By Dennis Thompson HealthDay Reporter
WEDNESDAY, July 27, 2022 (HealthDay News)
Bipolar sufferers who responded to the drug metformin skilled enchancment of their temper dysfunction as their insulin resistance decreased, mentioned lead researcher Dr. Cynthia Calkin, an affiliate professor of psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada.
“We saw this improvement as early as week six in the study,” she mentioned. “Week 14 was the study endpoint, and patients remained significantly improved or in remission. And then we went on to follow them up to 26 weeks and these patients remained well.”
Calkin famous that some sufferers who began off within the trial are nonetheless in remission, six or seven years later.
Studies have proven that greater than 50% of individuals with bipolar dysfunction even have insulin resistance, mentioned Dr. Claudia Baldassano, director of the Bipolar Outpatient Resident Teaching Clinic and the Mood Disorder Comprehensive Consultation Service on the University of Pennsylvania Perelman School of Medicine.
“As a clinician who treats thousands of bipolar patients, I found this really intriguing and not that surprising,” mentioned Baldassano, who wasn’t a part of the examine. “Our bipolar sufferers, so a lot of them are obese, They have issues with weight problems, They have issues with sort 2 diabetes and insulin resistance,
The potential hyperlink between insulin resistance and bipolar dysfunction is inflicting a “paradigm shift in psychiatry,” Calkin mentioned.
“We need to start thinking more about underlying mechanisms and not be treating patients simply from the neck up,” she mentioned. “We have to look at the whole patient and what’s going on besides their psychiatric things illness, because all of these appear to be connected.”
The key will not be that metformin is an antidepressant, “because I don’t believe it is,” Calkin mentioned. “The key is reversing this underlying aberrant mechanism, reversing the insulin resistance.”
For the scientific trial, Calkin and her colleagues randomly assigned 20 sufferers to take metformin for half a 12 months, and 25 to take a placebo. Both teams of sufferers had each bipolar dysfunction and insulin resistance.
“These patients on average had been sick for 25 years without a remission,” Calkin mentioned. “Over 55% had failed all 4 drug courses that we use when it comes to temper stabilizers — lithiumanti-epileptic medicineantipsychotics and antidepressants, And over 90% had failed three out of four of those drug classes. So this was really, really a very, very sick population.”
Half of the metformin sufferers responded to the drug, and now not had been insulin resistant by 14 weeks, the examine discovered.
Those sufferers additionally skilled vital enhancements on customary exams used to evaluate signs of bipolar dysfunction,
The drug additionally proved comparatively secure, Calkin added.
“When we looked at the side effect profile with metformin, there is no difference from patients who are on placebo,” Calkin mentioned. “We’ve had this drug for 50 years. It’s a very, very benign, cheap, safe drug.”
Researchers suppose insulin resistance would possibly do one thing to the blood-brain barrier — which separates the bloodstream within the mind from the bloodstream in the remainder of the physique — that both causes or influences bipolar dysfunctionCalkin and Baldassano mentioned.
“My hypothesis was that this barrier that normally protects the brain, it became leaky when people were insulin resistant,” Calkin mentioned. “Then inflammatory molecules could get into the brain where they otherwise wouldn’t have been able to, and that this would affect a brain disorder like bipolar dysfunction,
Disruption of the blood-brain barrier attributable to insulin resistance may additionally hamper the effectiveness of medicines that immediately deal with bipolar dysfunctionBaldassano mentioned.
“If you can prescribe a medication that can help a bipolar patient with two things — something that could prevent them from developing sort 2 diabetes and assist scale back their depressive signs — I believe that’s one thing psychiatrists will certainly use,” Baldassano mentioned.
Insulin resistance would be the key to figuring out who may be helped by metformin, Calkin mentioned, and that is not simply people who find themselves carrying extra weight.
,Obesity tends to result in insulin resistance, however I’ve as effectively slim triathletes in my follow who’re additionally insulin-resistant,” Calkin said. “So I believe there is a genetic element there as effectively.”
For metformin to be broadly adopted, nevertheless, there must be a large-scale trial definitively proving its profit, Baldassano mentioned.
“The results were impressive, but it does need to be replicated in a larger-scale study,” she mentioned.
The findings had been not too long ago revealed within the Journal of Clinical Psychiatry,
SOURCES: Cynthia Calkin, MD, affiliate professor, psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada; Claudia Baldassano, MD, director, Bipolar Outpatient Resident Teaching Clinic, and Mood Disorder Comprehensive Consultation Service, University of Pennsylvania, Perelman School of Medicine, Philadelphia; Journal of Clinical PsychiatryMarch/April 2022
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