Over the past 2 decades, longitudinal studies and registry analyses have revised prior estimates of lithium-induced nephropathy, indicating that while the absolute risk may be lower than historically reported, lithium exposure remains a cause and contributor to CKD progression and a not infrequent reason for treatment discontinuation.Reference Qian, Sud and Lee 3 , Reference Roxanas, Grace and George 29 Reference McIntyre, Mancini, Parikh and Kennedy 31 GLP-1 RAs are increasingly prescribed for metabolic conditions that differentially affect individuals living with bipolar disorder, including obesity, type 2 diabetes mellitus, obstructive sleep apnea, and CKD.Reference McIntyre, Alda and Baldessarini 32 Reference Liu, Ling and Lui 34 Beyond their metabolic benefits, GLP-1 RAs have demonstrated reductions in cardiovascular morbidity and mortality, which is the leading contributor to excess and premature mortality in bipolar disorder.Reference Goldstein, Baune and Bond 35 Moreover, GLP-1 RAs have been investigated for use in psychotropic-drug-related weight gain, binge eating, metabolic liver disease, and substance- or alcohol-use disorders, all of which are clinical presentations that are frequently encountered in the bipolar population.Reference McIntyre, Kwan, Rosenblat, Teopiz and Mansur 36 Reference Zheng, Soegiharto and Au 40 The molecular and cellular dynamics affected by GLP-1 RAs have separately introduced a hypothesis that these agents may hold therapeutic potential in the treatment and prevention of mental disorders and progressive cognitive impairment.Reference McIntyre, Rasgon and Goldberg 41 For example, GLP-1 RAs are known to promote neurogenesis, neuroplasticity, and autophagy while reducing inflammation, oxidative stress, and neuronal apoptosis within critical neural circuits.Reference McIntyre, Rasgon and Goldberg 41 Reference Au, Zheng and Le 43 The molecular, cellular, and circuit-level effects attributed to GLP1-RAs may confer neuroprotective effects against the progression of illness, particularly with respect to cognitive functioning.Reference Au, Lam, Lim and McIntyre 44 However, our findings must be carefully and cautiously interpreted, as they are regarded as highly exploratory and hypothesis-generating
38 Therefore, although injection of the LV-shBDNF into the CA3 induced a significant reduction in local BDNF levels, secretion of BDNF from the DG can partially compensate for this loss
Food supplements should be stored out of the reach of small children
Lifestyle and routine convenience Not everyone who chooses nighttime injections does it for side effect management
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