Obesity, but not metabolic syndrome, negatively affects outcome in bipolar disorder

S L McElroy; D E Kemp; E S Friedman; N A Reilly-Harrington; L G Sylvia; J R Calabrese; D J Rabideau; T A Ketter; M E Thase; V Singh; M Tohen; C L Bowden; E E Bernstein; B D Brody; T Deckersbach; J H Kocsis; G Kinrys; W V Bobo; M Kamali; M G McInnis; A C Leon; S Faraone; A A Nierenberg; R C Shelton

doi:10.1111/acps.12460

Obesity, but not metabolic syndrome, negatively affects outcome in bipolar disorder

Acta Psychiatr Scand. 2016 Feb;133(2):144-153. doi: 10.1111/acps.12460. Epub 2015 Jun 26.

Authors

S L McElroy^{1

2}, D E Kemp³, E S Friedman⁴, N A Reilly-Harrington^{5

6}, L G Sylvia^{5

6}, J R Calabrese³, D J Rabideau⁷, T A Ketter⁸, M E Thase⁹, V Singh¹⁰, M Tohen¹¹, C L Bowden¹⁰, E E Bernstein⁵, B D Brody¹², T Deckersbach^{5

6}, J H Kocsis¹², G Kinrys^{5

6}, W V Bobo¹³, M Kamali¹⁴, M G McInnis¹⁴, A C Leon¹², S Faraone¹⁵, A A Nierenberg^{5

6}, R C Shelton¹⁶

Affiliations

¹ Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
² Lindner Center of HOPE, Mason, OH, USA.
³ Department of Psychiatry, Case Western Reserve University, Cleveland, OH, USA.
⁴ Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
⁵ Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
⁶ Harvard Medical School, Boston, MA, USA.
⁷ Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA.
⁸ Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
⁹ Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA.
¹⁰ Department of Psychiatry, University of Texas Health Science Center, San Antonio, TX, USA.
¹¹ Department of Psychiatry, University of New Mexico Health Science Center, Albuquerque, NM, USA.
¹² Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA.
¹³ Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
¹⁴ Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
¹⁵ Department of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA.
¹⁶ Department of Psychiatry, University of Alabama at Birmingham, Birmingham, AL, USA.

Abstract

Objective: Examine the effects of obesity and metabolic syndrome on outcome in bipolar disorder.

Method: The Comparative Effectiveness of a Second Generation Antipsychotic Mood Stabilizer and a Classic Mood Stabilizer for Bipolar Disorder (Bipolar CHOICE) study randomized 482 participants with bipolar disorder in a 6-month trial comparing lithium- and quetiapine-based treatment. Baseline variables were compared between groups with and without obesity, with and without abdominal obesity, and with and without metabolic syndrome respectively. The effects of baseline obesity, abdominal obesity, and metabolic syndrome on outcomes were examined using mixed effects linear regression models.

Results: At baseline, 44.4% of participants had obesity, 48.0% had abdominal obesity, and 27.3% had metabolic syndrome; neither obesity, nor abdominal obesity, nor metabolic syndrome were associated with increased global severity, mood symptoms, or suicidality, or with poorer functioning or life satisfaction. Treatment groups did not differ on prevalence of obesity, abdominal obesity, or metabolic syndrome. By contrast, among the entire cohort, obesity was associated with less global improvement and less improvement in total mood and depressive symptoms, suicidality, functioning, and life satisfaction after 6 months of treatment. Abdominal obesity was associated with similar findings. Metabolic syndrome had no effect on outcome.

Conclusion: Obesity and abdominal obesity, but not metabolic syndrome, were associated with less improvement after 6 months of lithium- or quetiapine-based treatment.

Keywords: bipolar disorder; metabolic syndrome; obesity; outcome.

Grants and funding

R01 HS019371/HS/AHRQ HHS/United States