Research report Weight gain, obesity, and metabolic indices following a first manic episode: Prospective 12-month data from the Systematic Treatment Optimization Program for Early Mania (STOP-EM) David J. Bond, Marcia Kauer-Sant'Anna, Raymond W. Lam, Lakshmi N. Yatham ⁎ Mood Disorders Centre, University of British Columbia, Room 2C7 - 2255 Wesbrook Mall, Vancouver, British Columbia, Canada V6T 2A1 article info abstract Article history: Received 23 February 2009 Received in revised form 21 October 2009 Accepted 21 October 2009 Available online 14 November 2009 Background: Numerous studies have demonstrated an association between bipolar disorder (BD) and obesity. However, these reports are limited by retrospective or cross-sectional designs, and the assessment of patients with lengthy illnesses. Prospective data, and data on weight gain early in the course of BD, are lacking. Methods: We prospectively measured weight gain and laboratory metabolic indices over 12 months in 47 patients with BD receiving maintenance treatment following their first manic episode, and in 24 age- and gender-matched healthy subjects. Results: Although approximately two-thirds of patients had experienced previous depressive or hypomanic episodes, there was no difference between patients and healthy subjects in mean body mass index or rates of overweight or obesity at recovery from the first mania. Mean weight gain over 12 months was 4.76 kg in patients and 1.50 kg in healthy subjects (p = 0.047). Combined rates of overweight and obesity at 6 months and 12 months exceeded 50% in patients, and were almost double those of healthy subjects. Logistic regression demonstrated that weight gain in the first 6 months was significantly associated with male gender and prescription of olanzapine or risperidone. Patients who were obese at 6 months and/or 12 months had significantly greater mean serum triglyceride levels and fasting glucose levels than non-obese patients. Limitations: This was a naturalistic study. Conclusions: Even in patients with previous depressions and hypomanias, clinically significant weight gain in BD begins following the first manic episode, suggesting that it is primarily related to treatment with mood stabilizers and second-generation antipsychotics. However, the very small number of patients in our sample who were medication-free precludes a meaningful analysis of the degree to which weight gain might be an inherent feature of post-manic BD. © 2009 Elsevier B.V. All rights reserved. Keywords: Bipolar disorder First-episode mania Weight gain Overweight Obesity 1. Introduction Bipolar I disorder (BD) affects approximately 1% of the population, and has been estimated to cost the US economy $24–45 billion annually (Merikangas et al., 2007; Begley et al., 2001; Wyatt and Henter, 1995). North American studies have reported that 55%–75% of patients with BD are overweight (body mass index (BMI) = 25.00–29.99) or obese (BMI ≥ 30.00) (McElroy et al., 2002; Fagiolini et al., 2002; 2003; 2005; Shah et al., 2006; Wang et al., 2006; Fiedorowicz et al., 2008), that they are more likely to be so than the general population (McElroy et al., 2002; Fagiolini et al., 2003; 2005), and that the prevalence of overweight and obesity in BD is increasing with time (Fagiolini et al., 2005). However, these reports assessed patients with lengthy illnesses using cross-sectional or retrospective designs, and either did not utilize comparison groups (Fagiolini et al., 2002; Wang et al., 2006; Fiedorowicz et al., 2008) or com- pared patients to population norms (McElroy et al., 2002; Journal of Affective Disorders 124 (2010) 108–117 ⁎ Corresponding author. Research and International Affairs, Department of Psychiatry, University of British Columbia, Room 2C7 - 2255 Wesbrook Mall, Vancouver, Canada BC V6T 2A1. Tel.: +1 604 822 7325; fax: +1 604 822 7922. E-mail address: yatham@exchange.ubc.ca (L.N. Yatham). 0165-0327/$ – see front matter © 2009 Elsevier B.V. All rights reserved. doi:10.1016/j.jad.2009.10.023 Contents lists available at ScienceDirect Journal of Affective Disorders journal homepage: www.elsevier.com/locate/jad