease, malignancy and renal disease diagnoses had higher in-hospital mortality. LIMITATIONS Limitations include the use of data registered for administrative reasons rather than research purposes, and the analysis of hospitalization episodes, instead of patients. CONCLUSIONS In this Portuguese nationwide study, greater comorbidity had a measurable impact on BD hospitalization outcomes. During the study period the prevalence of CCI comorbidities rose from 8.1% to 17.4%, which may reflect the overall increasing quality of hospital-coded data in Portugal throughout the years. The detection and timely management of medical comorbid conditions will likely prevent the high BD medical burden.
Collapse
Affiliation(s)
- Fábio Henriques
- Faculty of Medicine, University of Porto (FMUP), Alameda Prof. Hernâni Monteiro, Porto 4200-319, Portugal.
| | - Ana Rita Ferreira
- Faculty of Medicine, University of Porto (FMUP), Alameda Prof. Hernâni Monteiro, Porto 4200-319, Portugal; Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS - Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Manuel Gonçalves-Pinho
- CINTESIS - Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal; Department of Psychiatry and Mental Health, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal; Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Alberto Freitas
- CINTESIS - Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal; Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Lia Fernandes
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS - Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal; Psychiatry Service, Centro Hospitalar Universitário de São João, Porto, Portugal
| |
Collapse
|
19
|
Petrova N. On the treatment of bipolar affective disorder. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:80-86. [DOI: 10.17116/jnevro202212201280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
20
|
Coughlin JW, Steffen KJ, Sockalingam S, Mitchell JE. Psychotropic Medications in Metabolic and Bariatric Surgery: Research Updates and Clinical Considerations. Curr Psychiatry Rep 2022; 24:89-98. [PMID: 35076886 DOI: 10.1007/s11920-022-01317-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW We review evidence for assessing and monitoring psychotropic medications in metabolic and bariatric surgery (MBS) patients. We describe weight gain side effects, potential perioperative risks, pharmacokinetic changes that occur after MBS, and conclude with clinical recommendations. RECENT FINDINGS Research on psychiatric medication use and post-MBS weight outcomes is lacking and inconsistent; however, there is consistent evidence that, though variable, psychiatric medication use is associated with weight gain. Several meta-analyses and reviews provide guidance on lowering risk when appropriate. Perioperative lithium toxicity and SSRI discontinuation syndrome also warrant consideration, as do potential post-operative pharmacokinetic changes. In the absence of data for each psychiatric drug classification, close symptom monitoring and, where appropriate, serum concentration monitoring are recommended. MBS patients are a psychiatrically vulnerable population, and many are on psychiatric medications. Given potential weight/metabolic side effects, perioperative complications, and post-operative pharmacokinetic changes that occur with psychotropic medication use, providers should stay well informed on psychiatric medication management considerations.
Collapse
Affiliation(s)
- Janelle W Coughlin
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, MD, 21224, Baltimore, USA.
| | - Kristine J Steffen
- North Dakota State University, College of Health Professions, ND, 58103, Fargo, USA.,Sanford Center for Biobehavioral Research, ND, 58103, Fargo, USA
| | - Sanjeev Sockalingam
- University Health Network Bariatric Surgery Program Centre for Addiction and Mental Health University of Toronto, ON, M6J 1H4, Toronto, Canada
| | - James E Mitchell
- Sanford Center for Biobehavioral Research, ND, 58103, Fargo, USA.,University of North Dakota School of Medicine and Health Sciences, ND, 58103, Fargo, USA
| |
Collapse
|
21
|
Şimşek F, Ceylan M, Kızıltunç A, İyigün İ. The correlation between carbamazepine and valproic acid monotherapy with serum adiponectin and carnitine. Acta Neurol Belg 2021; 121:1823-1830. [PMID: 33242193 DOI: 10.1007/s13760-020-01552-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 11/10/2020] [Indexed: 12/18/2022]
Abstract
Antiepileptic drugs may cause systemic and metabolic side effects. The aim of our study was to investigate the effects of valproic acid and carbamazepine monotherapy used in the treatment of epilepsy patients on serum adiponectin and carnitine levels. The study included 60 patients, of which 30 patients receiving valproic acid monotherapy and 30 patients receiving carbamazepine monotherapy, who were followed up by the epilepsy outpatient clinic with the diagnosis of idiopathic epilepsy, and 30 healthy volunteers. Patients, who used drugs for at least 6 months, were selected. Venous blood samples were collected from the patients and healthy volunteers after their consent was obtained. Serum carnitine and adiponectin levels in the collected samples were measured using the ELISA method. Serum carnitine levels were 5166.55 ng/ml (± 1954.92) in patients receiving carbamazepine, 4224.56 ng/ml (± 2055.54) in patients using valproic acid, and 5802.64 ng/ml (± 3422.57) in the control group. Serum adiponectin levels were 13,606.51 ng/ml (± 5915.92) in patients using carbamazepine, 11,986.58 ng/ml (± 5367.82) in patients receiving valproic acid, and 14,033.43 ng/ml (± 5646.34) in the control group. In both groups, both serum carnitine and serum adiponectin levels were lower than the control group. There was a negative but insignificant correlation between the duration and dose of carbamazepine and valproic acid drug use and serum adiponectin and carnitine levels. There is a need for more extensive studies with larger sample size to investigate the effect of antiepileptic drugs used on serum adiponectin and carnitine levels.
Collapse
Affiliation(s)
- Fatma Şimşek
- Department of Neurology, Faculty of Medicine, Ataturk University, Erzurum, Turkey.
| | - Mustafa Ceylan
- Department of Neurology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Ahmet Kızıltunç
- Department of Biochemistry, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - İbrahim İyigün
- Department of Neurology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| |
Collapse
|
22
|
Zhang H, Lu P, Tang HL, Yan HJ, Jiang W, Shi H, Chen SY, Gao MM, Zeng XD, Long YS. Valproate-Induced Epigenetic Upregulation of Hypothalamic Fto Expression Potentially Linked with Weight Gain. Cell Mol Neurobiol 2021; 41:1257-1269. [PMID: 32500354 DOI: 10.1007/s10571-020-00895-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 06/01/2020] [Indexed: 12/17/2022]
Abstract
Valproate (VPA), a widely-used antiepileptic drug, is a selective inhibitor of histone deacetylase (HDAC) that play important roles in epigenetic regulation. The patient with different diseases receiving this drug tend to exhibit weight gain and abnormal metabolic phenotypes, but the underlying mechanisms remain largely unknown. Here we show that VPA increases the Fto mRNA and protein expression in mouse hypothalamic GT1-7 cells. Interestingly, VPA promotes histone H3/H4 acetylation and the FTO expression which could be reversed by C646, an inhibitor for histone acetyltransferase. Furthermore, VPA weakens the FTO's binding and enhances the binding of transcription factor TAF1 to the Fto promoter, and C646 leads to reverse effect of the VPA, suggesting an involvement of the dynamic of histone H3/H4 acetylation in the regulation of FTO expression. In addition, the mice exhibit an increase in the food intake and body weight at the beginning of 2-week treatment with VPA. Simultaneously, in the hypothalamus of the VPA-treated mice, the FTO expression is upregulated and the H3/H4 acetylation is increased; further the FTO's binding to the Fto promoter is decreased and the TAF1's binding to the promoter is enhanced, suggesting that VPA promotes the assembly of the basal transcriptional machinery of the Fto gene. Finally, the inhibitor C646 could restore the effects of VPA on FTO expression, H3/H4 acetylation, body weight, and food intake; and loss of FTO could reverse the VPA-induced increase of body weight and food intake. Taken together, this study suggests an involvement of VPA in the epigenetic upregulation of hypothalamic FTO expression that is potentially associated with the VPA-induced weight gain.
Collapse
Affiliation(s)
- Huan Zhang
- Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University, 250 Changang East Road, Guangzhou, 510260, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou, 510260, China
| | - Ping Lu
- Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University, 250 Changang East Road, Guangzhou, 510260, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou, 510260, China
| | - Hui-Ling Tang
- Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University, 250 Changang East Road, Guangzhou, 510260, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou, 510260, China
| | - Hua-Juan Yan
- Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University, 250 Changang East Road, Guangzhou, 510260, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou, 510260, China
| | - Wei Jiang
- Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University, 250 Changang East Road, Guangzhou, 510260, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou, 510260, China
| | - Hang Shi
- Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University, 250 Changang East Road, Guangzhou, 510260, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou, 510260, China
| | - Si-Yu Chen
- Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University, 250 Changang East Road, Guangzhou, 510260, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou, 510260, China
| | - Mei-Mei Gao
- Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University, 250 Changang East Road, Guangzhou, 510260, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou, 510260, China
| | - Xiang-Da Zeng
- Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University, 250 Changang East Road, Guangzhou, 510260, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou, 510260, China
| | - Yue-Sheng Long
- Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University, 250 Changang East Road, Guangzhou, 510260, China.
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou, 510260, China.
| |
Collapse
|
23
|
Gomes-da-Costa S, Marx W, Corponi F, Anmella G, Murru A, Pons-Cabrera MT, Giménez-Palomo A, Gutiérrez-Arango F, Llach CD, Fico G, Kotzalidis GD, Verdolini N, Valentí M, Berk M, Vieta E, Pacchiarotti I. Lithium therapy and weight change in people with bipolar disorder: A systematic review and meta-analysis. Neurosci Biobehav Rev 2021; 134:104266. [PMID: 34265322 DOI: 10.1016/j.neubiorev.2021.07.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/09/2021] [Accepted: 07/10/2021] [Indexed: 01/13/2023]
Abstract
Lithium remains the gold standard maintenance treatment for Bipolar Disorder (BD). However, weight gain is a side effect of increasing relevance due to its metabolic implications. We conducted a systematic review and meta-analysis aimed at summarizing evidence on the use of lithium and weight change in BD. We followed the PRISMA methodology, searching Pubmed, Scopus and Web of Science. From 1003 screened references, 20 studies were included in the systematic review and 9 included in the meta-analysis. In line with the studies included in the systematic review, the meta-analysis revealed that weight gain with lithium was not significant, noting a weight increase of 0.462 Kg (p = 0158). A shorter duration of treatment was significantly associated with more weight gain. Compared to placebo, there were no significant differences in weight gain. Weight gain was significantly lower with lithium than with active comparators. This work reveals a low impact of lithium on weight change, especially compared to some of the most widely used active comparators. Our results could impact clinical decisions.
Collapse
Affiliation(s)
- Susana Gomes-da-Costa
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel St, 12-0, 08036, Barcelona, Spain
| | - Wolfgang Marx
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| | - Filippo Corponi
- School of Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Gerard Anmella
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel St, 12-0, 08036, Barcelona, Spain
| | - Andrea Murru
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel St, 12-0, 08036, Barcelona, Spain
| | - Maria Teresa Pons-Cabrera
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel St, 12-0, 08036, Barcelona, Spain
| | - Anna Giménez-Palomo
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel St, 12-0, 08036, Barcelona, Spain
| | - Felipe Gutiérrez-Arango
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel St, 12-0, 08036, Barcelona, Spain
| | - Cristian Daniel Llach
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel St, 12-0, 08036, Barcelona, Spain
| | - Giovanna Fico
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel St, 12-0, 08036, Barcelona, Spain
| | - Georgios D Kotzalidis
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, School of Medicine and Psychology, Sant'Andrea University Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy
| | - Norma Verdolini
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel St, 12-0, 08036, Barcelona, Spain
| | - Marc Valentí
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel St, 12-0, 08036, Barcelona, Spain
| | - Michael Berk
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel St, 12-0, 08036, Barcelona, Spain.
| | - Isabella Pacchiarotti
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel St, 12-0, 08036, Barcelona, Spain
| |
Collapse
|
24
|
Verhaegen AA, Van Gaal LF. Drugs Affecting Body Weight, Body Fat Distribution, and Metabolic Function-Mechanisms and Possible Therapeutic or Preventive Measures: an Update. Curr Obes Rep 2021; 10:1-13. [PMID: 33400222 DOI: 10.1007/s13679-020-00419-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/17/2020] [Indexed: 01/06/2023]
Abstract
PURPOSE OF REVIEW Weight gain and body fat redistribution are common side effects of many widely used drugs. We summarize recent literature on prevalence data and mechanisms associated with drug-induced body fat changes and mechanisms to prevent or treat metabolic side effects. RECENT FINDINGS The highest prevalence of metabolic complications is seen with antipsychotics and antiretroviral drugs used in the treatment of HIV and may, at least partly, be responsible for the increased risk for co-morbid diseases such as diabetes, steatosis of the liver, and cardiovascular disease. The pathogenetic mechanisms leading to weight gain from antipsychotics are increasingly known and help to unravel the complex interaction that exists between psychopathology and metabolic complications. Although the classic lipodystrophy mainly occurred with older HIV drugs, also with the newer HIV treatment, weight gain seems to be a major side effect. Early detection of the metabolic consequences of drugs can lead to an early diagnosis of the complications and their treatment. Different medications, including the newer antidiabetics, are being studied in the therapy of drug-induced obesity. Future research should focus on identifying individuals at risk for metabolic side effects and on early markers to identify individuals with side effects so that timely treatment of metabolic complications can be initiated.
Collapse
Affiliation(s)
- Ann A Verhaegen
- Department of Endocrinology, Diabetes and Metabolism, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium.
- Department of Endocrinology, ZNA - Jan Palfijn, Lange Bremstraat 70,, 2170, Merksem, Belgium.
| | - Luc F Van Gaal
- Department of Endocrinology, Diabetes and Metabolism, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium
| |
Collapse
|
25
|
Bedroom light exposure at night and obesity in individuals with bipolar disorder: A cross-sectional analysis of the APPLE cohort. Physiol Behav 2021; 230:113281. [DOI: 10.1016/j.physbeh.2020.113281] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 11/05/2020] [Accepted: 12/04/2020] [Indexed: 01/22/2023]
|
26
|
Besag FMC, Vasey MJ, Sharma AN, Lam ICH. Efficacy and safety of lamotrigine in the treatment of bipolar disorder across the lifespan: a systematic review. Ther Adv Psychopharmacol 2021; 11:20451253211045870. [PMID: 34646439 PMCID: PMC8504232 DOI: 10.1177/20451253211045870] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 08/25/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Bipolar disorder (BD) is a cyclic mood disorder characterised by alternating episodes of mania/hypomania and depression interspersed with euthymic periods. Lamotrigine (LTG) demonstrated some mood improvement in patients treated for epilepsy, leading to clinical studies in patients with BD and its eventual introduction as maintenance therapy for the prevention of depressive relapse in euthymic patients. Most current clinical guidelines include LTG as a recommended treatment option for the maintenance phase in adult BD, consistent with its global licencing status. AIMS To review the evidence for the efficacy and safety of LTG in the treatment of all phases of BD. METHODS PubMed was searched for double-blind, randomised, placebo-controlled trials using the keywords: LTG, Lamictal, 'bipolar disorder', 'bipolar affective disorder', 'bipolar I', 'bipolar II', cyclothymia, mania, manic, depression, depressive, 'randomised controlled trial', 'randomised trial', RCT and 'placebo-controlled' and corresponding MeSH terms. Eligible articles published in English were reviewed. RESULTS Thirteen studies were identified. The strongest evidence supports utility in the prevention of recurrence and relapse, particularly depressive relapse, in stabilised patients. Some evidence suggests efficacy in acute bipolar depression, but findings are inconsistent. There is little or no strong evidence in support of efficacy in acute mania, unipolar depression, or rapid-cycling BD. Few controlled trials have evaluated LTG in bipolar II or in paediatric patients. Indications for safety, tolerability and patient acceptability are relatively favourable, provided there is slow dose escalation to reduce the probability of skin rash. CONCLUSION On the balance of efficacy and tolerability, LTG might be considered a first-line drug for BD, except for acute manic episodes or where rapid symptom control is required. In terms of efficacy alone, however, the evidence favours other medications.
Collapse
Affiliation(s)
- Frank M C Besag
- East London NHS Foundation Trust, 9 Rush Court, Bedford MK40 3JT, UK
| | | | - Aditya N Sharma
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Ivan C H Lam
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| |
Collapse
|
27
|
Shen J, Tomar JS. Elevated Brain Glutamate Levels in Bipolar Disorder and Pyruvate Carboxylase-Mediated Anaplerosis. Front Psychiatry 2021; 12:640977. [PMID: 33708149 PMCID: PMC7940766 DOI: 10.3389/fpsyt.2021.640977] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 01/19/2021] [Indexed: 12/17/2022] Open
Abstract
In vivo 1H magnetic resonance spectroscopy studies have found elevated brain glutamate or glutamate + glutamine levels in bipolar disorder with surprisingly high reproducibility. We propose that the elevated glutamate levels in bipolar disorder can be explained by increased pyruvate carboxylase-mediated anaplerosis in brain. Multiple independent lines of evidence supporting increased pyruvate carboxylase-mediated anaplerosis as a common mechanism underlying glutamatergic hyperactivity in bipolar disorder and the positive association between bipolar disorder and obesity are also described.
Collapse
Affiliation(s)
- Jun Shen
- Section on Magnetic Resonance Spectroscopy, Molecular Imaging Branch, National Institute of Mental Health Intramural Research Program, National Institutes of Health, Bethesda, MD, United States
| | - Jyoti Singh Tomar
- Section on Magnetic Resonance Spectroscopy, Molecular Imaging Branch, National Institute of Mental Health Intramural Research Program, National Institutes of Health, Bethesda, MD, United States
| |
Collapse
|
28
|
Acceptability of Acute and Maintenance Pharmacotherapy of Bipolar Disorder: A Systematic Review of Randomized, Double-Blind, Placebo-Controlled Clinical Trials. J Clin Psychopharmacol 2020; 40:167-179. [PMID: 32134852 DOI: 10.1097/jcp.0000000000001169] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE/BACKGROUND The aim of the study was to estimate and rank the risk for the discontinuation due to adverse events (DAEs), 7% or more weight gain (WG), and somnolence during the acute and maintenance treatment of bipolar disorder with a mood stabilizer or an antipsychotic monotherapy. METHODS/PROCEDURES The search of MEDLINE, EMBASE, PsycINFO, and clinicaltrials.gov from the inception to December 31, 2018, provided 32 studies in mania, 16 in bipolar depression, and 13 in maintenance. Data of DAEs, WG, and somnolence from each study were extracted. The risk for these variables of an active treatment relative to placebo was estimated with a number needed to harm (NNH) as a single study and pooled sample. FINDINGS/RESULTS For DAEs, pooled NNH ranged from 19 with carbamazepine to -21 with quetiapine-XR in mania, 11 with quetiapine-IR 600 mg/d to -37 with olanzapine/fluoxetine combination in bipolar depression, and 5 with lithium to -8 with asenapine in maintenance. For WG, pooled NNH ranged from 9 with olanzapine to -78 with aripiprazole in mania, 5 with olanzapine to -112 with lithium in bipolar depression, and 4 with olanzapine to 126 with asenapine in maintenance. For somnolence, pooled NNH was from 5 with carbamazepine to 23 with cariprazine in mania, 3 with quetiapine-XR 300 mg/d to 79 with lurasidone in bipolar depression, and 11 with olanzapine to -49 with aripiprazole in maintenance. IMPLICATIONS/CONCLUSIONS All medications studied in bipolar disorder were relatively well tolerated during different phases of treatment; however, the risk for short- and long-term WG and somnolence varied widely among included psychotropics.
Collapse
|
29
|
Colomer L, Anmella G, Vieta E, Grande I. Physical health in affective disorders: a narrative review of the literature. BRAZILIAN JOURNAL OF PSYCHIATRY 2020; 43:621-630. [PMID: 33146344 PMCID: PMC8639004 DOI: 10.1590/1516-4446-2020-1246] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/03/2020] [Indexed: 12/11/2022]
Abstract
This article reviews the most common non-psychiatric comorbidities associated with affective disorders, examining the implications of their possible bidirectional link. A narrative review was conducted on the association among the three most common non-psychiatric diseases in major depressive disorder and bipolar disorder (obesity, metabolic syndrome, and cardiovascular diseases) in articles published from January 1994 to April 2020. The evidence suggests that obesity, metabolic syndrome, and cardiovascular diseases are highly prevalent in patients diagnosed with affective disorders. The presence of non-psychiatric comorbidities significantly worsens the therapeutic management and prognosis of affective disorders and vice versa. In many cases, these comorbidities may precede the onset of affective disorders, although in most cases they appear after it. The presence of these concurrent non-psychiatric diseases in an individual diagnosed with an affective disorder is associated with a more complex disease presentation and management. For professionals, the evidence unequivocally supports routine surveillance of comorbidities from a multidisciplinary approach.
Collapse
Affiliation(s)
- Lluc Colomer
- Institute of Neuroscience, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Gerard Anmella
- Institute of Neuroscience, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Eduard Vieta
- Institute of Neuroscience, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Iria Grande
- Institute of Neuroscience, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| |
Collapse
|
30
|
Salvi V, Aguglia A, Barone-Adesi F, Bianchi D, Donfrancesco C, Dragogna F, Palmieri L, Serafini G, Amore M, Mencacci C. Cardiovascular risk in patients with severe mental illness in Italy. Eur Psychiatry 2020; 63:e96. [PMID: 33100262 PMCID: PMC7681153 DOI: 10.1192/j.eurpsy.2020.94] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Patients with severe mental illness (SMI), such as schizophrenia or bipolar disorders, are more frequently affected by metabolic syndrome and cardiovascular (CV) diseases than the general population, with a significant reduction in life expectancy. Beyond metabolic syndrome, quantifying the risk of CV morbidity in the long-term may help clinicians to put in place preventive strategies. In this study, we assessed 10-year CV risk in patients with SMI and healthy individuals using an algorithm validated on the Italian general population. METHODS Patients aged 35-69 years diagnosed with SMI were consecutively recruited from psychiatric acute care units. Single CV risk factors were assessed, and 10-year CV risk calculated by means of the CUORE Project 10-year CV risk algorithm, based on the combination of the following risk factors: age, systolic blood pressure, total and high-density lipoprotein cholesterol, diabetes, smoking habit, and hypertensive treatment. Patients' data were compared with those from the general population. The 10-year CV risk was log-transformed, and multivariable linear regression was used to estimate mean ratios, adjusting for age, and education. RESULTS Three hundred patients and 3,052 controls were included in the analysis. Among men, the 10-year CV risk score was very similar between patients with SMI and the general population (mean ratio [MR]: 1.02; 95%CI 0.77-1.37), whereas a 39% increase in 10-year CV risk was observed in women with SMI compared to the general population (MR: 1.39; 95%CI 1.16-1.66). CONCLUSIONS In our study, women with SMI were consistently more at risk than the general population counterpart, even at younger age.
Collapse
Affiliation(s)
- Virginio Salvi
- Department of Neuroscience, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Davide Bianchi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Chiara Donfrancesco
- Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, National Institute of Health, Rome, Italy
| | - Filippo Dragogna
- Department of Neuroscience, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Luigi Palmieri
- Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, National Institute of Health, Rome, Italy
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Claudio Mencacci
- Department of Neuroscience, ASST Fatebenefratelli Sacco, Milan, Italy
| |
Collapse
|
31
|
Trastornos afectivos y salud física, implicaciones de la comorbilidad con enfermedades médicas: una revisión de la literatura. REVISTA MÉDICA CLÍNICA LAS CONDES 2020. [DOI: 10.1016/j.rmclc.2020.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
32
|
Mania and nitrated meat products. Mol Psychiatry 2020; 25:511. [PMID: 30846838 DOI: 10.1038/s41380-019-0389-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 12/29/2018] [Accepted: 02/14/2019] [Indexed: 02/07/2023]
|
33
|
Nestsiarovich A, Kerner B, Mazurie AJ, Cannon DC, Hurwitz NG, Zhu Y, Nelson SJ, Oprea TI, Crisanti AS, Tohen M, Perkins DJ, Lambert CG. Diabetes mellitus risk for 102 drugs and drug combinations used in patients with bipolar disorder. Psychoneuroendocrinology 2020; 112:104511. [PMID: 31744781 DOI: 10.1016/j.psyneuen.2019.104511] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/28/2019] [Accepted: 11/07/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To compare the largest set of bipolar disorder pharmacotherapies to date (102 drugs and drug combinations) for risk of diabetes mellitus (DM). METHODS The IBM MarketScan® database was used to retrospectively analyze data on 565,253 adults with bipolar disorder without prior glucose metabolism-related diagnoses. The pharmacotherapies compared were lithium, mood-stabilizing anticonvulsants, antipsychotics, and antidepressants (monotherapy and multi-class polypharmacy). Cox regression modeling included fixed pre-treatment covariates and time-varying drug exposure covariates to estimate the hazard ratio (HR) of each treatment versus "No drug". RESULTS The annual incidence of new-onset diabetes during the exposure period was 3.09 % (22,951 patients). The HR of drug-dependent DM ranged from 0.79 to 2.37. One-third of the studied pharmacotherapies, including most of the antipsychotic-containing regimens, had a significantly higher risk of DM compared to "No drug". A significantly lower DM risk was associated with lithium, lamotrigine, oxcarbazepine and bupropion monotherapies, selective serotonin reuptake inhibitors (SSRI) mono-class therapy and several drug combinations containing bupropion and an SSRI. As additional drugs were combined in more complex polypharmacy, higher HRs were consistently observed. CONCLUSIONS There is an increased risk of diabetes mellitus associated with antipsychotic and psychotropic polypharmacy use in bipolar disorder. The evidence of a lower-than-baseline risk of DM with lamotrigine, oxcarbazepine, lithium, and bupropion monotherapy should be further investigated.
Collapse
Affiliation(s)
- Anastasiya Nestsiarovich
- Center for Global Health, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Berit Kerner
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | | | | | | | - Yiliang Zhu
- Division of Epidemiology, Biostatistics, and Preventive Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Stuart J Nelson
- University of New Mexico Health Sciences Library and Informatics Center, Albuquerque, NM, USA; Translational Informatics Division, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Tudor I Oprea
- Translational Informatics Division, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Annette S Crisanti
- Department of Psychiatry & Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Mauricio Tohen
- Department of Psychiatry & Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Douglas J Perkins
- Center for Global Health, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Christophe G Lambert
- Center for Global Health, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA; Translational Informatics Division, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
| |
Collapse
|
34
|
Cheng YC, Lin Y, Tsai PC. High-dose disulfiram-induced delirium and manic features: A case report. TAIWANESE JOURNAL OF PSYCHIATRY 2020. [DOI: 10.4103/tpsy.tpsy_17_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
35
|
Im DU, Kim SC, Chau GC, Um SH. Carbamazepine Enhances Adipogenesis by Inhibiting Wnt/β-catenin Expression. Cells 2019; 8:cells8111460. [PMID: 31752244 PMCID: PMC6912407 DOI: 10.3390/cells8111460] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/08/2019] [Accepted: 11/14/2019] [Indexed: 12/17/2022] Open
Abstract
Carbamazepine is a drug that is widely used in the treatment of epilepsy and bipolar disorder. The prevalence of obesity in patients treated with carbamazepine has been frequently reported. However, whether carbamazepine affects adipogenesis, one of the critical steps in the development of obesity, remains unclear. Here, we show that carbamazepine increased the expression levels of peroxisome proliferator-activated receptor γ (PPARγ), CCAAT/enhancer-binding protein β (C/EBPβ), and fatty acid synthase (FASN) in 3T3-L1 cells. Notably, carbamazepine inhibited the expression levels of β-catenin, a negative regulator of adipogenesis, leading to enhanced adipogenesis. Conversely, β-catenin overexpression abolished the effect of carbamazepine on adipogenic gene expression. However, depletion of β-catenin further enhanced PPARγ expression. In addition, carbamazepine reduced β-catenin expression by lowering the levels of phospho-low density lipoprotein receptor-related protein 6 (p-LRP6) and phospho-glycogen synthase kinase 3β (p-GSK3β) in Wnt/β-catenin signaling. Moreover, carbamazepine reduced Wnt mRNA expression and decreased the promoter activities of TCF, the target of β-catenin during adipogenesis. These results suggest that carbamazepine enhances adipogenesis by suppressing Wnt/β-catenin expression, indicating its potential effects on obesity-related metabolism.
Collapse
Affiliation(s)
- Dong Uk Im
- Department of Molecular Cell Biology, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Suwon, Gyeonggi-do 16419, Korea; (D.U.I.); (G.C.C.)
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Samsung Medical Center, Sungkyunkwan University, Seoul 06351, Korea;
| | - Sang Chon Kim
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Samsung Medical Center, Sungkyunkwan University, Seoul 06351, Korea;
| | - Gia Cac Chau
- Department of Molecular Cell Biology, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Suwon, Gyeonggi-do 16419, Korea; (D.U.I.); (G.C.C.)
| | - Sung Hee Um
- Department of Molecular Cell Biology, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Suwon, Gyeonggi-do 16419, Korea; (D.U.I.); (G.C.C.)
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Samsung Medical Center, Sungkyunkwan University, Seoul 06351, Korea;
- Biomedical Institute Convergence at Sungkyunkwan University, Suwon, Gyeonggi-do 16419, Korea
- Correspondence: ; Tel.: +82-31-299-6123; Fax: +82-31-299-6109
| |
Collapse
|
36
|
Firth J, Siddiqi N, Koyanagi A, Siskind D, Rosenbaum S, Galletly C, Allan S, Caneo C, Carney R, Carvalho AF, Chatterton ML, Correll CU, Curtis J, Gaughran F, Heald A, Hoare E, Jackson SE, Kisely S, Lovell K, Maj M, McGorry PD, Mihalopoulos C, Myles H, O'Donoghue B, Pillinger T, Sarris J, Schuch FB, Shiers D, Smith L, Solmi M, Suetani S, Taylor J, Teasdale SB, Thornicroft G, Torous J, Usherwood T, Vancampfort D, Veronese N, Ward PB, Yung AR, Killackey E, Stubbs B. The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness. Lancet Psychiatry 2019; 6:675-712. [PMID: 31324560 DOI: 10.1016/s2215-0366(19)30132-4] [Citation(s) in RCA: 741] [Impact Index Per Article: 148.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 04/01/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Joseph Firth
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia; Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia.
| | - Najma Siddiqi
- Department of Health Sciences, University of York, Hull York Medical School, Bradford, UK; Bradford District Care NHS Foundation Trust, Bradford, UK
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Barcelona, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain; Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
| | - Dan Siskind
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia; School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Simon Rosenbaum
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Cherrie Galletly
- Ramsay Health Care Mental Health, Adelaide, SA, Australia; Northern Adelaide Local Health Network, Adelaide, SA, Australia; Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia
| | - Stephanie Allan
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Constanza Caneo
- Departamento de Psiquiatría, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rebekah Carney
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Youth Mental Health Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Andre F Carvalho
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Mary Lou Chatterton
- Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Melbourne, VIC, Australia
| | - Christoph U Correll
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Department of Psychiatry, Zucker Hillside Hospital, Glen Oaks, NY, USA; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Jackie Curtis
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Keeping the Body in Mind Program, South Eastern Sydney Local Health District, Sydney, NSW, Australia
| | - Fiona Gaughran
- South London and Maudsley NHS Foundation Trust, London, UK; Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Adrian Heald
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Manchester Academic Health Science Centre, University of Manchester, Manchester, UK; Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford, UK
| | - Erin Hoare
- Food and Mood Centre, Deakin University, Melbourne, VIC, Australia
| | - Sarah E Jackson
- Department of Behavioural Science and Health, University College London, London, UK
| | - Steve Kisely
- School of Medicine, University of Queensland, Brisbane, QLD, Australia; Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Mario Maj
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Patrick D McGorry
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Cathrine Mihalopoulos
- Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Melbourne, VIC, Australia
| | - Hannah Myles
- Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia
| | - Brian O'Donoghue
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Toby Pillinger
- South London and Maudsley NHS Foundation Trust, London, UK; Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Medical Research Council London Institute of Medical Sciences, London, UK; Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Jerome Sarris
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia; Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia; The Melbourne Clinic, Melbourne, VIC, Australia
| | - Felipe B Schuch
- Department of Sports Methods and Techniques, Federal University of Santa Maria, Santa Maria, Brazil
| | - David Shiers
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Lee Smith
- Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Marco Solmi
- Neurosciences Department and Padua Neuroscience Centre, University of Padua, Padua, Italy
| | - Shuichi Suetani
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia; Queensland Brain Institute, University of Queensland, Brisbane, QLD, Australia; Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia
| | - Johanna Taylor
- Department of Health Sciences, University of York, Hull York Medical School, Bradford, UK
| | - Scott B Teasdale
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Keeping the Body in Mind Program, South Eastern Sydney Local Health District, Sydney, NSW, Australia
| | - Graham Thornicroft
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Tim Usherwood
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Department of General Practice, Westmead Clinical School, University of Sydney, Westmead, NSW, Australia
| | - Davy Vancampfort
- Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium; University Psychiatric Centre, Katholieke Universiteit Leuven, Kortenberg, Belgium
| | - Nicola Veronese
- National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy
| | - Philip B Ward
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Schizophrenia Research Unit, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - Alison R Yung
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Eoin Killackey
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Brendon Stubbs
- South London and Maudsley NHS Foundation Trust, London, UK; Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| |
Collapse
|
37
|
Fan PC, Kuo PH, Lee MT, Chang SH, Chiou LC. Plasma Calcitonin Gene-Related Peptide: A Potential Biomarker for Diagnosis and Therapeutic Responses in Pediatric Migraine. Front Neurol 2019; 10:10. [PMID: 30733702 PMCID: PMC6353836 DOI: 10.3389/fneur.2019.00010] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 01/07/2019] [Indexed: 12/11/2022] Open
Abstract
Background: Plasma calcitonin gene-related peptide (CGRP) plays a key role in the migraine pathophysiology. This study aimed to investigate its role in predicting diagnosis and outcome of pharmacotherapy in pediatric migraine. Methods: We prospectively recruited 120 subjects, who never took migraine-preventive agents in a pediatric clinic, including 68 patients with migraine, 30 with non-migraine headache (NM), and 22 non-headache (NH) age-matched controls. Short-term therapeutic response was measured for at least 2 weeks after the start of therapy. Responders were defined with >50% headache reduction. Plasma CGRP concentrations were measured by ELISA. Results: In the migraine group, more patients required acute therapy, as compared to the NM group (62/68, 91% vs. 5/30, 15%, p = 0.001). The mean plasma CGRP level in migraineurs either during (291 ± 60 pg/ml) or between (240 ± 48) attacks was higher than in NM patients (51 ± 5 pg/ml, p = 0.006 and 0.018, respectively) and NH controls (53 ± 6 pg/ml, p = 0.016 and 0.045, respectively). Forty-seven patients (69%) needed preventive treatments and had higher plasma CGRP levels (364 ± 62 pg/ml, n = 47) than those not (183 ± 54 pg/ml, n = 21) (p = 0.031). Topiramate responders had higher plasma CGRP levels than non-responders (437 ± 131 pg/ml, n = 14 vs. 67 ± 19 pg/ml, n = 6, p = 0.021). Survival curves of plasma CGRP levels also showed those with higher CGRP levels responded better to topiramate. Differences were not found in the other preventives. Conclusion: The plasma CGRP level can differentiate migraine from non-migraine headache. It may also serve as a reference for the therapeutic strategy since it is higher in patients requiring migraine prevention and responsive to short-term topiramate treatment. These results are clinically significant, especially for the young children who cannot clearly describe their headache symptoms and may provide new insights into the clinical practice for the diagnosis and treatment of pediatric migraine.
Collapse
Affiliation(s)
- Pi-Chuan Fan
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.,Clinical Center for Neuroscience and Behavior, National Taiwan University Hospital, Taipei, Taiwan.,Department of Pediatrics, College of Medicine, National Taiwan University, Taipei, Taiwan.,Graduate Institute of Pharmacology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ping-Hung Kuo
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming Tatt Lee
- Graduate Institute of Pharmacology, College of Medicine, National Taiwan University, Taipei, Taiwan.,Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University, Taipei, Taiwan.,Faculty of Pharmaceutical Sciences, UCSI University, Kuala Lumpur, Malaysia
| | - Shu-Hui Chang
- Department of Epidemiology, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Lih-Chu Chiou
- Clinical Center for Neuroscience and Behavior, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Pharmacology, College of Medicine, National Taiwan University, Taipei, Taiwan.,Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University, Taipei, Taiwan.,Graduate Institute of Acupuncture Sciences, China Medical University, Taichung, Taiwan
| |
Collapse
|