Индуцированная сибутрамином мания как дебют биполярного аффективного расстройства

Background
Sibutramine, used in obesity treatment, has been associated with many neuropsychiatric side effects including hypomanic and manic episodes. Hypomanic or manic episodes related to sibutramine treatment were earlier reported in patients who had previous history of bipolar disorder, after sibutramine overdose, after over-the-counter product illegally containing very high dose of sibutramine, together with psychotic symptoms, in organic patient, or after interaction of sibutramine with other drugs.
Case presentation
We report the first case of a patient with clear manic episode, after treatment with recommended dose of sibutramine, without previous history of mood disorders, organic changes or drug interactions, that was followed by episode of depression.
Conclusion
Minimal recommended dose of sibutramine induced manic episode that was the first manifestation of bipolar disorder. The manic episode, associated with sibutramine treatment, was induced in a person without previous history of mood disorders. Potential risks associated with the treatment of obesity using sibutramine warn physicians to be alert not only to common and cardiovascular but also to psychiatric adverse effects. A careful assessment of patient's mental state and detailed psychiatric family history should be done before sibutramine treatment. In patients with a family history for bipolar disorder the use of even minimal dose of sibutramine should be contraindicated.

 Sibutramine-induced mania as the first manifestation of bipolar disorder.

Коррекция метаболических побочных эффектов антипсихотиков

This systematic review and meta-analysis included 32 randomized, open and double-blind, placebo-controlled studies (mean duration: 13.1 weeks, range: 6-16 weeks) with a total of 1482 subjects and which tested the following 15 medications: amantadine, dextroamphatamine, d-fenfluramine, famotidine, fluoxetine, fluvoxamine, metformin, nizatidine, orlistat, phenylpropanolamine, reboxetine, rosiglitazone, sibutramine, topiramate, and metformin plus sibutramine).
Five of the agents assessed lead to significantly greater weight loss than placebo. The greatest weight loss was achieved with metformin (N = 7, n = 334, -2.94 kg [CI, -4.89, -0.99]), followed by d-fenfluramine (N = 1, n = 16, -2.60 kg [CI,-5.14, -0.06]), sibutramine (N = 2, n = 55, -2.56 kg [CI, -3.91, -1.22]), topiramate (N = 2, n = 133, -2.52, [CI, -4.87, -0.16]) and reboxetine (N = 2, n = 79, -1.90 kg [CI, -3.07, -0.72]). Nausea rates did not differ between treatment and placebo groups. Results on the secondary outcome measures of waist circumference and weight gain, carbohydrate metabolism and blood lipids as well as sensitivity analysis regarding prevention vs intervention trials were largely heterogeneous. No significant differences between treatment and placebo groups were found for the secondary outcome measures of psychiatric symptoms and adverse events.

The Year in Psychosis and Bipolar Disorder: Treating Antipsychotic-related Metabolic Abnormalities