The Weekly Mind Reader: Research Linking Metformin and Bipolar Depression Wins ASCP's Wender Award

by Staff Writer
May 26, 2023 at 9:15 AM UTC

minor ear anomalies are more common in people with depressive order.

Cindy Calkin, MD is this year’s recipient of the American Society of Clinical Psychopharmacology’s Paul Wender Best Paper Award in The Journal of Clinical Psychiatry. Calkin, a professor with the department of psychiatry at Dalhousie University in Canada, led a groundbreaking study that explored an unconventional strategy for treatment-resistant bipolar depression (TRBD.)

paul wender award winner

A Metabolic Approach to Depression

TRBD and insulin resistance often go hand-in-hand, although the precise reasons behind their correlation remain under investigation. Whatever the connection, Calkin’s team speculated that managing insulin might also help mitigate symptoms of depression. 

For 14 weeks, 45 patients participated in the clinical trial, with 20 receiving the diabetes drug metformin, and 25 a placebo. To measure treatment success, the team focused on reduction in depression rating scores assessed through the Montgomery-Asberg Depression Rating Scale (MADRS.) They also kept tabs on additional outcomes, including measures of general functioning, bipolar disorder symptoms, and anxiety levels.

By the 14-week mark, 11 patients no longer met the criteria for insulin resistance. Of these, 10 were in the group given metformin, compared to just one in the placebo group. The researchers referred to patients whose numbers moved to improved or normal insulin sensitivity as “converters.”

The converters demonstrated a 45 percent greater improvement in their depression scores compared to their non-converting counterparts. Benefits appeared as early as the six-week mark and held to the end of the 26-week study. Even better, the positive results extended to overall functioning and anxiety levels.

Adverse events were uncommon and relatively minor. Some of the subjects reported transient gastrointestinal discomfort. No one dropped out of the study due to side effects or noncompliance.

We applaud Calkin’s novel concept to treat an underlying metabolic disorder to improve a psychiatric one. The idea hints at a possible future where metformin could offer a pathway out of the labyrinth of TRBD. It’s an inspired solution to a challenging condition.

The Wender Award is named after Paul H. Wender, MD. Known as the “Dean of ADHD” by his colleagues, Wender was a pioneer in identifying and treating attention deficit hyperactivity disorder. A researcher and clinician who treated patients with ADHD for many years, he offered insights into the progression of ADHD, as well as dietary, drug, and psychological treatments. He was the author of the classic handbook on the subject, ADHD: Attention-Deficit Hyperactivity Disorder in Children and Adults.


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