2019 issue 3-4


Volume 35, issue 3-4

Review article

Obesity and the pharmacotherapy of bipolar disorder

Anna M. Wasik1, Aleksandra Gorostowicz1, Dominika Dudek2, Jarosław Woroń3, Marcin Siwek1
1. Zakład Zaburzeń Afektywnych Katedry Psychiatrii UJ CM, Kraków
2. Klinika Psychiatrii Dorosłych Katedry Psychiatrii UJ CM, Kraków
3. Zakład Farmakologii Klinicznej Katedry Farmakologii UJ CM, Kraków, Uniwersytecki Ośrodek Monitorowania i Badania Niepożądanych Działań Leków Oddział Kliniczny Leczenia Bólu
Farmakoterapia w Psychiatrii i Neurologii 2019, 35 (3–4), 177–192
Date of publication: 03-03-2020
DOI: https://doi.org/10.33450/fpn.2019.12.001
Keywords: obesity, bipolar disorder, novel antipsychotics


Obesity, as an important risk factor for the development of diabetes, cancer or cardiovascular diseases, is one of the most important problems of modern medicine. Studies show that obesity often coexists with psychiatric disorders, including the bipolar disorder (BD) – the prevalence of obesity can be 1.5 times higher in BD patients when compared with the general population. Additionally, the risk of mood disorders in obese patients is also increased. The probable aetiology of the bidirectional relation between BD and overweight and obesity is likely complex – genetic factors, abnormalities in the immune system or an increased frequency of eating disorders are all present. Obesity in BD patients may be associated with an impairment of the mental and physical well-being, poorer co-operation in the treatment and lower quality of life. Drugs used in BD therapy have different predilections for inducing significant weight gain. The highest metabolic risk is associated with olanzapine and clozapine (among antipsychotics), amitriptyline, mirtazapine and paroxetine in the antidepressant group, and among the mood stabilizers (excluding antipsychotics) lithium and valproate. Amongst the possible therapeutic measures in patients with overweight or obesity, nonpharmacological as well as pharmacological procedures are mentioned. The newly registered antipsychotics with a possibly favourable metabolic profile (lurasidon, Cariprazine, and brexpiprazole) as well as the combination of bupropion/naltrexone or bariatric surgery carry interesting prospects for the future.

Address for correspondence:
Marcin Siwek
Zakład Zaburzeń Afektywnych, Katedra Psychiatrii UJ CM
ul. Kopernika 21a, 31-501, Kraków, Poland
email: drmarcinsiwek@gmail.com