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Efficacy of metformin for prevention of weight gain in psychiatric populations: a review

Newall, Hannaha; Myles, Nicholasa; Ward, Philip B.b; Samaras, Katherinec,d; Shiers, Davidf; Curtis, Jackieb,e

International Clinical Psychopharmacology: March 2012 - Volume 27 - Issue 2 - p 69–75
doi: 10.1097/YIC.0b013e32834d0a5b

There is uncertainty with regard to the appropriate use of metformin for the prevention and management of second-generation antipsychotic-induced weight gain and metabolic abnormalities. We aim to systematically review the primary literature and to provide recommendations with regard to the use of metformin in psychiatric populations prescribed second-generation antipsychotics. The authors undertook a literature search of Medline, EMBASE, and PsycINFO using the search terms; antipsychotic OR atypical antipsychotic AND weight AND metformin. Narrative review was undertaken without additional statistical analysis. The search provided 198 results from which 10 original research papers were identified: six randomized controlled trials and one open-label study for adults and two randomized controlled trials and one open-label study for children and adolescents. Four meta-analyses were also identified. We concluded that if weight gain occurs after second-generation antipsychotic initiation, despite lifestyle intervention, metformin should be considered. Further studies with adequate statistical power are required to determine the efficacy of metformin in those with chronic psychotic illness.

aFaculty of Medicine

bSchool of Psychiatry, University of New South Wales

cDepartment of Endocrinology, St Vincent’s Hospital

dDiabetes and Obesity Program Garvan Institute of Medical Research

eEarly Psychosis Programme, Eastern Suburbs Mental Health Programme, Sydney, Australia

fGP (retired) North Staffordshire and former joint lead on National Early Intervention in Psychosis Programme, UK

Correspondence Dr Jackie Curtis, MBBS, 26 Llandaff St, Bondi Junction, NSW 2022, Australia Tel: +44 612 9366 8611; fax: +44 612 9387 1070; e-mail:

Received June 6, 2011

Accepted September 12, 2011

© 2012 Lippincott Williams & Wilkins, Inc.