Metformin for Treatment of Antipsychotic-Induced Amenorrhea and Weight Gain in Women With First-Episode Schizophrenia: A Double-Blind, Randomized, Placebo-Controlled Study
Objective: Data on the treatment of antipsychotic-induced amenorrhea, particularly when occurring with weight gain, are limited. The authors investigated the efficacy and safety of metformin in the treatment of antipsychotic-induced amenorrhea and weight gain in women with first-episode schizophrenia.
Method: Eighty-four women (ages 18–40 years) with first-episode schizophrenia who suffered from amenorrhea during antipsychotic treatment were randomly assigned, in a double-blind study design, to receive 1000 mg/day of metformin or placebo in addition to their antipsychotic treatment for 6 months. The primary outcome measures were restoration of menstruation and change in body weight and body mass index (BMI). Secondary outcome measures were changes in levels of prolactin, luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol, and testosterone; in fasting levels of insulin and glucose; in LH/FSH ratio; and in insulin resistance index. Repeated mixed models with repeated-measures regression analyses and binary logistic regression were used in the analysis.
Results: A total of 76 patients completed the 6-month trial. Significantly more patients in the metformin group (N=28, 66.7%) than in placebo group (N=2, 4.8%) resumed their menstruation. Among patients treated with metformin, BMI decreased by a mean of 0.93 and the insulin resistance index by 2.04. In contrast, patients who received placebo had a mean increase in BMI of 0.85. The prolactin, LH, and testosterone levels and LH/FSH ratio decreased significantly in the metformin group at months 2, 4, and 6, but these levels did not change in the placebo group.
Conclusions: Metformin was effective in reversing antipsychotic-induced adverse events, including restoration of menstruation, promotion of weight loss, and improvement in insulin resistance in female patients with schizophrenia.
Dr. Reinhardt’s comments:
Metformin is an oral antidiabetic drug in the biguanide class. It is the first-line drug of choice for the treatment of type 2 diabetes, optimally in overweight and obese people and those with normal kidney function and for prediabetes treatment. Metformin is the only antidiabetic drug that has been conclusively shown to prevent the cardiovascular complications of diabetes. It helps reduce LDL cholesterol and triglyceride levels, and is not associated with weight gain. When prescribed appropriately, metformin causes few adverse effects (the most common is gastrointestinal upset) and is associated with a low risk of hypoglycemia.
Metformin was first synthesized in the 1920’s as the active component found in Galega officinalis, commonly known as goat’s rue, French lilac, Italian fitch or professor-weed. Galega officinalis has been known since the Middle Ages for relieving the symptoms of diabetes mellitus. It is still used as a tea preparation to normalize blood sugar.
With the exception of Metformin, nearly all diabetes medications have adverse effects on the liver, and seem to worsen diabetes over time. Liver inflammation is seen by many to be the root cause of most cases of diabetes, with inappropriate release of glucagons raising blood sugar, possibly as a result of infections (particularly viral), allergies and hypersensitivities, and exposure to environmental pollutants and synthetic food additives. It offers a logical explanation of why blood sugar may be high after 12 hours of fasting.
Natural treatments for blood sugar dysregulation have been successfully used for many centuries, and many have been extensively studied. Traditional Chinese and Ayurvedic Medicine rely on ginsengs (particularly Panax ginseng), Momordica charantia (Bitter Melon) and Coptis chinensis (Goldenthread). Western naturopathy also contributes treatments of magnesium, co-enzyme Q10, alpha-lipoic acid, prickly pear cactus, agaricus mushroom, banaba, gymnema and cinnamon. Fiber, including soy, guam gum, oat bran and blond psyllium has been shown to slow absorption of glucose. For a more detailed discussion please see http://tinyurl.com/CHS-Diabetes