Women treated for bipolar disorder (BP) exhibit higher rates of menstrual abnormalities and metabolic dysfunction, such as obesity or insulin resistance (IR). However, it is not clear whether these reported abnormalities are directly attributable to the disorder, are a consequence of pharmacotherapy, or are a result of some combination thereof. We previously reported data suggesting that BP women may exhibit obesity and IR prior to mood stabilizer (MS) exposure.

This study examined metabolic and reproductive markers in a sample of women with bipolar depression (type II), the majority of whom had not previously been treated with MS agents. Eleven BP reproductive-aged women underwent fasting morning blood sampling to assess metabolic and reproductive hormone levels.

Eight women were completely MS-naïve; 3 women had previously been treated with an MS. More than half of the women were obese/body mass index (BMI) >30. Five women exhibited symptoms of IR, as demonstrated by fasting insulin >20mU/mL and/or a homeostatic model assessment of insulin resistance (HOMA-IR) value >2.3. Nearly half of the women had blood lipids markers indicative of hyperlipidemia, which was observed in both obese and non-obese women. The 3 women who received MS treatment in the past demonstrated significant lipid abnormalities compared to those MS-naïve women, which remained even after controlling for BMI.

The results suggest that: (1) increased BMI, IR, and hyperlipidemia can be present in BP women even in the absence of MS treatment; (2) hyperlipidemia may also be an enduring side effect of treatment with mood stabilizing agents.