Managing Cardiometabolic Adverse Effects in Bipolar Disorder

One of the biggest challenges when it comes to treating bipolar disorder is managing cardiometabolic adverse effects in patients. From weight gain to elevated cholesterol, there are many metabolic markers to keep track of.

In this video from the 2024 Psych Congress NP Institute, meeting Co-Chair Julie Carbray, PhD, PMHNP-BC, APRN, provides an overview of some of the key cardiometabolic symptoms and adverse effects that clinicians should be on the lookout for in their patients with bipolar disorder. Dr Carbray also discusses some of the new treatment mechanisms available that help to cut down on these side effects, as well as reminds us that treatment goes beyond symptom control to include whole body functioning goals for patients.

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Key Takeaways for Clinical Practice

• Bipolar disorder management often involves agents linked to weight gain, impaired glucose, and elevated cholesterol/triglycerides, worsening inherent metabolic vulnerability and mortality risk.
• Continuous monitoring of metabolic markers (weight, glucose, lipids) and distinguishing disease-related vs. treatment-related changes are essential to reduce cardiometabolic morbidity.
• Newer agents with novel mechanisms of action may mitigate weight and glucose effects, improving both symptom control and functional outcomes—supporting patient wellness, activity, and quality of life.

Read the Transcript

Julie Carbray, PhD, PMHNP-BC, APRN: Hi, I'm Julie Carbray. I'm a clinical professor of psychiatry and nursing at the University of Illinois Chicago, Department of Psychiatry and College of Nursing, and I'm a psychiatric nurse practitioner.

Psych Congress NP Institute: What are the key possible cardiometabolic symptoms and adverse effects associated with conventional treatments for bipolar disorder? How can these cardiometabolic symptoms and adverse effects impact patient outcomes, and what strategies can be employed to mitigate these effects?

Dr Carbray: When treating a patient with bipolar disorder, one of the largest challenges is navigating cardiometabolic adverse effects that happen with many of the drugs that we currently have available to us. Weight gain, impaired glucose, beginning to see elevated cholesterol or triglycerides. So, tracking those metabolic markers along with weight and wellness routines for our patient becomes critical. Unfortunately, many of the medications we've had to date only make those markers worse. We know that bipolar illness in and of itself increases mortality risk because patients with bipolar disorder seem to have a preclusion towards metabolic risk to begin with. So, we have to be conscious knowing that many of the agents that we have may also have weight gain, sedation—so our patients are not feeling as active—elevated metabolic profile lipids, glucose, as potential adverse effects.

When we're working with patients, we have to understand what aspects of their wellness are related to their bipolar illness and illness effects. So, if they're gaining weight, is it related to medication adverse effects? Or is it because their illness is contributing when you're depressed, you're not moving. When you're manic, you're burning more calories. So, this illness state combined with our treatments can really lead to a storm of cardiometabolic risk. So, monitoring, understanding what elements are disease-related and treatment-related, and continuing to address those adverse risks across treatment really becomes critical for saving the lives of our patients in the context of their illness.

We have several new treatments available that mitigate the risk of cardiometabolic effects for our patients. These new mechanisms of action of these agents really address weight gain, address elevated glucose and mitigate the adverse risk that we see with our conventional agents used for bipolar disorder. So, being able to use newer agents to mitigate the effects of our treatments on compounding the risk of cardiometabolic effects really gives us more tools in our toolbox to be able to help our patients to navigate improved symptom control without having to take that risk of enhanced cardiometabolic morbidity. So, it's exciting new technologies that we have available to us to be able to address cardiometabolic adverse effects.

When we're treating persons with bipolar illness, it's not just about symptom control. It's also about their ability to work, their ability to care for their health, and their ability to mitigate treatment adverse effects that really can impair their everyday functioning. So, we want for patients to keep working, to keep feeling like they can exercise and tend to their wellness. Sometimes our medications get in the way of that. It's exciting to think that we have new technologies, new medications to help patients with their overall functional impairment due to their illness beyond symptom control. I think as mental health providers, it's important for us to always recognize that our ability to help persons with bipolar illness is not just about symptom reduction, it's also about their ability to work, to have meaningful relationships, and their overall ability to function across their life. And these newer products are giving us more hope that we can see that for our patients and to have them, re-engage in their life in meaningful ways.

Thank you for this discussion today on bipolar disorder and how we might help our patients with an overall wellness plan and approaching holistic treatment to better the lives of persons we care for.  Stay tuned for more information on bipolar disorder and information that will help us as clinicians to provide best care for our patients.

Julie Carbray, PhD, PMHNP-BC, PMHCNS-BC, APRN, holds her PhD (93) and Master of Science (88) degrees from Rush University, Chicago and her Bachelor of Science (87) degree from Purdue University in West Lafayette, Indiana. A Clinical Professor of Psychiatry and Nursing at the University of Illinois Chicago, she has been practicing as a Psychiatric Nurse Practitioner over 35 years. As the Director of the Pediatric Mood Disorder Clinic, Dr. Carbray leads the clinical program and multidisciplinary training and is a nationally recognized clinical expert in children and adolescents with mood disorders. Dr. Carbray holds a national reputation of excellence in serving families of children with mood disorders, and was recognized with the UIC Preceptor of the year award, the Karen Gousman Excellence in Nursing Award, the American Psychiatric Nurses Association Best Practices in an Outpatient Program for Bipolar Disorder Award, the UIC Inspire Award, the APNA Distinguished Service Award and the Susan McCabe psychopharmacology lectureship from the International Society of Psychiatric Nurses. 

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