Cardiometabolic risk markers during mood-stabilizing treatment: Correlation with drug-specific effects, depressive symptoms and treatment response

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avisTidsskriftartikelForskningpeer review

DOI

  • Maya Kuperberg, Massachusetts General Hospital , Harvard Medical School, Boston
  • ,
  • Ole Köhler-Forsberg
  • Alec P. Shannon, Massachusetts General Hospital, Boston, Harvard Medical School, Boston
  • ,
  • Nevita George, Harvard Medical School, Boston, Massachusetts General Hospital
  • ,
  • Sophie Greenebaum, Massachusetts General Hospital , Harvard Medical School, Boston
  • ,
  • Charles L. Bowden, University of Texas Health Science Center at San Antonio
  • ,
  • Joseph R. Calabrese, Case Western Reserve University
  • ,
  • Michael Thase, Pennsylvania State University
  • ,
  • Richard C. Shelton, University of Alabama at Birmingham
  • ,
  • Melvin McInnis, University of Michigan, Ann Arbor
  • ,
  • Thilo Deckersbach, Harvard Medical School, Boston, Massachusetts General Hospital
  • ,
  • Mauricio Tohen, University of New Mexico
  • ,
  • James H. Kocsis, Cornell University
  • ,
  • Terence A. Ketter, Stanford University
  • ,
  • Edward S. Friedman, University of Pittsburgh
  • ,
  • Dan V. Iosifescu, Massachusetts General Hospital
  • ,
  • Michael J. Ostacher, Massachusetts General Hospital
  • ,
  • Louisa G. Sylvia, Massachusetts General Hospital , Harvard Medical School, Boston
  • ,
  • Susan L. McElroy, University of Cincinnati
  • ,
  • Andrew A. Nierenberg

Background: Patients with bipolar disorder have higher rates of cardiometabolic comorbidities and mortality. Although guidelines emphasize the importance of cardiovascular monitoring, few studies characterized the cardiometabolic risk profile during treatment and their relation to symptomatology and treatment response. Methods: We analyzed data from two similar 24-weeks comparative effectiveness trials, with a combined sample of 770 participants randomized to two different lithium doses, quetiapine (300 mg/day), or standard treatment without lithium. Glucose, lipids and vital signs were measured before and after 24 weeks of treatment. We calculated several cardiovascular risk scores, assessed baseline correlations and compared the four treatment arms via multiple linear regression models. Results: Higher cholesterol and LDL levels were associated with greater depression severity, showing differential correlations to specific symptoms, particularly agitation, low energy and suicidality. Those randomized to quetiapine showed a significant worsening of cardiometabolic markers during the 24-week trial. Neither baseline nor change in lipid levels correlated with differential treatment response. Limitations: Study duration was short from the perspective of cardiometabolic risk markers, and all treatment arms included patients taking adjunct antipsychotics. The trials compared quetiapine to lithium, but not to other medications known to affect similar risk factors. Conclusions: Treatment with 300 mg/day quetiapine for 24 weeks, representing a short and common dose course, resulted in increased cardiometabolic risk markers, emphasizing the importance of monitoring during mood-stabilizing treatment. The symptom-specific associations are in line with previous studies in unipolar depression, suggesting a cardiometabolic-depression link that needs to be further studied in bipolar depression.

OriginalsprogEngelsk
TidsskriftJournal of Affective Disorders
Vol/bind300
Sider (fra-til)41-49
Antal sider9
ISSN0165-0327
DOI
StatusUdgivet - mar. 2022

Bibliografisk note

Funding Information:
Bipolar CHOICE was funded by the Agency for Healthcare Research and Quality [1R01HS019371-01]. LiTMUS was funded by the National Institute of Mental Health [N01MH80001]. Funding sources were not involved in current analysis, interpretation, writing or submission of this article.

Funding Information:
Dr. Nierenberg is a consultant for the Abbott Laboratories, American Psychiatric Association, Appliance Computing Inc. (Mindsite), Basliea, Brain Cells, Inc., Brandeis University, Bristol Myers Squibb, Clintara, Corcept, Dey Pharmaceuticals, Dainippon Sumitomo (now Sunovion), Eli Lilly and Company, EpiQ, L.P./Mylan Inc., Forest, Genaissance, Genentech, GlaxoSmithKline, Hoffman LaRoche, Infomedic, Lundbeck, Janssen Pharmaceutica, Jazz Pharmaceuticals, Medavante, Merck, Methylation Sciences, Naurex, Novartis, PamLabs, Parexel, Pfizer, PGx Health, Ridge Diagnostics Shire, Schering-Plough, Somerset, Sunovion, Takeda Pharmaceuticals, Targacept, and Teva; consulted through the MGH Clinical Trials Network and Institute (CTNI) for Astra Zeneca, Brain Cells, Inc, Dianippon Sumitomo/Sepracor, Johnson and Johnson, Labopharm, Merck, Methylation Science, Novartis, PGx Health, Shire, Schering-Plough, Targacept and Takeda/Lundbeck Pharmaceuticals. He receives grant/research support from American Foundation for Suicide Prevention, AHRQ, Brain and Behavior Research Foundation, Bristol-Myers Squibb, Cederroth, Cephalon, Cyberonics, Elan, Eli Lilly, Forest, GlaxoSmithKline, Janssen Pharmaceutica, Lichtwer Pharma, Marriott Foundation, Mylan, NIMH, PamLabs, PCORI, Pfizer Pharmaceuticals, Shire, Stanley Foundation, Takeda, and Wyeth-Ayerst. Honoraria include Belvoir Publishing, University of Texas Southwestern Dallas, Brandeis University, Bristol-Myers Squibb, Hillside Hospital, American Drug Utilization Review, American Society for Clinical Psychopharmacology, Baystate Medical Center, Columbia University, CRICO, Dartmouth Medical School, Health New England, Harold Grinspoon Charitable Foundation, IMEDEX, Israel Society for Biological Psychiatry, Johns Hopkins University, MJ Consulting, New York State, Medscape, MBL Publishing, MGH Psychiatry Academy, National Association of Continuing Education, Physicians Postgraduate Press, SUNY Buffalo, University of Wisconsin, University of Pisa, University of Michigan, University of Miami, University of Wisconsin at Madison, APSARD, ISBD, SciMed, Slack Publishing and Wolters Klower Publishing ASCP, NCDEU, Rush Medical College, Yale University School of Medicine, NNDC, Nova Southeastern University, NAMI, Institute of Medicine, CME Institute, ISCTM. He was currently or formerly on the advisory boards of Appliance Computing, Inc., Brain Cells, Inc., Eli Lilly and Company, Genentech, Johnson and Johnson, Takeda/Lundbeck, Targacept, and InfoMedic. He owns stock options in Appliance Computing, Inc., Brain Cells, Inc, and Medavante; has copyrights to the Clinical Positive Affect Scale and the MGH Structured Clinical Interview for the Montgomery Asberg Depression Scale exclusively licensed to the MGH Clinical Trials Network and Institute (CTNI).

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