(home)                                                                                                                                                       Metabolic Syndrome      

Weight gain, mood/anxiety symptoms, 
and treatment with metformin

The story -- which begins ~25 years ago

Short version
Patients kept telling me they'd had unexplained, rapid, huge weight gain right around the time of their symptoms worsening.  Then Depakote was accused of causing PCOS (here's that story, including the latest evidence and conclusions), leading to another connection to weight gain via that condition.  

Through another website, people wrote and strengthened the idea that a diabetes treatment might be able to reverse some of that weight gain, and the increase in symptoms that goes with it.  One of those folks even helped me reach another psychiatrist who'd not only had the same idea 25 years ago, but had gotten quite far with testing the diabetes medicine as a treatment.  

Now, as of February 2003, formal research articles are coming in making this connection also. e.g. Raikkonen Even the head of bipolar research at the NIMH has indicated he sees this connection (here's his note on that:  Manji).  Soon there will be a wide recognition, in part because one of the best medications for bipolar disorder appears to cause metabolic syndrome, an effect that may be blocked by the diabetes treatment patients spoke about.  

If you'd like to hear more of this fascinating series of connections, including more of the work of Dr. Hicks 25 years ago and the letters patients have sent me, read on and follow the links.  JP  

Longer version
Right around the time I was beginning to wonder about whether weight gain alone could cause mood/anxiety symptoms, I received a letter from a woman describing just that.  Here's her letter and my reply.   This correspondence was picked up by yet another woman who wrote the following letter, used with appreciation and permission:

My father was bipolar. In my mid thirties I was diagnosed as being hyperinsulinemic and DBI (phenformin) was prescribed. I am not sure what it did for my metabolic condition but it did great things for my mental state. I went from foggy mindedness and inability to concentrate my energies sufficiently to be productive to being clear minded and very able to focus. Moodwise I seem to have a ongoing mild high with no appreciable mood swings.

I was concerned about my three children and whether they had the same condition. They were tested and all did. Mark my youngest seemed to be having the most problems so he and my daughter as well were placed on DBI. I spoke with a Dr. Richard Hicks at Friends Hospital in Philadelphia and he was conducting research using the DBI on psychiatric patients at the hospital with startling preliminary results. Using DBI he reported that patients who were completely out of it in "padded cells" were coming back to themselves in short periods of time. Unfortunatley, the removal of phenformin from the US market interrupted his studies.

Ultimately all three of my children took phenformin or metformin. While they have all had problems indicative of bipolar illness and one has actually been diagnosed as bipolar type II, none have developed the full blown condition. All have gone on to live productive lives without the disruptions typical of bipolar illness. My daughter who has been diagnosed bipolar also had PCOS as I probably do also.

I believe from our experiece that Glucophage can moderate the course of bipolar illness and that bipolar illness can be a component of "Syndrome X." What I find amazing is that except for the studies done by Dr. Hicks, I have never been able to find any indication that the formin family of drugs has been used in research studies on bipolar illness. If you know of any such studies please let me know about them.


With her help I reached Dr. Hicks, who kindly discussed his work and wrote back that he was "flabbergasted" to see interest in this connection resurface so many years later.  He'd actually been using phenformin as a treatment in a research study -- until it was removed from the market.  Here's a summary, if you're interested, of his results and conclusions (courtesy of Dr. Richard E. Hicks). 

If you have a story about metabolic syndrome, write and include your permission for me to post it (leave out information that identifies you personally; just your initials if you like).  Here's that patient history collection.