Strategies for managing metabolic side effects associated with antipsychotics in bipolar disorder

Background: second-generation (“atypical”) antipsychotics are widely used for the treatment of bipolar disorder, although they may be associated, to a different degree, according to the specific antipsychotic, with metabolic side effects. The aim of this study is to review the available literature on clinical and therapeutic strategies to manage metabolic syndrome in patients with bipolar disorder. Subjects and methods: a PubMed/Medline research was performed on papers with regards to metabolic adverse events induced by second-generation antipsychotics in bipolar disorder. Articles published from 1st January 1990 to 31st January 2015 were selected. Results: the following issues were discussed: a) identification of patients at risk for developing metabolic side effects (the following clinical features were found associated with an increased risk: young males, older subjects at baseline, and patients in treatment with olanzapine or risperidone both in the short and long-term); b) monitoring metabolic parameters such as cholesterol, triglycerides, glycated hemoglobin, body mass index, waist circumference, weight: bipolar patients taking atypical antipsychotics should be monitored more carefully in the first year of treatment; c) managing the antipsychotic treatment with regard to metabolic side effects (e.g. switching strategies); non-pharmacological interventions aimed at promoting regular lifestyles, in particular ABCDE approach promoted by Johns Hopkins Hospital. Conclusions: psychiatrists or general practitioners may consider the aforementioned strategies in order to limit the metabolic side effects induced by atypical antipsychotics in patients with bipolar disorder. Future researches should try to identify genetic risk factors associated with the onset of metabolic side effects in order to predict the onset of this phenomenon.