Antipsychotic Drug-induced Weight Gain Stopped With Metformin
Antipsychotic drugs are a standard and important treatment for people who have schizophrenia - but the side effects of weight gain and diabetes are something that a significant portion of people also suffer from. Recently, in a new study published in the American Journal of Psychiatry, David Klein from Cincinnati Children's Hospital tested a well-established (over 20 years on the market) drug that diabetics use to counteract the high blood glucose levels and weight gain called Metformin.
In the four month study done in the US, Dr. Klein found that kids on antipsychotic medications gained an average of nearly nine pounds. But those who also took Metformin lost a little weight.
In a news story CBS13.com reported:
Bethany did especially well dropping 15-pounds during the study and later another ten. "It worked miracles, my self esteem went up, my body looked slimmer and I was happier," said Twine.
"If we tackle this problem we'll be able to keep people on these very important drugs," said Dr. Klein.
Metformin can cause side effects like nausea - but overall it's been shown to be safe and effective for dozens of years that it has been available. Metformin is used by millions of diabetics each day in the US - so its a well established and effective drug. It might also reduce the incidence of diabetes - and in mice studies it has been shown to extend their lives (due to more effective blood glucose/insulin level maintenence). Moreover, its off-patent, which means it is very inexpensive compared to drugs that are still "on patent".
We recommend you print out this information and take it to your doctor, if you (or someone you know) are taking anti-psychotic medications.
Klein et al. (p. 2072) compared metformin and placebo in 39 children and adolescents ages 10-17 who had gained at least 10% of their pretreatment weight while taking olanzapine, risperidone, or quetiapine. Metformin halted weight gain and decreased measures of insulin resistance. Over 4 months, the patients taking placebo gained an additional 4.0 kg on average, while weight was stable in the metformin group. However, the metformin group had a decrease in weight relative to height, as measured by body mass index, because the study was conducted in growing children. No serious side effects occurred. Since the substantial weight gain produced by second-generation antipsychotics can decrease compliance with treatment, metformin also has the potential to increase compliance and improve outcome.
Dr. Kenneth Towbin discusses the importance of this study in an editorial here: Gaining: Pediatric Patients and Use of Atypical Antipsychotics
The study was published in the American Journal of Psychiatry.
More Information on Metformin:
NOTE: There are two other recent studies focusing on Metformin use for weight prevention in young people using anti-psychotic medications. One small study done in 2002 suggested "Of the 19 patients, 15 lost weight, three gained 1.6 kg or less, and one had no change. The mean changes in weight and body mass index at 12 weeks were highly significant. CONCLUSIONS: Metformin merits further study as a treatment for weight gain in patients taking psychotropic medications.".
In March, 2006 there was a similar study with that lacked success in preventing weight gain published in Canada back (Metformin for prevention of weight gain and insulin resistance with olanzapine: a double-blind placebo-controlled trial.). The article concluded "Metformin did not prevent olanzapine-induced bodily weight gain. While some lipid parameters worsened during placebo, the HOMA-IR improved in both the placebo and the metformin groups". We have not reviewed the actual journal articles - so we recommend you have your doctor assess the viability of this avenue as a possible means to prevent weight gain.
Wikipedia on Metformin
Diabetes Prevention Program
Metformin information (National Institute of Health)
Past Research Studies on Metformin and Antipsychotics:
Gaining: Pediatric Patients and Use of Atypical Antipsychotics
Metformin for weight loss in pediatric patients taking psychotropic drugs.
Metformin for prevention of weight gain and insulin resistance with olanzapine: a double-blind placebo-controlled trial. (Canadian Journal of Psychiatry)
Posted by szadmin at December 2, 2006 09:23 AM
More Information on Schizophrenia Med Side-effects
This is very promising and good to hear. The weight gain is definitely a factor in why I prefer not to take the medications, and would be very good news for people who have already been on the meds for some time and would like to undo the weight gain.
Posted by: Cory Schulz at December 2, 2006 11:34 PM
That's great for preventing diabetes, but what about movement disorders like tardive dyskinesia? Once people get that sort of side effect, they are usually cruelly shunned by the rest of humanity. What good is extending one's life if no one will even look at you? And if one stays on antipsychotics long enough at the dosages typically used in the USA, a person probably will get those things, because the risk is cumulative.
Posted by: Anonymous at December 5, 2006 07:48 AM
This is true. One time I tried taking Abilify (0.8mg) for 4 days, and then my hands started to make jerky movements, so I stopped taking it, and then they got even worse. I was really scared, but after 2 weeks it slowly went away. Now I'm afraid of taking any type of anti-psychotic, as my body seems to be very sensitive to them.
It is a frustrating situation.
Posted by: Cory Schulz at December 5, 2006 09:05 AM
tardive dyskenesia is very rare these days, but other movement disorders, like the hand tremble described above, can still be found. the hand tremble is called "EPS" (for extrapyramidal, the nerves it involves) it's less in people using the newer medicines and less since the super high doses of state hospitals and the like are less common.
Extrapyramidal side effects are fortunately, just annoying, and not dangerous. However, they can be very annoying and irritating. i recall taking a writing class with a lady who was in her 60's (long history of high doses of typical meds) and had to be careful with her coffee cup on our break, or it would slosh over and i was concerned she could burn her hand. we all took half cups and went along with her in hopes that she wouldn't be embarrassed, but it can be quite annoying.
Related side effects, such as akathisia (a restless feeling in the legs, i have experienced from asthma medications) can be a minor irritation or it can be very, very unplesant and severe.
EPS should be controlled by managing doses, using side effect medications, or switching to another antipsychotic. as much as many people like abilify, it has a different action from other drugs similar to it, instead of blocking dopamine, it 'weakly enables' it, a subtle difference, but i've found that some ppeople, depending on what conventional ('typical') meds they've had and what doses, can find their nerves have a hard time adjusting to abilify after other meds. fortunately not many people experience that problem with abilify, and it seems less of an issue for people starting out with abilify as their first med. if a person does get it, it's the dr's job to adjust dose or change meds and deal with it.
Posted by: slc2 at December 8, 2006 08:37 AM
Cogentin ia a very effective medication to treat all the symptoms you guys have described. i had tardive dyskinisia as well as restlessness at times ( ive been on antipsychotics for ten years now)and now have no symtoms at all.
Posted by: rachel at December 20, 2006 06:22 PM
This article talks about children, does anyone know if this info carries over into adults? Will adults experience the same benefits of metformin as growing children?
Posted by: Todd at March 15, 2007 08:37 AM
Posted by: Elizabeth at September 25, 2007 08:51 AM
We carried out a study at a Boston psychiatric hospital several years ago with patients who gained weight on first and second generation antipsychotic drugs to see if nutritional counseling and an active exercise program would reverse weight gain. Both interventions were effective as was finding ways to get many of the house bound patients to engage in recreational and volunteer activities so eating is not their only recreation.
Posted by: Judy Wurtman at October 10, 2007 10:39 AM