Weekly Mind Reader: Does Valproate Spark Metabolic Changes?

The Journal of Clinical Psychiatry published a paper demonstrating a link between higher doses of valproate and weight gain in psychiatric patients. The research highlights the need for closely monitoring dosage to minimize adverse metabolic effects.

Associations of Valproate Doses With Weight Gain in Adult Psychiatric Patients

Scientists launched the research project to assess the association between valproate (VPA) dosage and various metabolic outcomes, including weight change, blood glucose, lipid levels, and blood pressure, in a psychiatric population.

The researchers analyzed data from 215 patients taking VPA for up to one year. The results indicated a significant association between weight gain over time and higher VPA doses, particularly those equal to or exceeding 1,300 mg/day. Weight gain appeared to be more pronounced within the first three months of treatment and continued throughout the year. Men showed a stronger association between dose and weight gain compared to women. They found no significant associations between VPA doses and blood glucose, lipid levels, or blood pressure over a 6-month treatment period.

Additionally, patients taking VPA in combination with medium-risk antipsychotics experienced more weight gain compared to those taking VPA alone.

The study’s strengths included its longitudinal design, incorporating multiple time points for each patient, and its real-world setting. Nevertheless, limitations included the inability to ascertain treatment compliance and the lack of data on lifestyle factors that could affect metabolic outcomes.

In conclusion, the study suggests that higher doses of VPA are associated with weight gain in psychiatric patients. This revelation emphasizes the importance of closely monitoring patients on VPA and prescribing the lowest effective doses to minimize adverse metabolic effects.

The paper’s authors argue for further research to better understand the complex relationship between VPA dosage and metabolic outcomes.

IN OTHER PSYCHIATRY AND NEUROLOGY NEWS

• In a companion commentary piece, Joseph F. Goldberg, MD, remarks on the revelation that an association between valproate and weight gain in psychiatric patients suggests the need for a more cautious dosing approach.
• A case study discusses a 20-year-old woman with no previous neuropsychiatric history. She arrived at the ED with violent outbursts and incoherent speech, followed by mutism and urinary incontinence. She had significant stressors before the illness.
• Another report details the clinical course of a patient with schizophrenia who developed a likely risperidone hepatocellular hepatotoxicity.
• This study reports on a patient with cystic fibrosis who experienced psychiatric symptoms after elexacaftor/tezacaftor/ivacaftor initiation.
• Recent media coverage – and research – looking at ketamine highlight the drug’s efficacy in treating major depressive disorder.