Atypical Antipsychotic Usage-Related Higher Serum Leptin Levels and Disabled Lipid Profiles in Euthymic Bipolar Patients

Abstract

Atypical antipsychotics (AA)-induced weight gain is associated with increased leptin levels. AA have been increasingly used in the treatment of bipolar disorders. This cross-sectional study aimed to evaluate the association between serum leptin and lipid profiles considering the drug treatments in euthymic bipolar outpatients. Leptin and lipid profiles were compared, and no differences were noted in leptin, cholesterol, and low-density lipoprotein levels among the patients and controls. Glucose, very-low-density lipoprotein, and triglyceride levels in patients were higher than in controls, while high-density lipoprotein levels were low. Patients were divided into three groups according to their type of drug usage: AA users, AA + mood stabilizer users, and mood stabilizer users. Each group of patients was compared with a healthy control group for mentioned biochemical parameters. Lipid profiles were disordered by using both AA and mood stabilizers, but higher leptin levels are associated with AA usage. However, leptin does not seem to be responsible for dyslipidemia caused by AA or mood stabilizers in euthymic bipolar patients.

Impact of atypical antipsychotic therapy on leptin, ghrelin, and adiponectin

“…These studies indicate conclusively that, when matched appropriately with nonpsychiatric subjects, patients with schizophrenia do not exhibit greater than expected serum leptin levels regardless of antipsychotic drug exposure (Baptista et al, 2001;Eder et al, 2001;Herran et al, 2001;Hagg et al, 2001;Zhang et al, 2003;Arranz et al, 2004;Sporn et al, 2005;Haupt et al, 2005;Gergerlioglu et al, 2006;Atmaca et al, 2007). The one controlled comparative study of medication-treated bipolar patients vs. matched controls also reported no significant difference in leptin levels between the psychiatric patients and their peers (Gergerlioglu et al, 2006).…”

“…These studies indicate conclusively that, when matched appropriately with nonpsychiatric subjects, patients with schizophrenia do not exhibit greater than expected serum leptin levels regardless of antipsychotic drug exposure (Baptista et al, 2001;Eder et al, 2001;Herran et al, 2001;Hagg et al, 2001;Zhang et al, 2003;Arranz et al, 2004;Sporn et al, 2005;Haupt et al, 2005;Gergerlioglu et al, 2006;Atmaca et al, 2007). The one controlled comparative study of medication-treated bipolar patients vs. matched controls also reported no significant difference in leptin levels between the psychiatric patients and their peers (Gergerlioglu et al, 2006). Interestingly, a 6-month prospective risperidone study in autistic children noted no increase in serum leptin levels despite a mean weight gain of 5.6 kg (Martin et al, 2004), Lastly, a single 12-week prospective trial compared the effects of olanzapine, risperidone and quetiapine for levodopa psychosis in 30 Parkinson's Disease (PD) patients, using one group of PD subjects (n=10) treated solely with antiparkinsonian medications and another unmedicated cohort (n=10) as controls (Rustembegovic et al, 2006).…”

“…Nonetheless, in many instances leptin levels increased significantly without significant changes in serum insulin, other glycemic or lipid measures (Zhang et al, 2004;Murashita et al, 2005;Sporn et al, 2005;Chiu et al, 2006;Hosojima et al, 2006;Atmaca et al, 2007). One cross-sectional study in bipolar subjects also found no correlation between any glucose or lipid parameter and leptin levels (Gergerlioglu et al, 2006), although a small number reported significant correlations between leptin and serum insulin (Baptista et al, 2000;Melkersson et al, 2000;Melkersson and Hulting, 2001), glucose (Wang et al, 2006) and serum triglycerides (Atmaca et al, 2003c); however, most of the authors reporting significant correlations did not control for BMI.…”

“…(Gergerlioglu et al, 2006) Mood stabilizer + antipsychotic: 9 olanzapine 12 risperidone 10 quetiapine 30 mood stabilizer (no antipsychotic) 45 controls Cross-sectional study in bipolar patients with age-, gender-and BMI matched controls No difference in leptin levels between patients and controls. Bipolar patients were divided into 3 cohorts on the basis of medications: antipsychotics only, mood stabilizers only, and combination treatment, with higher leptin levels associated with antipsychotic usage, but not with any glucose or lipid parameter.…”

Metabolic Effects of Sodium Valproate on Atypical Antipsychotics in Japanese Psychotic Patients

“…Reports have been published on the metabolic effects of atypical antipsychotics and mood stabilizers. One study has shown that the use of atypical antipsychotics and mood stabilizers is associated with disordered lipids in euthymic bipolar patients [16], and the other study confirmed that only users of atypical antipsychotics (olanzapine, quetiapine, or risperidone) had higher metabolic syndrome rates than either users of atypical antipsychotics in combination with mood stabilizers (sodium valproate and/or lithium) or users of mood stabilizers alone [17]. In another retrospective study of bipolar patients receiving risperidone, olanzapine, or clozapine as an add-on to standard mood stabilizers, weight gain was significantly greater with olanzapine (4.0 kg) than with risperidone (2.4 kg) for 4 weeks, and the combination of divalproex and atypical antipsychotics caused more weight gain than did combination therapy with lithium [18].…”