Weight gain, obesity, and metabolic indices following a first manic episode: prospective 12-month data from the Systematic Treatment Optimization Program for Early Mania (STOP-EM).
BACKGROUND
Numerous studies have demonstrated an association between bipolar disorder (BD) and obesity. However, these reports are limited by retrospective or cross-sectional designs, and the assessment of patients with lengthy illnesses. Prospective data, and data on weight gain early in the course of BD, are lacking.


METHODS
We prospectively measured weight gain and laboratory metabolic indices over 12 months in 47 patients with BD receiving maintenance treatment following their first manic episode, and in 24 age- and gender-matched healthy subjects.


RESULTS
Although approximately two-thirds of patients had experienced previous depressive or hypomanic episodes, there was no difference between patients and healthy subjects in mean body mass index or rates of overweight or obesity at recovery from the first mania. Mean weight gain over 12 months was 4.76kg in patients and 1.50kg in healthy subjects (p=0.047). Combined rates of overweight and obesity at 6 months and 12 months exceeded 50% in patients, and were almost double those of healthy subjects. Logistic regression demonstrated that weight gain in the first 6 months was significantly associated with male gender and prescription of olanzapine or risperidone. Patients who were obese at 6 months and/or 12 months had significantly greater mean serum triglyceride levels and fasting glucose levels than non-obese patients.


CONCLUSIONS
This was a naturalistic study.


CONCLUSIONS
Even in patients with previous depressions and hypomanias, clinically significant weight gain in BD begins following the first manic episode, suggesting that it is primarily related to treatment with mood stabilizers and second-generation antipsychotics. However, the very small number of patients in our sample who were medication-free precludes a meaningful analysis of the degree to which weight gain might be an inherent feature of post-manic BD.
Bond
David J
DJ
Mood Disorders Centre, University of British Columbia, Room 2C7 - 2255 Wesbrook Mall, Vancouver, British Columbia, Canada.
Kauer-Sant'Anna
Marcia
M
Lam
Raymond W
RW
Yatham
Lakshmi N
LN
D000328:Adult; D018692:Antimanic Agents / Q000009:adverse effects / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001569:Benzodiazepines / Q000009:adverse effects / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology*; D001786:Blood Glucose / Q000378:metabolism*; D015992:Body Mass Index; D002784:Cholesterol / Q000097:blood; D003987:Dibenzothiazepines / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007328:Insulin / Q000097:blood; D016651:Lithium Carbonate / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D009765:Obesity / Q000097:blood / Q000139:chemically induced* / Q000453:epidemiology*; D000077152:Olanzapine; D050177:Overweight / Q000097:blood / Q000139:chemically induced* / Q000453:epidemiology*; D011446:Prospective Studies; D000069348:Quetiapine Fumarate; D018967:Risperidone / Q000009:adverse effects / Q000627:therapeutic use; D014280:Triglycerides / Q000097:blood*; D014635:Valproic Acid / Q000009:adverse effects / Q000627:therapeutic use; D015430:Weight Gain / Q000187:drug effects*; D055815:Young Adult
D018692:Antimanic Agents; D014150:Antipsychotic Agents; D001786:Blood Glucose; D003987:Dibenzothiazepines; D007328:Insulin; D014280:Triglycerides; D001569:Benzodiazepines; D016651:Lithium Carbonate; D000069348:Quetiapine Fumarate; D014635:Valproic Acid; D002784:Cholesterol; D018967:Risperidone; D000077152:Olanzapine