Metformin: A Promising Tool for Controlling Weight Gain in Young Bipolar Disorder Patients

A recent research indicates that metformin aids in preventing weight gain in young people receiving treatment for bipolar disorder with SGAs. Out of 1,565 involved in the study, metformin was found effective in managing weight, notwithstanding its minimal effect on metabolic syndrome.

The researchers from the University of Cincinnati and Northwell Health reported that metformin is effective in preventing weight gain among youth under treatment for bipolar disorder using SGAs, based on a study that included over 1,500 participants.

A comprehensive study carried out by researchers at the University of Cincinnati and Northwell Health, a well-known healthcare provider in New York, showed that the drug metformin can assist in preventing or reducing weight gain in young individuals taking medicine to treat bipolar disorder.

The results were introduced to the public during a symposium at the American Academy of Child and Adolescent Psychiatry conference in New York City last year.

Drugs such as the second-generation antipsychotics (SGAs), which are prescribed for bipolar disorder often have a significant impact on the improving mental health of young individuals but often lead to side effects such as an increase in blood pressure and glucose, a surge in appetite and weight gain.

Victor Fornari, MD, a child/adolescent psychiatrist at Northwell Health, stated that patients have stopped taking the medication as they refuse to gain weight, despite the significant improvements in their psychosis.

UC's Christina Klein, PhD, added that more than non-adherence to medication, the side effect of weight gain can lead to harmful health outcomes in the future.

Klein pointed out that a patient's physical health is as crucial as their mental health. A survey conducted revealed that patients sought immediate intervention concerning side effects, whereas doctors and caregivers were inclined towards a ‘wait and watch’ approach.

Metformin, a medicine generally prescribed for Type 2 diabetes, which is known to prevent weight gain, was initially not favored by most psychiatrists, thus giving rise to the study testing the effect of metformin.

The MOBILITY study was conducted to determine the effectiveness of metformin in preventing or reducing weight gain in young patients receiving treatment for bipolar disorder.

Klein added that the study was of a pragmatic design, making it open to patients from all types of clinics, not just those with previous research participation.

The study included 1,565 patients aged 8-19 with bipolar disorder taking SGAs, a significant feat as per Fornari.

All participants received lifestyle intervention promoting healthy diet and exercise. Half of the participants were also prescribed metformin.

Jeffrey Welge, PhD, observes that a healthy lifestyle plays a significant role in achieving good outcomes; however, in some cases, metformin provides an additional boost.

If patients were faced with issues due to metformin, they were allowed to withdraw from the medication but stay in the study. The study, lasting over two years, aimed to study the changes happening to patients in their environment.

Prior to implementing the interventions, researchers collected data on the quality of life and medication adherence in young patients living with bipolar disorders.

Although 87% of the young respondents reported consistent medication use, a majority of them reported dissatisfaction with their weight and expressed feelings of sadness, anger, or frustration about their weight.

Researchers also gathered baseline metabolic data to determine the prevalence of metabolic syndrome, a common side effect of taking SGAs, that makes the youth prone to diabetes and cardiovascular diseases. Claudine Higdon, MD, from Northwell mentioned that 33% of the youth involved in the study were found with metabolic syndrome at the onset.

“The key elements of metabolic syndrome are obesity, high blood pressure, elevated triglycerides, and elevated glucose,” said Higdon, a child/adolescent psychiatrist. “It is important that clinicians monitor for metabolic syndrome when treating youth with second-generation antipsychotics.”

The youth in the study received a lifestyle intervention with recommendations for eating a low glycemic index diet and exercise, with half additionally being prescribed metformin.

UC’s Jeffrey Welge, PhD, said in the short-term six-month follow-up data, metformin had a modest but significant effect at preventing and in some cases reversing weight gain in the study’s patient population. The drug was also found to be safe, with some gastrointestinal distress symptoms being the only side effects reported.

“It’s not a drug you take and weight falls off of you, but it tends to reduce that out of control appetite which we think then makes it easier for patients to adhere to a healthy diet and as they lose some weight maybe also make it easier for them to engage in more exercise,” said Welge, professor in UC’s Department of Psychiatry and Behavioral Neuroscience and Department of Environmental and Public Health Sciences. “So, the lifestyle is really what’s driving good outcomes, but metformin is in some cases putting the wind at their back to help with that.”

“It’s safe, effective and very inexpensive. It’s an intervention that has the potential to have widespread applicability,” Fornari added. “It’s not a medicine that you need to have an endocrinologist or a pediatrician prescribe, and I think it really speaks to the fact that the psychiatrist needs to be caring for the entire person, the physical and the mental health of the patient.”

While having an effect on weight gain, metformin was not found to have a significant effect on youth’s metabolic syndrome in the short term, Welge said.

“Further research is needed on effective interventions for metabolic syndrome,” Higdon said.

The study received funding from the Patient-Centered Outcomes Research Institute (PCORI), and included patient and caregiver advocate input throughout.

“We really could not have done it without the support of youth living with bipolar disorders and their caregivers, and their continued recommendations on how to keep the trial patient-centered throughout the study,” Klein said.

Most research studies take about 15-17 years from being published to being widely applied in clinics across the country, so PCORI has additionally supported the research team with a dissemination grant so the knowledge can be spread more quickly.

Klein said the team will conduct focus groups with youth living with bipolar disorders, as well as their caregivers and clinicians, to see how they want information to be presented to them.

UC’s Melissa DelBello, MD, served as the trial’s principal investigator.