Metformin for Lithium-induced Weight Gain: A Case Report

다국어 초록 (Multilingual Abstract)

Lithium is the first line treatment for maintenance treatment of bipolar disorder. Among the long term adverse effects, weight gain is likely to affect a subset of patients. There is no specific guideline for the treatment of lithium-induced weight gain. We report a young male with bipolar disorder who had significant weight gain with lithium (25 kg), which responded to metformin treatment at 500 mg twice daily. The proposed mechanism of weight lowering effect of metformin includes changes in hypothalamic physiology, including leptin and insulin sensitivity, as well as circadian rhythm changes affecting food intake, regulation of fat oxidation and storage in liver, skeletal muscle, and adipose tissue.

참고문헌 (Reference)

1 Garland EJ, "Weight gain with antidepressants and lithium" 8 : 323-330, 1988

2 Torrent C, "Weight gain in bipolar disorder: pharmacological treatment as a contributing factor" 118 : 4-18, 2008

3 Atmaca M, "Weight gain and serum leptin levels in patients on lithium treatment" 46 : 67-69, 2002

4 Hasnain M, "Weight considerations in psychotropic drug prescribing and switching" 125 : 117-129, 2013

5 Dempsey M, "Treatement of excessive weight gain in patients taking lithium" 133 : 1082-1084, 1976

6 Brufani C, "Systematic review of metformin use in obese nondiabetic children and adolescents" 80 : 78-85, 2013

7 Baxter K, "Stockley’s drug interactions: A source book of interactions, their mechanisms, clinical importance and management" Pharmaceutical Press 2010

8 Desilets AR, "Role of metformin for weight management in patients without type 2 diabetes" 42 : 817-826, 2008

9 Gracious BL, "Psychotropic-induced weight gain and potential pharmacologic treatment strategies" 2 : 36-42, 2005

10 Björkhem-Bergman L, "Metformin for weight reduction in non-diabetic patients on antipsychotic drugs: a systematic review and meta-analysis" 25 : 299-305, 2011

11 Praharaj SK, "Metformin for olanzapine-induced weight gain: a systematic review and meta-analysis" 71 : 377-382, 2011

12 Coryell W, "Maintenance treatment in bipolar disorder: a reassessment of lithium as the first choice" 11 (11): 77-83, 2009

13 Vendsborg PB, "Lithium treatment and weight gain" 53 : 139-147, 1976

14 McKnight RF, "Lithium toxicity profile: a systematic review and meta-analysis" 379 : 721-728, 2012

15 Levine S, "Lithium increases body weight of rats: relation to thymolysis" 30 : 155-158, 2006

16 Baptista T, "Lithium and body weight gain" 28 : 35-44, 1995

17 Vendsborg PB, "Fat cell number and weight gain in lithium treated patients" 53 : 355-359, 1976

18 Malin SK, "Effects of metformin on weight loss:potential mechanisms" 21 : 323-329, 2014

19 Maayan L, "Effectiveness of medications used to attenuate antipsychotic-related weight gain and metabolic abnormalities: a systematic review and meta-analysis" 35 : 1520-1530, 2010

20 Chengappa KN, "Changes in body weight and body mass index among psychiatric patients receiving lithium, valproate, or topiramate: an open-label, nonrandomized chart review" 24 : 1576-1584, 2002

21 Coxhead N, "Carbamazepine versus lithium in the prophylaxis of bipolar affective disorder" 85 : 114-118, 1992

22 Naranjo CA, "A method for estimating the probability of adverse drug reactions" 30 : 239-245, 1981