Metformin for weight loss and metabolic control in overweight outpatients with schizophrenia and schizoaffective disorder

L. Fredrik Jarskog, Robert M. Hamer, Diane J. Catellier, Dawn D. Stewart, Lisa LaVange, Neepa Ray, Lauren H. Golden, Jeffrey A. Lieberman, T. Scott Stroup, Lawrence Adler, Glen Burnie, Michael Barber, Matthew Byerly, Jose M. Canive, Ira Glick, David C. Henderson, J. Steven Lamberti, Ahsan Khan, Joseph Patrick McEvoy, Herbert MeltzerAlexander Miller, Del D. Miller, Henry A. Nasrallah, Stephen Olson, Jayendra K. Patel, Bruce L. Saltz

Research output: Contribution to journalArticle

82 Scopus citations

Abstract

Objective: The purpose of this study was to determine whether metformin promotes weight loss in overweight outpatients with chronic schizophrenia or schizoaffective disorder. Method: In a double-blind study, 148 clinically stable, overweight (body mass index [BMI] ≥27) outpatients with chronic schizophrenia or schizoaffective disorder were randomly assigned to receive 16 weeks of metformin or placebo. Metformin was titrated up to 1,000 mg twice daily, as tolerated. All patients continued to receive their prestudy medications, and all received weekly diet and exercise counseling. The primary outcome measure was change in body weight from baseline to week 16. Results: Fifty-eight (77.3%) patients who received metformin and 58 (81.7%) who received placebo completed 16 weeks of treatment. Mean change in body weight was 23.0 kg (95% CI=24.0 to 22.0) for the metformin group and 21.0 kg (95% CI= 22.0 to 0.0) for the placebo group, with a between-group difference of 22.0 kg (95% CI=23.4 to 20.6). Metformin also demonstrated a significant between-group advantage for BMI (20.7; 95% CI=21.1 to 20.2), triglyceride level (220.2 mg/dL; 95% CI=239.2 to 21.3), and hemoglobin A1c level (20.07%; 95% CI=20.14 to 20.004). Metformin-associated side effects were mostly gastrointestinal and generally transient, and they rarely led to treatment discontinuation. Conclusions: Metformin was modestly effective in reducing weight and other risk factors for cardiovascular disease in clinically stable, overweight outpatients with chronic schizophrenia or schizoaffective disorder over 16 weeks. A significant timeby- treatment interaction suggests that benefits of metformin may continue to accrue with longer treatment. Metforminmay have an important role in diminishing the adverse consequences of obesity and metabolic impairments in patients with schizophrenia.

Original languageEnglish (US)
Pages (from-to)1032-1040
Number of pages9
JournalAmerican Journal of Psychiatry
Volume170
Issue number9
DOIs
StatePublished - Sep 1 2013

ASJC Scopus subject areas

  • Psychiatry and Mental health

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    Jarskog, L. F., Hamer, R. M., Catellier, D. J., Stewart, D. D., LaVange, L., Ray, N., Golden, L. H., Lieberman, J. A., Stroup, T. S., Adler, L., Burnie, G., Barber, M., Byerly, M., Canive, J. M., Glick, I., Henderson, D. C., Lamberti, J. S., Khan, A., McEvoy, J. P., ... Saltz, B. L. (2013). Metformin for weight loss and metabolic control in overweight outpatients with schizophrenia and schizoaffective disorder. American Journal of Psychiatry, 170(9), 1032-1040. https://doi.org/10.1176/appi.ajp.2013.12010127