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Elevated cardiovascular risk in youth with bipolar disorder is related to depression symptoms

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In the largest study of its kind, researchers have found that adolescents and young adults with bipolar disorder (BD), in particular those with more persistent depression, have an increased rate of metabolic syndrome (MetS).

It’s estimated one in five Canadians suffer from MetS, a group of conditions that increase the risk of chronic illnesses such as heart disease, stroke and diabetes.  Conditions include: high blood pressure, high blood sugar, obesity, as well as high cholesterol or triglyceride levels.

BD is a severe mood disorder that causes extreme mood swings between “highs” and “lows.”  The highs are called manic or hypomanic episodes and the lows are called depressive episodes. BD affects between one and five percent of teenagers.

MetS and youth with bipolar disorder

The study included young people, on average 21 years old. Researchers determined that the prevalence of MetS among young people with BD is at least double that of the general population. The study also found that MetS is associated with increased depression symptoms, but not with increased manic symptoms.

“The link between cardiovascular risk and depression in this study is likely due to a combination of behavioural and biological factors,“ says Dr. Benjamin Goldstein, a study author and director of the Centre for Youth Bipolar Disorder at Sunnybrook.  “Behaviourally, people who are depressed often eat more and exercise less than when they are well. Biologically, depression is associated with increased markers of inflammation. Each of these factors is also relevant to cardiovascular health.”

While past studies have looked at MetS in adults with bipolar disorder (BD), this study is considered to be the first study focusing on MetS among adolescents and young adults with BD.

“Cardiovascular risk factors among young people with bipolar disorder are associated with worse mental health in the here-and-now and confer longer-term risks of early cardiovascular disease and stroke,” says Dr. Goldstein. “While awareness is important, we have reached a point where it is abundantly clear that action is needed.”

Treatment for bipolar disorder: brain and body

“From the clinical and policy perspectives, physical health should be, but is not yet, integrated into the usual care of people with bipolar disorder and other severe mental illnesses,” says Dr. Goldstein. “That’s unfortunate, because improvements in cardiovascular health or depression may have reciprocal benefits for patients.”

At Sunnybrook’s Centre for Youth Bipolar Disorder researchers are investigating the underlying links between bipolar and cardiovascular disease. An area of interest involves the study of the role exercise can play in the treatment for bipolar disorder.

Experts say physical activity is an important part of a healthy lifestyle and that aerobic exercise can help provide physical and psychological health benefits for adolescents with bipolar disorder.

Research has shown that exercise can help improve symptoms of depression and anxiety. Being active can improve the ability to concentrate, make decisions and problem solve. Physical activity can also help lower the risk of heart disease that is linked with bipolar disorder.

Dr. Goldstein says finding treatment approaches addressing the body and the brain together is integral to the future treatment of adolescents with bipolar disorder.

“From a research perspective, there is a largely untapped opportunity to learn about the causes of bipolar disorder through its link with cardiovascular health.”

Read the study, High Prevalence of Metabolic Syndrome Among Adolescents and Young Adults with Bipolar Disorder, in the Journal of Clinical Psychiatry.

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Jennifer Palisoc

Jennifer Palisoc is a Communications Advisor at Sunnybrook.

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