When’s the last time you saw your doctor for a med check? A month ago? Six months ago? A year or more? Getting regular med checks, which can vary from weekly to quarterly depending on the level of acuteness of your symptoms, is important for a number of reasons:

• If you were placed on medications to treat acute mania or depression and you’re feeling better now, your doctor may want to remove certain medications and/or decrease dosages to maintenance levels. You don’t want to be taking more medication than necessary. During a major manic episode, for example, doctors often prescribe a mood stabilizer, such as lithium, along with an atypical antipsychotic, such as Zyprexa, and then gradually withdraw the atypical antipsychotic as the patient improves.
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At a recent meeting of the American Psychiatric Association, researchers presented a study suggesting that ziprasidone (Geodon) was less effective in treating acute mania in people with obesity or hyperglycemia (very high blood sugar level). The study was funded by Pfizer, which makes Geodon, and was done by looking at pooled data from previous studies performed by Pfizer looking at this medication’s effectiveness.

The lead author of the study, Roger S. McIntyre, Associate Professor of Psychiatry and Pharmacology at the University of Toronto, indicated that while the findings could be related to a need for higher doses in people with higher body mass indexes, it could also be that these differences in body mass and blood sugar could reduce the effectiveness of the drug at any dose. While this type of study is apparently uncommon in psychiatric research, it is actually quite important in helping us understand patterns of effectiveness in various medications used to treat bipolar disorder.

Abilify (aripiprazole) is an atypical antipsychotic medication commonly used to treat schizophrenia and acute mania. In 2005, the Food and Drug Administration (FDA) approved its use in the maintenance treatment of bipolar disorder – to prevent the recurrence of mood episodes. Unfortunately, evidence proving the effectiveness of Abilify as a maintenance medication for bipolar disorder is scarce and questionable.

Exposing the Truth

An article published this week in the open access journal PLoS Medicine (Tsai et al) looks critically at the scientific evidence that supports such widespread use of this medicine for maintenance treatment of bipolar disorder.

A recent study published in the Journal of Clinical Psychiatry entitled “Are Mood Disorders and Obesity Related? A Review for the Mental Health Professional” (McElroy, Susan L.; Kotwal, Renu; Malhotra, Shishuka; Nelson, Erik B.; Keck, Paul E., Jr.; Nemeroff, Charles B.) reveals a possible connection between obesity and mood disorders including major depressive disorder and bipolar disorder.

The study found that:

• Children and adolescents with major depressive disorder may be at increased risk for developing obesity.
• Patients with bipolar disorder may have elevated rates of overweight, obesity, and abdominal obesity. (Abdominal obesity is specifically related to higher risk of cardiovascular disease.)
• Persons living with obesity who seek weight-loss treatment may have elevated rates of depressive and bipolar disorders.
• Obesity is associated with major depressive disorder in females.
• Abdominal obesity may be associated with depressive symptoms in females and males.
• Most overweight and obese persons do not have mood disorders.

Kim Asks…

Is there a way to combat the headaches and joint pains when taking the lithium?

Dr. Fink Answers…

Hi, Kim. Good question. Most importantly discuss these side effects with your doctor immediately. Your doctor may want to run a blood test to determine your lithium level and make sure your lithium level is not toxic. Headaches can indicate toxicity. Headaches may also be a sign of dehydration, which can occur with lithium, so keeping hydrated is important.

Until recently, doctors and researchers had believed that brain volume loss in schizophrenia was caused primarily by the disease itself. One recent study, however, questions this long-held belief and identifies antipsychotics, the medications most commonly used to treat schizophrenia, as the more likely culprits.

With the increased long-term use of antipsychotics to treat schizophrenia and other forms of mental illness, especially bipolar mania, it’s important to determine whether the illness or the medication (or both) contribute to the potential loss of brain volume.

In an article published in the Archives of General Psychiatry (February, 2011) entitled “Long-term Antipsychotic Treatment and Brain Volumes,” Beng-Choon Ho, MRCPsych, et al. conclude the following:

It is well known that some people with bipolar disorder experience a variety of neuro-cognitive deficits (problems in areas such as attention, learning, and memory) in addition to their emotional and behavioral symptoms.

Because many of the medications used to treat bipolar disorder can cause cognitive problems as a side effect, psychiatrists have often debated whether these problems with learning and thinking are due to medications or are related to the underlying brain changes found in bipolar disorder. It seems likely that both factors are at play.

Some ongoing studies are looking at a medication called galantamine (Razadyne is the trade name), which is FDA approved for treating the cognitive deficits in Alzheimer’s disease.

We often discuss the potential risks to a fetus when the mother is taking psychiatric medications, but we rarely if ever consider the potential risks of a prospective father taking psychiatric medications. One of our readers posted a question addressing this issue.

Heidi asks…

Hi there, my husband started taking Depakote for bipolar disorder several months ago. We are talking about having another baby and are wondering whether it’s safe for us to conceive while he is on Depakote? Any advice is helpful, thanks.

Over the last several years, a number of studies have found a relationship between decreased bone mineral density – bone strength – and long-term use of SSRI antidepressants. The theory behind this association is that serotonin is part of the system that regulates signaling in bone cells and that medicines that affect the serotonin system could change bone metabolism.

At the American Psychiatric Association meeting in May of this year, researchers from Canada (Bolton, et al. 2010) presented a large, well done study that provides even more evidence that bone density can be reduced in people taking SSRI’s for long periods of time. Following are additional details from the study:

I just read a press release entitled “Patients With Bipolar Disorder at Increased Risk for Wide Range of Health Problems.” The study, conducted Thomson Reuters, found that “patients with bipolar disorder were at greater risk for a wide range of medical conditions than a control group of patients with no mental health diagnoses.” I’m not surprised. I think two factors are at work here:

• Bipolar disorder: Everyone knows that stress is a major contributing factor for a host of illnesses, and what’s more stressful than living with bipolar disorder? Bipolar is not just a mental illness. It is a physical illness, too. A single episode of full mania completely exhausts the person who had the misfortune of experiencing it. Likewise, depression can make the entire body ache.
• Poor treatment options: Many of the medications used to treat bipolar cause other health health-related problems, including weight gain, nausea, dizzyness, impaired thinking, and fatigue, to name only a few. It’s no surprise, then, that people taking these medications are more likely to head to their doctors for a “wide range of health problems.”

How do the results of this report stack up to your experience with bipolar? Other than seeing your psychiatrist for issues directed related to bipolar, do you feel that you tend to visit your doctor more often than the average person for other health-related issues? Do you attribute these other health related issues to bipolar or the medications you’re taking to treat bipolar? Do you find the results of the report surprising?