NORMAN J CLEMENT RPH., DDS, NORMAN L.CLEMENT PHARM-TECH, MALACHI F. MACKANDAL PHARMD, BELINDA BROWN-PARKER, IN THE SPIRIT OF JOSEPH SOLVO ESQ., IN THE SPIRIT OF REV. C.T. VIVIAN, JELANI ZIMBABWE CLEMENT, BS., MBA., WILLIE GUINYARD BS., JOSEPH WEBSTER MD., MBA, SHELLEY HIGHTOWER, BS., PHARMD., LEROY BAYLOR, WALTER L. SMITH BA., ADRIENNE EDMUNDSON, WALTER L. SMITH BS., LEROY BAYLOR, BS., MS., MS., IN THE SPIRIT OF BRAHM FISHER ESQ., MICHELE ALEXANDER, CUDJOE WILDING BS, MARTIN NDJOU, BS., RPH., DEBRA LYNN SHEPHERD, BERES E. MUSCHETT, STRATEGIC ADVISORS
In a randomized, placebo-controlled trial, treatment with the diabetes drug metformin reversed insulin resistance in 50% of patients, and this reversal was associated with significant improvement of depressive symptoms. One patient randomly assigned to a placebo also achieved a reversal of insulin resistance and improved depressive symptoms.
JESSICA GANNON MD
“The study needs replication, but this early clinical trial suggests that the mitigation of insulin resistance by metformin significantly improves depressive symptoms in a significant percentage of treatment-resistant bipolar patients,” presenting author Jessica M. Gannon, MD, University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania, told Medscape Medical News.
“It looks like in treatment-resistant bipolar depression treating insulin resistance is a way to get people well again, to get out of their depression,” principal investigator Cynthia Calkin, MD, from Dalhousie University, Halifax, Canada, added.
CYNTHIA CALKIN, MD
The findings were presented at the virtual American Society of Clinical Psychopharmacology 2021 Annual Meeting.
The study was a joint effort by UPMC and Dalhousie University and was sponsored by the Stanley Medical Research Institute.
Patients with bipolar disorder (BD) who are obese tend to have a more serious illness, with a more chronic course, more rapid cycling, and more morbidity. These patients also fail to respond to lithium, Calkin said.
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“Untreated hyperinsulinemia could be contributing to a state of chronic inflammation and be involved in disease progression. So the question for me was, if we treat this insulin resistance, would patients get better?” she said.
Calkin said investigators used metformin because it is already used by psychiatrists for weight management in patients on antipsychotics.
“I wanted to test the drug that would work to reverse insulin resistance and that psychiatrists would be comfortable prescribing,” she said.
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