Navigating Cardiometabolic Symptoms With Conventional Bipolar Disorder Therapies

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Psych Congress Network: What are the possible cardiometabolic symptoms with conventional treatments for bipolar disorder and how can these adverse effects impact patient outcomes/adherence? How can clinicians strategize when that happens?

Rakesh Jain, MD, MPH: Metabolic side effects of many of our medications are perhaps the single greatest challenge in achieving adherence and if you don't achieve adherence you don't end up achieving anything, right? So we must face this large problem, no pun intended. It's a large challenge for us.

The smartest thing to do is to choose your medications wisely on day 1. So if you wait to correct a cardiometabolic challenge after the problem has happened, it's doable but it's so much harder. It's best to think of the strategy day 1. So choose your medications wisely. For example, if you have a patient where weight gain is a risk, but you really do think olanzapine is the right medication choice for them, what you could do is consider a medication that is olanzapine, but combined with samidorphan. So that would be Lybalvi. Wouldn't that be smart? It reduces the risk by 50%. 50% is a pretty tremendous reduction in risk. That's one strategy to employ.

The other could be that you could think of a medication with a lower weight gain risk profile. Can we think of a couple of them? Sure, I can think of cariprazine, which is Vraylar. I can think of lumateperone, which is Caplyta. Those could be effective strategies.

Now having said that, it's so important to educate patients, get the buy-in about the need to monitor for cardiometabolic issues, request a good diet, request exercise, and of course do your routine blood monitoring. When you do all that, sometimes with an augmented agent like metformin or it could be a medication that affects glucose, then success often comes our way.

I'm very glad you asked that question because it is one of the most important issues in contemporary psychiatry. 

Rakesh Jain, MD, MPH, attended medical school at the University of Calcutta in India. He then attended graduate school at the University of Texas School of Public Health in Houston, where he was awarded a “National Institute/Center for Disease Control Competitive Traineeship”. He graduated from the School of Public Health in 1987 with a Masters of Public Health (MPH) degree. Dr Jain served a 3-year residency in Psychiatry at the Department of Psychiatry and Behavioral Sciences at the University of Texas Medical School at Houston. In addition, Dr Jain completed a postdoctoral fellowship in Research Psychiatry at the University of Texas Mental Sciences Institute, in Houston. He was awarded the “National Research Service Award” for the support of this postdoctoral fellowship.