The majority of people who experience a first episode of psychosis will gain a significant amount of weight in the first number of months. This weight gain is a side-effect of antipsychotic medications, which are the first-line treatment for the disorder. This is a distressing side effect for many people, which can impact their long-term health. As this weight gain occurs rapidly and occurs at the time that an individual has received a new diagnosis of a psychotic disorder, it can be challenging to prevent this weight gain with lifestyle interventions alone, such as diet and exercise, in such a short space of time.
Metformin is a medication that has been used to manage type 2 diabetes for over sixty years and there is evidence that this medication can be effective in managing weight gain from antipsychotic medication, However, metformin is more effective at preventing antipsychotic induced weight gain and therefore, it can be started at the same time as an antipsychotic medication or after early indicators of weight gain.
An international team of researchers, led by Irish researchers from UCD, RSCI and St John of God Hospital have developed a guideline for using Metformin to prevent weight gain caused by antipsychotics. Despite having been studied for decades, clear recommendations for how and when to start metformin to prevent weight gain caused by antipsychotics were lacking. The guideline seeks to address this gap and support clinicians and people living with psychosis to use metformin safely and effectively. The guideline, published in Schizophrenia Bulletin, is summarised in a one-page algorithm containing three core recommendations and key prescribing information.
The project is part of the PROGRESS research group, which is led by Prof Brian O’Donoghue from UCD School of Medicine. The Health Research Board has funded this project to develop national guidelines for the treatment of psychosis. The team comprises of psychiatrists, endocrinologists, general practitioners, pharmacists, people with lived experience of psychosis and experts from Australia, Canada, the UK and Germany.
Mr. Michael Norton, the lead PPI representative with the PROGRESS research said the following about the guideline: "Within the recovery journey of those with psychosis, it is vital that we consider physical health when prescribing antipsychotic medications. This guideline is an attempt for all clinicians to stop and think about the physical effects of these medications in the hope that with the guideline implementation, service users can be more holistically supported in their recovery journey."
Prof Donal O’Shea, National lead for Obesity with the HSE, said: '‘I am delighted to see this guideline go live. I work in the area of obesity and see the role that medication plays in driving weight gain. We understand obesity so much better now and realise that prevention of weight gain is absolutely critical. These guidelines will ensure early identification of those at most risk of worsening obesity with their anti-psychotic medication - and ensure metformin is introduced early to try and mitigate the risk.''
The article has been published as open access and is available via this link.