Safety of Available Agents Used to Treat Bipolar Disorder: Focus on Weight Gain
J Clin Psychiatry 2003;64(5):532-539
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management of bipolar disorder has advanced considerably since
the introduction of lithium therapy nearly 50 years ago. The
sizable percentage of patients who do not respond adequately to
lithium and/or are intolerant to its side effects has served as
an impetus for identifying alternative pharmacotherapeutic
agents. Recent advances in the understanding of the
neurotransmitter systems and their receptors as it applies to
treatment of bipolar disorder has, in part, led to progress in
delineating applications of anticonvulsant/antiepileptic drugs
(AEDs) in this area. Although the efficacy of many drugs has been
evaluated in patients with this disorder, medication tolerability
and adherence issues related to unfavorable side effect profiles
are substantial impediments to the development of novel
pharmacotherapies. The potential for excessive weight gain as a
side effect of certain psychopharmacologic agents remains a
concern to both clinicians and patients.
Method: English-language literature from
1985-2001 in MEDLINE was searched for the terms bipolar
disorder, anticonvulsant, antiepileptic, lithium, antipsychotic,
weight, and compliance. This article reviewed current
therapeutic options for bipolar disorder, including newer AEDs
and atypical antipsychotic drugs, with emphasis on the issue of
weight gain and possible approaches to minimizing this risk.
Results: Certain newer AEDs are
characterized by more favorable safety and tolerability profiles
that include weight loss as a desirable side effect. Because
bipolar disorder is associated with unacceptably high rates of
relapse, recurrence, and morbidity, the concept of
pharmacotherapeutic efficacy logically not only includes symptom
relief but also necessarily encompasses issues related to regimen
tolerability and adherence.
Conclusion: There is a need for
guidelines to help physicians carefully formulate and
individualize management plans to reach safe, effective, and
cost-efficient patient outcomes. Monitoring the weight of
patients with bipolar disorder and educating them regarding this
issue should be standard components of any treatment plan.