What 4 new studies reveal about staying on medication, reducing suicide risk, and understanding bipolar biology.
Key Takeaways
- Adding the diabetes drug metformin helps patients stay on atypical antipsychotics longer, likely by managing weight-related side effects.
- Talk therapy alone — specifically IPSRT — was found to effectively reduce suicidal thoughts in bipolar 2 disorder, even without medication.
- A buildup of “brain waste” caused by a sluggish glymphatic system is linked to a higher risk of suicide attempts.
- Bipolar disorder and schizophrenia are biologically very similar, sharing roughly 60 percent of their genetic risk factors.
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Living with bipolar disorder means making complex treatment decisions, managing distressing symptoms, and wondering why certain challenges keep showing up. Your journey is yours to navigate, but you don’t have to do it alone. One resource you can draw on is the latest research. Four new studies address questions that can help guide you:
- Could a common diabetes medication help you be more consistent with your bipolar treatment plan?
- Can a widely used bipolar talk therapy reduce suicidal thoughts?
- Could a waste buildup in the brain play a role in suicide risk in bipolar disorder?
- How might genetic research reshape psychiatric diagnostic labels in the future?
Metformin Might Help You Stick With Atypical Antipsychotics
Second-generation antipsychotics — also called atypical antipsychotics — help manage symptoms of bipolar disorder and other brain-based health conditions. These medications include iloperidone (Fanapt), risperidone (Risperdal), and quetiapine (Seroquel).
Yet atypical antipsychotics can also have a negative impact on metabolic health, and evidence suggests that the medications can contribute to weight gain and insulin resistance.
It can be difficult to stick with a medication you know helps with your mental health goals while setting you back on your physical health. That could help explain the research finding that people with obesity who take an atypical antipsychotic are about twice as likely as others to say they skip doses.
A University of Houston in Texas research team wondered if metformin — a diabetes medication that helps your body raise GLP-1 levels and help with weight loss — might make it easier for people to stay on atypical antipsychotics. Using insurance data, the researchers compared 1,547 people taking both metformin and an atypical antipsychotic with 6,188 people taking an atypical antipsychotic alone. About 36 percent of participants had bipolar disorder.
The findings, published in November 2025 in the Journal of Clinical Psychiatry, suggest that adding metformin helps. At a six-month follow-up, people also taking metformin had been on their atypical antipsychotic for about a month longer than those who hadn’t.
What This Means for You
- Weight gain is a legitimate medical issue. Being concerned about medication-related weight gain isn’t superficial. Atypical antipsychotics may increase your risk of metabolic changes that may lead to cardiovascular disease and type 2 diabetes. You’re not alone if these side effects make it difficult to be consistent with your medication plan.
- Metformin might help you stay on atypical antipsychotics. Previous research found that metformin can reduce weight gain associated with these medications. This study suggests that addressing this side effect may help people stick with their atypical antipsychotic, whether they started metformin right away or added it later.
- Using metformin this way is off-label. Although this study focused on people without diabetes, metformin is currently only approved by the U.S. Food and Drug Administration (FDA) for use in people with type 2 diabetes, according to Mayo Clinic. Some doctors prescribe it off-label for weight management, but cost and individual health factors may still mean it’s not practical or appropriate for your situation. If you’re concerned about the metabolic side effects of atypical antipsychotics, talk with your healthcare prescriber about what options might work best for you.
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Therapy Alone May Reduce Suicidal Thoughts in Bipolar 2 Disorder, Study Finds
If you have bipolar 2 disorder, you’re at significantly higher risk for suicidal thoughts than most people. Despite this, almost no research has looked at whether talk therapy helps with this specific problem.
A new study published in the Journal of Clinical Psychiatry tackled this question. An American research team followed 92 people with bipolar 2 disorder in a depressive episode who got a type of weekly mental health therapy developed specifically for bipolar disorder called interpersonal and social rhythm therapy (IPSRT). Half took quetiapine, and half took a placebo.
The study results were surprising. Not only did IPSRT help with suicidal thoughts when people took the psychiatric medication — which the researchers expected — but it also helped even when people took no medication at all. Each week of therapy reduced the odds of suicidal thoughts by 13 percent. There was no meaningful difference in the group taking quetiapine and the unmedicated group.
What Is IPSRT?
IPSRT is a structured psychotherapy originally developed for bipolar disorder by Ellen Frank, PhD, and colleagues at the University of Pittsburgh. It’s based on the idea that many people with bipolar have vulnerable internal “biological clocks,” so changes in routine or high stress can more easily disrupt sleep-wake patterns and trigger mood episodes.
IPSRT works in two main areas to help stabilize mood:
- Social Rhythms This part focuses on building a more regular daily routine. The aim is to keep your internal clock steadier by doing key activities — such as getting up, eating meals, being active, and going to bed — at roughly the same times each day.
- Interpersonal Therapy This part looks at how your relationships affect your mood. Since relationship conflict often disrupts routines (like staying up late to argue or skipping meals due to stress), IPSRT teaches skills to manage relationship stress so it doesn’t undermine your stability.
What This Means for You
- Therapy is a valid medication alternative. If you struggle with medication side effects or cannot take certain medications, this study suggests therapy alone might be a real option for managing suicidal thoughts.
- IPSRT isn’t a crisis intervention. This approach is intended for people stable enough to attend weekly outpatient sessions. The study specifically excluded people with psychosis or anyone needing a higher level of care. If you’re currently in an emergency or need intensive stabilization, IPSRT alone is unlikely to be enough.
- It isn’t a cure-all. While effective for most, 1 in 7 participants still experienced suicidal thoughts after treatment. If IPSRT doesn’t fully resolve your symptoms, it doesn’t mean you have failed; it simply means you may need additional support or medication. Talk to your bipolar care team about what might help next.
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Problems With Your Brain’s Waste-Removal System May Play a Role in Bipolar Suicide Risk
Known as the brain’s waste-removal system, the glymphatic system is key to brain health. When it fails to properly clear out toxic proteins and metabolic debris, your brain and central nervous system don’t work at their best. Poor glymphatic functioning has been linked with headache disorders, sleep disorders, stroke, Alzheimer’s disease, mood disorders, and more, per Cleveland Clinic.
Researchers in China recently shared a study in the Journal of Affective Disorders exploring if glymphatic glitches could play a role in suicide attempts among people with bipolar disorder, and whether there was any connection to personality patterns.
To answer this question, the researchers used brain scans and psychological tests to compare three groups: 37 people with bipolar who had recently attempted suicide, 35 people with bipolar who had never attempted suicide, and 35 volunteers without a psychiatric diagnosis.
People with bipolar disorder who had attempted suicide showed two key differences:
- Impaired brain waste clearance: Their glymphatic system wasn’t working as efficiently. Waste fluid was building up in their brain tissue rather than being properly cleared.
- Distinct personality patterns: They scored higher on personality traits related to depression, health anxiety, and scattered thinking.
Importantly, these two factors appeared to work together: The combination of poor waste clearance and certain personality traits (like impulsiveness and low empathy) fueled stronger suicidal thoughts.
What This Means for You
- The glymphatic system might play a role in some bipolar symptoms. These findings suggest that some people with bipolar disorder — particularly those with a history of suicide attempts and certain personality patterns — may have impaired brain “waste clearance.” While many factors drive symptoms, recognizing glymphatic dysfunction as a possible contributor could point to new treatment approaches beyond what’s available now.
- Sleep might help. While this study didn’t specifically examine sleep, other research suggests that the glymphatic system does most of its cleaning work during sleep and that sleep disturbances are linked to glymphatic dysfunction. While bipolar disorder can make getting good sleep difficult, doing what you can to prioritize healthy sleep is one concrete way you can support your brain’s waste-removal system and overall mental health.
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Bipolar Disorder and Schizophrenia Share Most of Their Genetic Risk, Major Study Finds
If you’re diagnosed with a mental health condition, there’s a good chance you’ll receive a second or third diagnosis at some point. What if that was because there was something beneath the surface that connected them?
An international team of scientists used cutting-edge statistics to analyze DNA from over one million people with 14 common psychiatric conditions to understand the genetic factors they share and what makes each unique.
The study, recently published in Nature, suggests that these disorders fall into five groups, each with a common genetic foundation.
One group — dubbed the SB factor — included bipolar disorder and schizophrenia. About 60 percent of bipolar disorder’s genetic risk comes from the SB factor. This means that bipolar disorder and schizophrenia overlap genetically more with each other than either does with conditions like depression or autism. In both bipolar disorder and schizophrenia, genes affecting excitatory neurons (brain cells that help transmit signals) are particularly active.
What This Means for You
- Your experience of multiple diagnoses makes biological sense. Having more than one psychiatric diagnosis is especially common in bipolar disorder. This research suggests that shared genetic pathways may help explain why. You’re likely experiencing how overlapping biology can express itself in different ways.
- Future treatment might focus on shared causes. Current treatments often address each diagnosis separately. Future approaches might target shared biological pathways directly, potentially simplifying and improving treatment effectiveness.
- Diagnostic labels are imperfect. Seeing a diagnosis like bipolar disorder on your medical chart can make the label feel like an indisputable fact. But the current diagnostic system is just one human-made method for talking about the real mental health symptoms you’re experiencing. This doesn’t mean your current diagnosis is wrong or unimportant. This research introduces shared genetics as another lens for understanding conditions, though it’s too soon to change diagnostic practices. In the future, as brain science advances, classifications may shift toward biology-based approaches.
Editorial Sources and Fact-Checking
- Weiden PJ et al. Obesity as a Risk Factor for Antipsychotic Noncompliance. Schizophrenia Research. January 1, 2004.
- Daggolu J et al. Effect of Concurrent Metformin on Adherence to and Persistence of Treatment With Second-Generation Antipsychotics in Nondiabetic Patients. Journal of Clinical Psychiatry. Nov 17, 2025.
- Metformin (Oral Route). Mayo Clinic. January 1, 2026.
- Yu O et al. Metformin Co-Commencement at Time of Antipsychotic Initiation for Attenuation of Weight Gain: A Systemic Review and Meta-Analysis. Therapeutic Advances in Psychopharmacology. May 30, 2024.
- Bailey BC et al. Effects of Interpersonal and Social Rhythm Therapy on Suicidal Ideation in Adults With Bipolar 2 Depression. Journal of Clinical Psychiatry. September 29, 2025.
- Glymphatic System. Cleveland Clinic. October 3, 2025.
- Chen C et al. Associations of Glymphatic System Dysfunction and Personality Traits Alterations in Bipolar Depression with Suicidal Attempt. Journal of Affective Disorders. April 15, 2026.
- Yun Jung B et al. Altered Brain Glymphatic Flow at Diffusion-Tensory MRI in Rapid Eye Movement Sleep Behavior Disorder. Radiology. June 2023.
- Grotzinger AD et al. Mapping the Genetic Landscape Across 14 Psychiatric Disorders. Nature. December 10, 2025.