Metabolic Effects of Psychotropic Drugs Insulin Resistance in Bipolar Women: Effects of Mood-Stabilizing Drugs Vemuri M, Stemmle P, Jiang B, Morenkova A, Rasgon N Thakore J, Leonard BE (eds): Metabolic Effects of Psychotropic Drugs. Basel, Karger, 2009, vol 26, pp 12-24 (DOI: 10.1159/000189772)
Abstract: Women with bipolar disorder (BD) may have unique risk factors for insulin resistance (IR). Specific periods in a woman’s reproductive timeline, specifically pregnancy and after the menopause, may represent times of increased IR. Moreover, women with BD demonstrate higher rates of obesity compared to men with BD, suggesting a sex-specific vulnerability to metabolic sequelae in BD. Additional contributors to metabolic sequelae, such as psychotropic medication, dysregulation of the hypothalamic-pituitary-adrenal axis, and genetic influences common in BD, may also manifest differently between the sexes. Several studies have suggested that women with BD may have more menstrual cycle irregularities than women in the general population. It has been hypothesized that such irregularities may be due to endocrinological disorders, such as polycystic ovarian syndrome or to hypothalamic-pituitary-adrenal axis dysfunction, both of which are also be associated with IR. Women treated with valproate may be particularly vulnerable to such irregularities. Lithium has not been observed to be associated with IR; however, it could theoretically influence IR through weight gain or effects of hypothyroidism. Treatment with atypical antipsychotics is associated with a greater risk of metabolic abnormalities, but sex-specific effects have not been observed. Definitive associations with IR have not thus far been demonstrated with either carbamazepine or lamotrigine. |
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