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Metformin reversed weight gain from certain antipsychotic drugs
Diabetes drug may be a feasible alternative in the battle against antipsychotic drug-induced weight gain.
Patients who take antipsychotic medications can turn to lifestyle intervention and metformin, a potential combination to fight weight gain.
The link between antipsychotic medications and weight gain is well known, and there is growing concern that use of these medications may also be related to potentially serious adverse metabolic effects, such as hyperlipidemia and glucose intolerance.
“To maintain a balanced weight is often challenging, but especially so for patients with schizophrenia due to their poor diet, sedentary lifestyle and long-time need for antipsychotic medication,” researchers in Hunan, China and San Diego wrote in the Journal of the American Medical Association.
Based on their findings, the researchers recommended lifestyle intervention plus metformin as the go-to therapy for patients taking antipsychotic medications.
The researchers conducted a randomized controlled trial of 128 patients with schizophrenia treated at the Mental Health Institute of the Second Xiangya Hospital, Central South University, in China. Patients taking atypical antipsychotic therapy who gained more than 10% of their predrug weight were randomly assigned to four treatment groups: metformin 750 mg per day, metformin 750 mg per day plus lifestyle intervention, lifestyle intervention alone, or placebo. All patients continued their antipsychotic treatment.
“In this 12-week study, we found statistically significant decreases in mean weight, BMI, waist circumference, insulin and insulin resistance index among patients in the lifestyle plus metformin, metformin alone and lifestyle plus placebo groups, but not among those in the placebo alone group whose measurements continued to increase,” the researchers wrote.
Metformin alone was superior to lifestyle intervention alone. Thus, the researchers recommended metformin alone if the patient poorly adheres to metformin plus lifestyle intervention. During the study, all patients with schizophrenia maintained relatively stable psychiatric improvement. – by Katie Kalvaitis
Efficacy of lifestyle intervention and metformin alone (n=128) |
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For more information:
- Wu RR, Zhao JP, Jin H, et al. Lifestyle intervention and metformin for treatment of antipsychotic-induced weight gain. JAMA. 2008;299:185-193.
Metformin is not approved in this country as a weight loss drug or as a diabetes prevention drug. Weight gain on atypical antipsychotic agents is a recognized problem in the area of psychiatry and this concern has been recognized by the FDA with a black box warning. This study is important because the findings show success in preventive measures with the weight gain in a severely mentally ill population that was in the past looked on as being refractory to these kinds of therapy because their severe mental illness. The findings also confirm the importance of obtaining baseline monitoring of schizophrenic patients including height, weight, BMI, blood pressure, glucose and lipids with frequent monitoring of weight early in therapy to find patients who are at high risk. Family history of diabetes is also important. These recommendations were confirmed by consensus conference recommendations published in both Diabetes Care and The Journal of Clinical Psychiatry in early 2004. This conference was jointly sponsored by the American Diabetes Association, American Psychological Association, American Association of Clinical Endocrinologists and North American Association for the Study of Obesity. The results are limited by the small sample size and the short duration. The results, however, are encouraging in terms of minimizing the effect on weight gain by the second generation antipsychotic agents. Data from previous studies have shown good results with lifestyle medication. Once again, we have to be somewhat concerned by the small number of patients and the short 12-week duration of the study by Wu, et al. It is encouraging that patients with schizophrenia can follow such programs with good results.
– Philip Levy, MD
Endocrine Today Editorial Board member