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"Metabolic Syndrome"
 (revised Feb 2003)

Metabolic Syndrome is important in mental health for at least 5 reasons (evidence in following sections): 

1. There is emerging evidence that it can cause mood and anxiety symptoms, and that it can make Bipolar II worse. 
2. There is a smaller bit of evidence, just a tiny bit so far, to suggest that treating  metabolic syndrome can decrease the mood/anxiety symptoms, at least a little, sometimes a lot. 
3. Metabolic syndrome is almost certainly caused by several of the very medications we use to treat mood and anxiety symptoms  (you see the problem, of course: the medications we use to treat the symptoms can cause more such symptoms?!)
4. Treating metabolic syndrome can, in some people, lead to weight loss.  That catches most people's interest -- especially if they've been given one of the medications that can cause weight gain!    
5. Finally, metabolic syndrome is important to know about because it can be caused by gaining weight.  Certainly weight gain is a widespread problem in the United States.  Metabolic syndrome might affect as much as one quarter of the adult U.S.  population, according to a recent review.^Ovalle

Here's what metabolic syndrome looks like in a mental health context: 

• major weight gain for no clear reason (no increase in intake or decrease in exercise to account for it);
• in the context of stress or perimenopausal age range (40-50 for most women);
• with blood pressure increases, triglyceride increases, "central adiposity" (fat accumulates in the abdomen); 
• and features of "insulin resistance":
      a) increased blood glucose
      b) features of "polycystic ovarian syndrome", even without ovaries, including:
          - darkening and/or thickening of skin, and/or acne;
          - hair on chin, between breasts, above pubic hair toward belly-button
          - thinning of scalp hair;
          - irregular menses, and/or infertility.

This phenomenon was described in 1988 but not linked to psychiatric conditions or menopause at that time.  Most of the research in this area has been done by the cardiovascular and diabetes researchers, who recognize risks from this syndrome to the heart and to the development of diabetes.  For more about metabolic syndrome from the heart/diabetes perspective, try this site for basics (interestingly, you'll see nothing there about mental health symptoms).  

Read on in the next section, with all the evidence links, about: Metabolic Syndrome -- Causes Mental Health Symptoms?  But first, if you would like to ask...

Do I have it?  
Among the several definitions you will encounter, here's a simple one.  It has the advantage of being the version used by our National Heart, Lung and Blood Institute (NHLBI, the cardiovascular cousin of the NIMH).  And it's the version used in several important research papers on this topic.  

You must have at least 3 of the following: 

• fasting blood glucose greater than 110 (mg/dL)
• fasting triglycerides greater than 150
• HDL cholesterol (the good one) less than 50
• waist circumference (a tape measure around the widest part, sorry) greater than 88 centimeters / 34.5 inches 
• blood pressure greater than 135/85 (both top and bottom numbers over the limit)

So, you need a cholesterol panel (blood test) that includes triglycerides and HDL, and a basic chemistry test that includes glucose, done at least 12 hours after your last meal.  You need a tape measure for your waist.  And you need your blood pressure measurements.  

Now, on to Metabolic Syndrome -- Causes Mental Health Symptoms.