Bipolar Treatment can get Heavy

Mental health concerns are so deeply personal and so immediately urgent that it can be difficult to give consideration to long-term risks of particular medications when the meds are working well.

A new study has shown that psychiatrists prescribe second-generation antipsychotics associated with weight gain based upon psychiatric symptoms alone - without regard for vascular health.

Evaluate a medication's effectiveness and side effects with your psychiatrist.

Maithri Prabhakar, M.B.B.S. and colleagues from the University of Iowa reviewed past medical records to identify what clinical, demographic and social factors correlated strongly with being prescribed a second-generation antipsychotic drug - Seroquel (quetiapine), Zyprexa (olanzapine), and Risperdal (risperdone).

 The patients numbered 340. They were all adults with one of the following diagnoses:

• Major depressive disorder with psychotic features
• Bipolar disorder type I
• Bipolar disorder type II
• Schizoaffective disorder
• Bipolar not otherwise specified

All cases examined in the study involved patients receiving inpatient or outpatient psychiatric services at an academic medical center. The study examined an individual patient's chance of being prescribed a second-generation antipsychotic associated with weight gain over two time periods: August 30 through October 30, 2009, and April 1 through May 31, 2010.

Researchers found that clinical factors played a huge role in a given psychiatrist's decision to employ second-generation antipsychotics (SGAs). These factors included mania, psychosis and inpatient treatment. Patients using lithium and those who were married were less likely to be prescribed an SGA. Metabolism and vascular risk did not seem to be factors taken into consideration by psychiatrists when prescribing these drugs.

Psychiatrists' primary goal seems to be finding the ideal medication most likely to relieve the obvious distress of patients with manic and psychotic symptoms. This priority seems to come at the cost of paying less attention to the long-term cardiovascular effects of using a given drug.

Patients and psychiatrists need to weigh the long-term health costs and risks of the medication against the more obvious immediate benefits in deciding what drug regimen to use for long-term maintenance therapy.

This study was published in the journal Pharmacotherapy.