Glucophage (brand name for metformin) is primarily an anti-diabetic medication, but in psychiatry, it has gained significant secondary use due to its metabolic benefits—especially in counteracting antipsychotic-induced weight gain and metabolic syndrome.
Here’s a clear overview:
🧠 Uses of
Metformin (Glucophage)
in Psychiatry
1.
Treatment of Antipsychotic-Induced Weight Gain
- Most common and evidence-based use in psychiatry.
- Particularly useful for patients taking:
- Olanzapine, Clozapine, Quetiapine, or Risperidone
- These drugs often cause:
- Weight gain
- Insulin resistance
- Dyslipidemia
- Metabolic syndrome
📊 Evidence:
- Multiple RCTs show metformin leads to modest but significant weight loss (~2–4 kg on average).
- Reduces waist circumference, fasting glucose, and insulin levels.
- Works even prophylactically if started early in antipsychotic treatment.
2.
Adjunct in Clozapine-Resistant Schizophrenia (for metabolic control)
- Clozapine is highly effective for treatment-resistant schizophrenia but causes extreme metabolic issues.
- Metformin is often co-prescribed to manage:
- Hyperglycemia
- Weight gain
- Type 2 diabetes risk
3.
Polycystic Ovary Syndrome (PCOS) in Women with Mood Disorders
- Metformin is used in women with PCOS, which is often comorbid with depression, bipolar disorder, and eating disorders.
- It helps regulate:
- Insulin sensitivity
- Menstrual cycles
- Mood fluctuations related to hormonal imbalances
4.
Potential Cognitive Benefits?
- Some early studies suggest metformin may enhance cognitive function in patients with:
- Schizophrenia
- Bipolar disorder
- Late-life depression
- Likely mediated by insulin signaling, neuroinflammation, and oxidative stress reduction
- However, more research is needed before it’s used as a cognitive enhancer in psychiatry.
5.
Adjunctive Role in Mood Disorders and Atypical Depression (Experimental)
- Atypical depression often involves weight gain, carbohydrate craving, and lethargy.
- In theory, metformin might help manage metabolic dysregulation, indirectly aiding mood stability.
- Some small studies and anecdotal reports suggest benefit, but this is not standard practice.
⚠️ Clinical Caveats
|
Consideration |
Note |
|
Tolerability |
GI side effects common at initiation (nausea, diarrhea) |
|
Vitamin B12 deficiency |
Long-term use can reduce B12; periodic monitoring recommended |
|
Renal function |
Needs dose adjustment or avoidance in impaired kidney function |
|
Not a primary psychiatric treatment |
Always used as an adjunct, not a standalone psychiatric drug |
✅ Summary Table
|
Psychiatric Context |
Use of Metformin |
|
Antipsychotic-induced weight gain |
Strong evidence |
|
Clozapine metabolic management |
Common adjunct |
|
PCOS with mood symptoms |
Endocrine-psychiatric interface |
|
Cognitive enhancement |
Experimental |
|
Atypical depression/metabolic subtype |
Theoretical/early studies |
Would you like a comparison between metformin and GLP-1 receptor agonists (like semaglutide) for metabolic management in psychiatry? Or the pros and cons of starting metformin early in first-episode psychosis?
