The rate of metabolic syndrome in euthymic Canadian individuals with bipolar I/II disorder.

OBJECTIVE: To report on the rate of metabolic syndrome, as defined by the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III), in asymptomatic adults with bipolar I/II disorder evaluated at the Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto. To our knowledge, this is the first study reporting on the rate of metabolic syndrome in a Canadian clinical sample and exclusively evaluating asymptomatic individuals. METHODS: This was a post-hoc, cross-sectional analysis of adult bipolar subjects who were primarily enrolled in a clinical intervention study. All subjects in this sample were asymptomatic at the time of assessing metabolic parameters. RESULTS: Data from 99 euthymic bipolar subjects (n=51 female, n=48 male) were included for the analysis. The sample mean age±SD was 38±11.15 years. Thirty-one subjects (32.6%) met criteria for the metabolic syndrome with no significant differences as a function of sex. The waist circumference criterion was met in 37 (41.1%) subjects. Diastolic and systolic blood pressure criteria were met in 26 (27.6%) and 28 (29.7%) subjects, respectively. Thirty-one subjects (36.4%) met the high-density lipoprotein (HDL) criterion, while 33 (38.8%) met the triglyceride criterion. Moreover, five (6.1%) met the criterion for high fasting glucose level (diabetes mellitus or glucose/insulin dysregulation at screening was an exclusion criterion). Men were more likely to have high diastolic (P=0.001) and systolic blood pressure (P=0.007) as well as hypertriglyceridemia (P=0.037). Abdominal obesity, HDL, and fasting glucose levels were not significantly different between men and women. Bipolar individuals with concurrent metabolic syndrome had a later age at first treatment and increased number of total hospitalizations. CONCLUSION: Asymptomatic Canadian individuals with bipolar disorder exhibit a high rate of concurrent metabolic syndrome. The results herein buttress recommendations for risk factor screening and modification, ongoing surveillance, as well as primary and secondary prevention strategies for metabolic abnormalities in individuals with bipolar disorder.

Metabolic syndrome and major depressive disorder: co-occurrence and pathophysiologic overlap.

The metabolic syndrome and its components are associated with depressive symptomatology. This article discusses the rate of co-occurrence and the points of pathophysiologic commonality between the metabolic syndrome and major depressive disorder.

The hepatic safety profile of duloxetine: a review.

BACKGROUND: Hepatotoxicity related to the use of duloxetine resulted in rewording of the US product insert. OBJECTIVE: To characterize the hepatic safety profile of duloxetine. METHODS: We conducted a PubMed search of all English-language articles published between January 1990 and December 2007 and contacted the manufacturer (Eli Lilly, Inc.). RESULTS: Elevations of alanine aminotransferase to three times the upper limit of normal occurs in 0.9-1.7% of duloxetine-treated patients versus 0.0-0.3% of placebo-treated patients. Hepatocellular, cholestatic and mixed hepatocellular-cholestatic forms of hepatic injury have been described. CONCLUSION: Duloxetine does not appear to pose a greater hazard for hepatic toxicity when compared to other conventional antidepressants. Systematic monitoring of liver aminotransferases does not appear to be warranted with routine duloxetine use.