Bipolar Disorder, Obesity, and Pharmacotherapy-Associated Weight Gain.

Background: Bipolar disorder, overweight, and obesity are each national public health problems. Overweight and obesity also appear to be related to mood disorders, and patients with bipolar disorder, in particular, may be at greater risk for overweight and obesity than individuals in the general population. This risk may be due to factors associated with the illness itself and/or with medications used to treat bipolar disorder.

Method: We conducted a MEDLINE literature search of all English-language articles (1966-2002) using the keywords lithium, olanzapine, valproate, valproic acid, divalproex sodium, carbamazepine, lamotrigine, obesity, weight, and bipolar disorder. We augmented this search with manual review of relevant references. Our focus was on studies examining the prevalence of overweight and obesity in bipolar disorder, the risk and magnitude of weight gain associated with medications used to treat bipolar disorder, and the prevention and treatment of overweight and obesity in patients with bipolar disorder.

Results: Forty-five studies were reviewed. Patients with bipolar disorder appear to be at greater risk than the general population for overweight and obesity. Comorbid binge-eating disorder; the number of depressive episodes; treatment with medications associated with weight gain, alone or in combination; excessive carbohydrate consumption; and low rates of exercise appear to be risk factors for weight gain and obesity in patients with bipolar disorder.

Conclusions: More research is required to identify the impact of specific risk factors for overweight and obesity in patients with bipolar disorder. These data could be used to develop better weight gain prevention and treatment programs for those with bipolar disorder. Therapeutic options include dietary counseling, use of mood stabilizers with lower propensities for weight gain, and combination pharmacotherapy with medications that have weight loss properties.