Managing the symptoms of bipolar disorder can often feel like a full-time job — and for many people with the illness, it’s not the only condition that needs to be treated. Individuals with bipolar are more likely to develop physical health conditions such as diabetes and migraine, and getting treatment for both the mind and the body is critical. These are the five most common medical conditions that co-occur with bipolar disorder.
The Cleveland Clinic defines metabolic syndrome as a group of health concerns — such as high blood pressure, elevated blood sugar levels, irregular cholesterol or triglyceride levels, and excess fat around the waistline — that collectively elevate the risk of cardiovascular disease, stroke, and type 2 diabetes. A common characteristic of metabolic syndrome is insulin resistance.
Metabolic syndrome is thought to be present in 30 to 50 percent of people with bipolar disorder, says Stephen M. Strakowski, MD, professor of psychiatry at Dell Medical School in Texas. “This is approximately a two-fold increase over the general population (although reported rates are widely variable). Particularly common are obesity and type 2 diabetes mellitus.”
According to a study published in Frontiers in Neuroscience in 2021, 30 percent of people with bipolar disorder have metabolic syndrome compared to 15 percent of a control group. Furthermore, individuals with co-occurring bipolar disorder and metabolic syndrome had less favorable responses to psychiatric treatment and higher rates of hospitalization.
There have been multiple studies that show people with bipolar disorder in North America may be at increased risk of being overweight and having obesity. A study review published in the Cochrane Database of Systematic Reviews showed that approximately 68 percent of people who sought treatment for bipolar disorder were overweight or obese.
This is often attributed to a medication side effect and, while that’s a contributing factor, high rates of overweight are observed even in people with bipolar who are not taking medication, Strakowski points out in his book Bipolar Disorder. Obesity is understood to contribute to other medical conditions, including type 2 diabetes mellitus and metabolic syndrome.
People with bipolar disorder are twice as likely to develop type 2 diabetes than the general population, according to a meta-analysis published in The European Journal of Psychiatry in 2022.
Strakowski notes that there are high rates of obesity in both those with bipolar and the those without a psychiatric illness, and other factors may contribute to the elevated rate of type 2 diabetes, such as certain medications used to treat bipolar. Strakowski explains that bipolar disorder may involve “general hormonal dysregulation of multiple systems that include those responsible for glucose management.”
Type 2 diabetes and metabolic syndrome are related, but not the same. Being diagnosed with metabolic syndrome indicates the presence of multiple factors that, if not addressed, can greatly heighten the chance of developing diabetes, per the Mayo Clinic.
Research shows that cardiovascular disease in people with bipolar disorder is twice as high compared to individuals without bipolar, and is a serious concern. The risk factors include high rates of obesity, type 2 diabetes, smoking, and drug and alcohol use disorders. As with obesity, the inherently increased risk of cardiovascular disease could be related to hormonal dysregulation or inflammatory processes associated with bipolar.
Studies have indicated that up to 39 percent of those with bipolar develop migraine. This represents a rate that’s three to six times more common than it is for individuals without bipolar — and it usually worsens the course of the illness.
“The specific cause of this co-occurrence is unknown,” writes Strakowski, “although it may be related to abnormal serotonergic neurotransmission or inflammatory processes.”
Editorial Sources and Fact-Checking
Metabolic Syndrome. Cleveland Clinic. September 13, 2023.
Dalkner N, Bengesser S, Birner A, et al. Metabolic Syndrome Impairs Executive Function in Bipolar Disorder. Frontiers in Neuroscience. August 2021.
Tully A, Smyth S, Conway Y, et al. Interventions for the Management of Obesity in People With Bipolar Disorder. Cochrane Database of Systematic Reviews. July 2020.
Breznoscakova D, Pallayova M. Bipolar Disorder and Type 2 Diabetes Mellitus: A Bidirectional Relationship. The European Journal of Psychiatry. July-September 2022.
Metabolic Syndrome. Mayo Clinic. May 6, 2021.
Ralat S, Barrios R. The Management of Cardiovascular Disease Risk Factors in Bipolar Disorder Patients in Primary Healthcare Settings. Puerto Rican Journal of Psychology. January 2020.
Duan J, Yang R, Lu W, et al. Comorbid Bipolar Disorder and Migraine: From Mechanisms to Treatment. Frontiers in Psychiatry. January 2021.
UPDATED: Originally published on February 26, 2017
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For the people who have Fibromyalgia, did the occurrence of it happen before you were diagnosed or after? I am suspecting I have it: but did not have any problems until I went on my medications.
Tanya, I am a co-vacillator in two DBSA bipolar groups in my church. I just want to thank you and the others on your writing team for the important articles you write. I frequently share how new attendees may sign up for your inspiring and caring articles in bphope. Thank you again, so much.
Thank you for this article. Wonderful information.
I’ll be honest I am a little disappointed that tardive dyskinesa is not being talked about.
I’m surprised that drug-induced Parkinsonism does not make the list. It is a subtle but deeply disabling effect of prolonged use of neuroleptic medicine, especially as a person with bipolar disorder advances in age. Thankfully, at least in an urban setting, neurologists are beginning to be trained to diagnose it, but sadly, in the same setting, there is a dearth of geriatric psychiatrists who don’t “major” in dementia and depression. Obviously careful monitoring of medications is essential at every age. I am, of course, aware of the shorter life expectancy for folks with brain disorders…and the way health insurance is tilted against BOTH the mentally ill AND the elderly. Good luck!! if you tick both those boxes. Even BPHope doesn’t have many articles on “What to Expect as you Age with Bipolar” . I’d like to see something on “drug fatigue” and “metabolic changes” (not the syndrome).
I agree, Matriarch77. Aging with Bipolar Disorder and drug fatigue; drug interactions as the body requires more medications; and metabolic — as well as cognitive — changes…each and all would be worthy topics for future bphope.com articles.
Thank you for all your helpful information and motivating testimonies, bphope!