Metabolic Syndrome in Bipolar Disorder

Weight disturbances and their associated risk factors are seen in a large number of those with a diagnosis of bipolar disorder (BD) and have shown to be the primary contributor to premature mortality. Consequently, the term metabolic syndrome (MetS) is often applied to this population denoting the increased risk of cardiovascular diseases and type 2 diabetes. Contributing to the development of MetS in BD are analogous risk factors such as social determinants, environmental exposures, and illness treatment. In particular, it has been well studied that medication often used for BD (e.g., antipsychotics and mood stabilizers) contributes grossly to weight gain and metabolic disturbances; however, they are still commonly used due to their effectiveness in treating psychiatric symptoms. The presence of MetS can have a large effect on the lifestyle of those with BD and can influence a number of areas, for example, impacting illness prognosis by contributing to a greater burden of illness and mediating cognitive dysfunctions that can be apparent both structurally and functionally. Toward management of metabolic symptoms, a variety of interventions are available which include behavioral, pharmacological, and surgical. Specifically, one-third of patients requesting bariatric surgery (BS) for weight management have a diagnosis of BD. Bariatric surgery has shown to alleviate more than metabolic disturbances but also improve cognitive functioning. Unfortunately, while BS appears to be a long-term solution for weight management, it is often not applied for those with BD, as there is conflicting evidence surrounding post-surgery psychiatric effects.