Bipolar disorder (BD) is a serious mental illness characterized by mood instability, resulting in marked impairment in overall functioning and health-related quality of life. Individuals with bipolar disorder often grapple with significant challenges related to weight, including overweight, obesity, and chaotic eating patterns. This article explores the complex relationship between bipolar disorder and weight, examining the impact of medications, lifestyle factors, and potential strategies for effective weight management.
Understanding Bipolar Disorder
Bipolar disorder is a recurrent and sometimes chronic mental illness, characterized by episodes of depression and either mania (elated or irritable mood with increased energy and reduced need for sleep) or hypomania (less severe or protracted symptoms than mania). The World Health Organization (WHO) defines bipolar disorder as characterized by two or more episodes where the individual's mood and activity levels are very disturbed, involving either an elevation of mood with increased energy and activity, or a lowering of mood and decreased energy and activity.
Bipolar disorder is the sixth leading cause of disability worldwide in people aged 15 to 44 years and has a worldwide prevalence of 2.4%. The economic burden of bipolar disorder on both the individual and society is significant, with indirect physical health costs accounting for most of this burden, largely due to lost work productivity.
The Link Between Bipolar Disorder and Weight
Weight gain and obesity have long been recognized as significant concerns in mental health practice. Individuals with bipolar disorder are more frequently overweight (body mass index (BMI) 25.0 to 29.9), obese (BMI ≥ 30), or have a higher prevalence of central obesity compared with the general population. Clinical research suggests that approximately 68% of treatment-seeking bipolar disorder individuals are overweight or obese.
Factors Contributing to Weight Gain
Factors contributing to obesity in the bipolar disorder population are diverse, stemming from illness-related factors (mood-related factors such as mania or depression), treatment-related factors (weight implications and other side effects of medications), and lifestyle factors (physical inactivity, poor diet, smoking, substance abuse), or a combination of these.
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Weight Cycling and Inflammation
Adults with bipolar disorder excessive in weight are not only more susceptible to a relapse-prone course of illness but also are more likely to present with weight cycling (WCYC). Individuals with BD with a history of WCYC were provided evidence of a greater frequency of prior episodes (i.e., both manic and depressed), as well as of significantly higher levels of circulating IL-6 concentrations when compared to non-WCYC individuals with BD. The finding of elevated pro-inflammatory cytokines in this subpopulation may identify a separate subpopulation with greater susceptibility to cardiovascular disease.
Impact of Medications on Weight
Weight gain is a commonly reported side effect of medications used in the treatment of bipolar disorder and is associated with lower quality of life in this population. While some medications may cause weight gain by increasing appetite, especially for sweet or fatty foods, others can interfere with sleep patterns, potentially leading to weight gain. However, individual experiences with medication side effects vary.
Mood Stabilizers
Mood stabilizers help reduce mood swings in people with bipolar disorder. Common mood stabilizers include lithium, valproate, carbamazepine, and lamotrigine. One common side effect of valproate is weight gain. However, a meta-analysis found that lithium did not lead to significant changes in weight, and lamotrigine was associated with no weight change or sometimes weight loss.
Antipsychotics
Antipsychotics can help treat episodes of mania and work as long-term mood stabilizers. Some antipsychotic medications include haloperidol, aripiprazole, asenapine, olanzapine, cariprazine, clozapine, quetiapine, and risperidone. Weight gain is often a side effect of antipsychotic medications, with olanzapine and clozapine associated with the highest risk. Aripiprazole is less likely to cause weight gain compared with other antipsychotics, and some people taking it may experience weight loss as a side effect.
Antidepressants
Antidepressants, when used along with a mood stabilizer or antipsychotic, may be used in treating bipolar disorder. However, antidepressants alone could cause mania or rapid cycling in people with bipolar disorder. Some antidepressants may be more likely to cause weight gain than others, but this can vary from person to person.
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Strategies for Managing Weight Gain
Managing weight gain while on bipolar disorder medication presents challenges, but several strategies can help. Lifestyle changes, emerging weight-neutral drugs, and personalized treatment plans can address weight concerns.
Lifestyle Modifications
Lifestyle modifications are a cornerstone of weight management. These include dietary changes and increased physical activity.
Dietary Changes: A balanced diet plays a vital role in weight management. Focus on whole foods, lean proteins, and plenty of fruits and vegetables. Reducing processed foods and sugary drinks can make a significant difference. Portion control is essential. Using smaller plates and measuring food can prevent overeating. Keeping a food diary helps track intake and identify patterns.
Physical Activity: Exercise helps with weight management and improves mood and overall well-being. Start small with a 10-minute daily walk and gradually increase activity level.
Behavioral Therapies
Behavior-change strategies can elicit behavior change by enabling individuals to explore and resolve mixed feelings they may have about change.
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Motivational Interviewing: This client-centered approach helps individuals move to a greater readiness to change behavior.
Cognitive Behavioral Therapy (CBT): CBT teaches individuals behavioral and cognitive strategies, such as breaking negative behavior cycles, with a focus on achieving and maintaining lifestyle changes through stimulus control, goal setting, and self-monitoring.
Medication Management
If weight gain persists despite lifestyle changes, discuss medication adjustments with a psychiatrist. Combining medications can sometimes help. Never stop or change medication without professional guidance.
- Medication Switching: This involves changing from drugs associated with weight gain to those with less weight gain.
Weight Loss Medications
Obesity guidelines recommend drug therapy for patients with a BMI of 30 kg/m² or more. Common weight-loss drugs include orlistat, lorcaserin, phentermine/topiramate, naloxone/bupropion, and liraglutide.
Surgical Interventions
Bariatric surgery (weight-loss surgery) is considered for patients with a BMI of 40 kg/m² or more. It reduces the size of the stomach, restricting food intake and inducing weight loss.
Emerging Treatments and Research
Recent developments in bipolar medication research focus on effective treatments that minimize weight gain side effects.
Lurasidone: Approved in 2013 for bipolar depression, it demonstrates minimal impact on weight.
Cariprazine: Another newer antipsychotic shows a neutral effect on weight in bipolar patients.
Combination Therapies: Studies explore adding topiramate to mood stabilizers, and metformin use alongside antipsychotics shows promise.
Ketogenic Diets: Johns Hopkins University researchers investigate the potential of ketogenic diets in conjunction with mood stabilizers.
Genetic Testing: Genetic testing may predict which patients are most likely to experience weight gain from specific medications, allowing for tailored treatment plans.
Practical Tips for Weight Management
Strive for Progress, Not Perfection: Focus on small, sustainable changes rather than aiming for drastic overhauls.
Prioritize Nutrient-Dense Foods: Choose foods that provide the most vitamins and minerals for their calorie content.
Practice Mindful Eating: Take time to enjoy and savor meals, paying attention to hunger and fullness cues.
Build an Accountability System: Share goals with friends or family for encouragement and support.
The Importance of a Multidisciplinary Approach
A multidisciplinary approach often yields the best results. Support groups provide valuable insights and motivation. Regular check-ins with healthcare providers are essential to monitor weight, adjust treatments, and address concerns promptly.
Considerations and Cautions
It’s important to acknowledge the limitations of relying on personal information and the potential for bias in self-reported data. Additionally, small control group sizes and differing medication statuses can affect the generalizability of research findings.