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Body Mass Index Predicts Lithium Response in Patients With Bipolar Disorder: Presented at APA

By Charlene Laino

WASHINGTON, DC -- May 7, 2008 -- Patients with bipolar disorder who have an elevated body-mass index (BMI) have a more severe course of the disease and are significantly less likely to respond to lithium compared with patients who have a normal BMI, suggests the results of an observational study presented here on May 5.

Cynthia V. Calkin, MD, Resident, Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada, presented the findings here at the 161st Annual Meeting of the American Psychiatric Association (APA).

Dr. Calkin said that several previous studies have shown a higher prevalence of obesity in patients with bipolar disorder compared with the general population. Cardiovascular disease is the number 1 cause of death among people with bipolar disorder, she said.

To investigate more closely the relationship between obesity and bipolar disorder, the researchers enrolled 276 patients aged 16 to 83 years from the Maritime Bipolar Registry.

Overall, 108 (39.1%) of the patients had a BMI between 30.0 and 34.9 kg/m², and 101 (36.6%) had a BMI of 25.0 to 29.9 kg/m². Sixty-three patients (22.8%) had a BMI between 18.5 and 24.9 kg/m², and the rest were underweight, with a BMI <18.4 kg/m².

Of the total cohort, 186 participants had a diagnosis of type 1 bipolar disorder, 85 had a diagnosis of type 2 bipolar disorder, and 5 had "bipolar not otherwise specified," she said.

Results showed that elevated BMI was significantly associated with a more chronic course of bipolar illness (P < .001), a longer duration of illness (P = .02), a lower score on the Global Assessment of Functioning Scale (P = .02), and increased disability (P = .002).

Additionally, higher BMI significantly correlated with generalized anxiety disorder (P = .05), an increased risk of diabetes (P < .001), and an increased risk of hypertension (P = .001).

Participants who had a complete remission of symptoms on lithium treatment had significantly lower BMI compared with those who had no therapeutic effects (P = .01), Dr. Calkin said.

What this means for clinicians treating patients with bipolar disorder is that nutrition and exercise counseling and other efforts to lower BMI to normal levels "are critical," she said. Clinicians should also screen and treat patients for metabolic syndrome and cardiovascular disease risk factors, she said.

A prospective trial is needed to determine "whether the metabolic consequences of obesity affect the response to lithium or whether the response to lithium affects the metabolic aspects of the disease," she added.

[Presentation title: BMI Correlates of Bipolar Disorder: Can BMI Help Predict Prognosis and Outcome? Abstract NR1-043]

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