Metformin is Mitochondrial Enhancer and Helps Bipolar Depression

A 25 yr old bipolar patient of mine was put on metformin and a weight loss program prior to hip surgery. Her mood was more stable and she noticed particularly fewer manic episodes. There is evidence in literature for metformin helping bipolar cases. Bipolar, particularly those inherited from mother, could be more likely a mitochondrial disease, and recent developments suggest metformin with weight loss is a mitochondrial metabolic enhancer. Given metabolic syndrome is almost universal in bipolar, should metformin be universally used? Day after I wrote this up, I had a Bipolar victim come in refusing to take any stabilizing meds because she would put on 30 lbs. Metformin  then became a serious option.

Increased risk of affective disorders in type 2 diabetes is minimized by sulfonylurea and metformin combination: a population-based cohort study
Mark L Wahlqvis et al
BMC Medicine 2012, 10:150
http://www.biomedcentral.com/content/pdf/1741-7015-10-150.pdf

Results metformin reduced bipolar diagnosis rates while other diabetic med (sulfonylureas) did not.

Interestingly, in unipolar depression, only the combination of metformin with other meds was effective. The fact that those on combination pills had less depression is more difficult to interpret as the diabetic disease is more advanced and other factors could be involved.

Comment – implication is that bipolar disease is helped with metformin. A recent study found metformin to be a mitochondrial metabolic enhancer particularly if they lost weight:

Fibromyalgia (FM) – Mitochondrial Dysfunction Helped by Metformin and Weight Loss
http://painmuse.org/?p=4468

Many bipolar patients are on atypical antipsychotic meds that can cause weight gain. It has been found that metformin can help this:

Lifestyle Intervention and Metformin for Treatment of Antipsychotic-Induced Weight Gain. A Randomized Controlled Trial
Ren-Rong Wu, MD; Jing-Ping Zhao, MD, PhD; Hua Jin, MD; Ping Shao, MD; Mao-Sheng Fang, MD; Xiao-Feng Guo, MD; Yi-Qun He, MD; Yi-Jun Liu, MD; Jin-Dong Chen, MD; Le.
JAMA. 2008;299(2):185-193. doi:10.1001/jama.2007.56-b
http://jama.jamanetwork.com/article.aspx?articleid=1380162

With these factors in might, one could make a case for all bipolar victims being put on metformin and a weight loss program not only for weight, but for its mitochondrial enhancements. Its cancer preventative effects are well known.