The Weekly Mind Reader: Research Linking Metformin and Bipolar Depression Wins ASCP's Wender Award

Cindy Calkin, MD is this year’s recipient of the American Society of Clinical Psychopharmacology’s Paul Wender Best Paper Award in The Journal of Clinical Psychiatry. Calkin, a professor with the department of psychiatry at Dalhousie University in Canada, led a groundbreaking study that explored an unconventional strategy for treatment-resistant bipolar depression (TRBD.)

A Metabolic Approach to Depression

TRBD and insulin resistance often go hand-in-hand, although the precise reasons behind their correlation remain under investigation. Whatever the connection, Calkin’s team speculated that managing insulin might also help mitigate symptoms of depression. 

For 14 weeks, 45 patients participated in the clinical trial, with 20 receiving the diabetes drug metformin, and 25 a placebo. To measure treatment success, the team focused on reduction in depression rating scores assessed through the Montgomery-Asberg Depression Rating Scale (MADRS.) They also kept tabs on additional outcomes, including measures of general functioning, bipolar disorder symptoms, and anxiety levels.

By the 14-week mark, 11 patients no longer met the criteria for insulin resistance. Of these, 10 were in the group given metformin, compared to just one in the placebo group. The researchers referred to patients whose numbers moved to improved or normal insulin sensitivity as “converters.”

The converters demonstrated a 45 percent greater improvement in their depression scores compared to their non-converting counterparts. Benefits appeared as early as the six-week mark and held to the end of the 26-week study. Even better, the positive results extended to overall functioning and anxiety levels.

Adverse events were uncommon and relatively minor. Some of the subjects reported transient gastrointestinal discomfort. No one dropped out of the study due to side effects or noncompliance.

We applaud Calkin’s novel concept to treat an underlying metabolic disorder to improve a psychiatric one. The idea hints at a possible future where metformin could offer a pathway out of the labyrinth of TRBD. It’s an inspired solution to a challenging condition.

The Wender Award is named after Paul H. Wender, MD. Known as the “Dean of ADHD” by his colleagues, Wender was a pioneer in identifying and treating attention deficit hyperactivity disorder. A researcher and clinician who treated patients with ADHD for many years, he offered insights into the progression of ADHD, as well as dietary, drug, and psychological treatments. He was the author of the classic handbook on the subject, ADHD: Attention-Deficit Hyperactivity Disorder in Children and Adults.

IN OTHER PSYCHIATRY AND NEUROLOGY NEWS THIS WEEK

• This week JCP launched 5 Minute Pearls in Psychopharmacology, a new video series that shares quick takes on important topics in psychiatry from top experts. In the inaugural feature, Marlene Freeman, MD shares the latest clinically relevant updates for postpartum depression and other postpartum psychiatric disorders.
• People with co-occurring substance use disorders and chronic health or psychiatric conditions may be at higher risk for suicidal ideation. 
• Make a judicious selection of medications for patients with depression. Treatments with lower risk of depressive symptom side effects could enhance the likelihood of achieving full remission.
• Risk of mood disorders may change with the seasons. A new study suggests a higher risk of suicide in the spring and a higher risk of depression in the winder. 
• In a new case study, a patient gets a rush from burning herself, demonstrating that pain itself can be addictive. 
• Our Tweet of the Week is a reminder that no one is immune from PTSD given the right set of challenging circumstances. Hopefully it also makes you consider taking a kind and respectful approach to social media posting. As this story demonstrates, and the new Surgeon General advisory cautions, attacking someone online can have a profoundly negative impact on their mental health.

Sadiq Khan says he has PTSD caused by death threats https://t.co/EEWOSgCe2G

— The Guardian (@guardian) May 20, 2023

NEW AT CME INSTITUTE

It’s not too late to join the Emerging Perspectives in Psychiatry meeting in New York City on June 24. Book your seat now to earn free 5.0 CME credits and learn from leading experts on schizophrenia, ADHD, addiction, MDD, and PPD.