These data suggest that female patients, in particular, were self-medicating their affective episodes and comorbid anxiety disorders with alcohol. They suggest the importance of asking patients directly about alcohol use to identify the need for primary and secondary prevention. In an adolescent or young adult, affective illness—and bipolar disorder in particular—should be considered a major risk factor for subsequent problems with alcohol and drug abuse. When taking a careful history, the treating physician should include questions regarding any substance abuse.
Overweight and obesity
One-half of the women and two-thirds of the men in the SFBN were overweight at network entry.8 Although this rate of overweight sounds alarmingly high, it was not significantly different from rates in the general U.S. population. A greater percentage of women than men in the network had morbid obesity, however.
In our cohort, being overweight or obese was associated with an increased incidence of cardiovascular disease, diabetes, arthritis, hypertension, hypothyroidism, and cancer. The degree of obesity also correlated significantly with past use of the numerous psychotropic drugs that have been associated with weight gain. Also, as might be expected, increased weight was associated with physical inactivity.
Many of the psychotropic drugs routinely used to treat bipolar disorder are associated with weight gain. Among these are the mood stabilizers lithium and valproate and the atypical antipsychotics, with the exception of ziprasidone (and, to follow, aripiprazole). Lithium’s liability to cause weight gain may be counterbalanced by its antisuicide effects and its ability to reverse excess medical mortality associated with affective illness. Thus, lithium should continue to play a major therapeutic role in bipolar disorder.
It may be more effective and easier to prevent weight gain than to attempt to reduce weight that has been gained. Recommending exercise and other weight-reduction measures may be helpful, as may co-administering drugs associated with weight loss, such as topiramate.9
Thyroiditis
Antithyroid antibodies were detected in 28% of network patients, compared with rates of 3% in the general population and 18% in psychiatric controls.10 The increased rate was associated with the need to augment thyroid function in 17% of network patients, but it was not related to age, mood state, rapid cycling status, or lithium treatment.
These data indicate that bipolar patients are prone to autoimmune thyroid changes. Further analysis is required to ascertain whether this finding has therapeutic implications, especially related to adjunctive T3 and T4 treatment.11