Perceptions of weight gain and bipolar pharmacotherapy

Results of a 2005 survey of physicians in clinical practice

Terence A. Ketter, Daniel (Dan) Haupt

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Objective: To assess the perceptions of clinicians in the psychiatric community about pharmacotherapy and its impact on weight gain and adverse metabolic effects in patients with bipolar disorder. Methods: In November 2005, self-administered questionnaires were sent to 7000 psychiatrists who treat bipolar disorder in their clinical practice. An additional mailing of these questionnaires was sent in January 2006 to a different group of 7000 psychiatrists who treat bipolar disorder in their clinical practice. The first 298 completed surveys were analyzed. Results: Almost half of the respondents (48%) were psychiatrists in individual private practice and 32% were in community mental health centers. About two-thirds of respondents reported that 30-60% of their bipolar patients were overweight. Thirty-eight percent of respondents reported metabolic syndrome present in 20-40% of their patients. Almost all respondents (96%) reported a 20 Ib increase in patients' weight as a troublesome potential adverse event associated with the use of some agents. After initiating a new medication, more than 80% of respondents monitored their patients' weight, fasting plasma glucose level, and fasting lipid profile at regular intervals. However, 80% did not monitor waist circumference. Overall, respondents viewed several agents (aripiprazole, ziprasidone, carbamazepine, and lamotrigine) as not (or minimally) problematic In terms of weight gain and adverse metabolic concerns. Clozaplne and olanzapine were viewed as highly problematic due to their propensity to induce weight gain and negatively influence lipid and glucose metabolism. Other agents considered to be minimally to moderately problematic in terms of weight gain and metabolic issues were quetiapine, risperidone, lithium, and valproate. Respondents reported that the profile of a bipolar agent in terms of weight gain and adverse metabolic effects was an important consideration in the management of bipolar disorder. Conclusion: Although the study is limited by a low response rate and self-selection of respondents, clinicians who did respond were concerned about the risks of weight gain and metabolic disturbances in their patients treated with bipolar agents. For most parameters, such concerns were being integrated into clinical care. However, it appears that there is a need to increase clinicians' appreciation of the importance of abdominal obesity and the need to monitor waist circumference. A growing recognition of the differences in weight-gain potential and adverse metabolic effects among agents appears to have had a definite impact on prescribing patterns in the management of bipolar disorder.

Original languageEnglish (US)
Pages (from-to)2345-2353
Number of pages9
JournalCurrent Medical Research and Opinion
Volume22
Issue number12
DOIs
StatePublished - Dec 2006
Externally publishedYes

Fingerprint

Weight Gain
Physicians
Drug Therapy
Bipolar Disorder
Psychiatry
Waist Circumference
olanzapine
Fasting
Surveys and Questionnaires
Community Mental Health Centers
Weights and Measures
Glucose
Risperidone
Abdominal Obesity
Private Practice
Carbamazepine
Valproic Acid
Lipid Metabolism
Lithium
Lipids

Keywords

  • Atypical antipsychotics
  • Bipolar disorder
  • Metabolic syndrome
  • Mood stabilizers
  • Obesity
  • Weight gain

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Perceptions of weight gain and bipolar pharmacotherapy : Results of a 2005 survey of physicians in clinical practice. / Ketter, Terence A.; Haupt, Daniel (Dan).

In: Current Medical Research and Opinion, Vol. 22, No. 12, 12.2006, p. 2345-2353.

Research output: Contribution to journalArticle

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abstract = "Objective: To assess the perceptions of clinicians in the psychiatric community about pharmacotherapy and its impact on weight gain and adverse metabolic effects in patients with bipolar disorder. Methods: In November 2005, self-administered questionnaires were sent to 7000 psychiatrists who treat bipolar disorder in their clinical practice. An additional mailing of these questionnaires was sent in January 2006 to a different group of 7000 psychiatrists who treat bipolar disorder in their clinical practice. The first 298 completed surveys were analyzed. Results: Almost half of the respondents (48{\%}) were psychiatrists in individual private practice and 32{\%} were in community mental health centers. About two-thirds of respondents reported that 30-60{\%} of their bipolar patients were overweight. Thirty-eight percent of respondents reported metabolic syndrome present in 20-40{\%} of their patients. Almost all respondents (96{\%}) reported a 20 Ib increase in patients' weight as a troublesome potential adverse event associated with the use of some agents. After initiating a new medication, more than 80{\%} of respondents monitored their patients' weight, fasting plasma glucose level, and fasting lipid profile at regular intervals. However, 80{\%} did not monitor waist circumference. Overall, respondents viewed several agents (aripiprazole, ziprasidone, carbamazepine, and lamotrigine) as not (or minimally) problematic In terms of weight gain and adverse metabolic concerns. Clozaplne and olanzapine were viewed as highly problematic due to their propensity to induce weight gain and negatively influence lipid and glucose metabolism. Other agents considered to be minimally to moderately problematic in terms of weight gain and metabolic issues were quetiapine, risperidone, lithium, and valproate. Respondents reported that the profile of a bipolar agent in terms of weight gain and adverse metabolic effects was an important consideration in the management of bipolar disorder. Conclusion: Although the study is limited by a low response rate and self-selection of respondents, clinicians who did respond were concerned about the risks of weight gain and metabolic disturbances in their patients treated with bipolar agents. For most parameters, such concerns were being integrated into clinical care. However, it appears that there is a need to increase clinicians' appreciation of the importance of abdominal obesity and the need to monitor waist circumference. A growing recognition of the differences in weight-gain potential and adverse metabolic effects among agents appears to have had a definite impact on prescribing patterns in the management of bipolar disorder.",
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