Managing Weight Gain in Mental Health Treatment

Antipsychotic Medications are used to treat severe Mental Health issues, like schizophrenia and bipolar disorder. These medicines help manage symptoms such as hallucinations, delusions, and mood swings. Among these medications, second-generation antipsychotics (SGAs) are popular. In the UK, four SGAs — olanzapine, quetiapine, risperidone, and aripiprazole — are the most commonly prescribed. These medications make up a huge 79% of all prescriptions in primary care settings for patients with severe mental illness.

#Side Effects of Antipsychotic Medications

While SGAs can be effective in treating mental health conditions, they can also cause some unwanted side effects. One of the most common issues is Weight Gain. This is especially true for olanzapine, quetiapine, and risperidone. Even aripiprazole, which is known to have a lower risk of weight gain, can still cause some individuals to pack on the pounds.

For many patients, starting SGAs can lead to significant weight gain in the early years, especially during the first three years after starting the medication. About 80% of patients experiencing their first episode of psychosis can gain a noticeable amount of weight, which can lead to more serious health issues like heart disease, diabetes, and other metabolic conditions. Furthermore, weight gain can have a negative impact on mental health, often leading to stress and even causing people to stop taking their medication.

#Non-Drug Approaches to Managing Weight Gain

To tackle the weight gain linked to antipsychotic medications, various non-drug strategies can be helpful for some patients. These include cognitive behavioral therapies, exercise, and dietary changes. However, these approaches do not work for everyone. Research shows that many studies looking at these non-drug methods have struggled with high dropout rates, reflecting the difficulty in keeping patients engaged.

One medication that has gained attention for its potential benefits is Metformin. This medicine is typically used to manage blood sugar levels in patients with diabetes and polycystic ovarian syndrome (PCOS). Studies have indicated that metformin might help in managing antipsychotic-induced weight gain (AIWG) effectively and performs better than some other options.

In the UK, guidelines from the British Association for Psychopharmacology recommend considering metformin alongside antipsychotic treatment to help control weight gain and reduce the risk of diabetes. Despite these recommendations and positive research findings, it remains unclear how widely metformin is actually used for managing weight gain associated with antipsychotic medications in primary care settings.

#Study Goals and Objectives

In an effort to better understand how metformin is prescribed alongside second-generation antipsychotics, a study was conducted focusing on patients diagnosed with severe mental illness. The study aimed to provide insights into a range of areas, including:

1. The number of patients who were co-prescribed metformin when they began treatment with SGAs.
2. Differences in demographic and clinical factors among patients who received both medications.
3. Changes in weight over two years for those treated with both metformin and SGAs versus those on SGAs alone.

#Study Design and Data Collection

This research was observational, looking at a group of patients over time. It examined the prescribing patterns of SGAs and metformin in UK primary care between 2005 and 2019. Researchers used data from the Clinical Practice Research Datalink, which holds a wealth of medical records from millions of patients.

The focus was on patients freshly prescribed one of the four main SGAs within the study period. To qualify, patients had to meet certain criteria, like having a recorded diagnosis of a severe mental illness and being registered at a primary care practice for at least six months. Patients with previous prescriptions for SGAs or other types of antipsychotics were excluded from the study.

#Data Management and Analysis

To identify the prescriptions being filled, researchers set up a strategy to search for relevant product codes in the data. They collected various demographic information, including the patients' age, sex, ethnicity, and health conditions. They also looked at baseline characteristics like weight and any other medications the patients might be on.

For patients with missing data, researchers used a method called multiple imputation to fill in the gaps, aiming to ensure that the analysis was as accurate and complete as possible.

#Understanding Metformin Co-Prescriptions

Among the 26,537 patients who began treatment with SGAs, only a small portion (about 4,652) were ever prescribed metformin. Of those, just over 600 started metformin around the same time as their SGA prescription.

The study found that the cumulative incidence of starting metformin within one year was just 1.9%. By two years, this number had increased slightly to 3.3%. On a broader scale, the prevalence of metformin prescriptions rose from 13.1 per 1,000 patients in 2005 to 58.4 in 2017, indicating a growing awareness but still showing that many patients were not benefiting from this potential treatment.

#Comparing Patients with and without Metformin

When comparing the two groups, researchers found some intriguing differences. The group that did not take metformin had a higher proportion of white individuals compared to the metformin group. Additionally, those on metformin tended to come from more deprived backgrounds and had higher rates of obesity and other health issues.

The mean baseline weight was also significantly higher for those taking both medications, highlighting that these patients were generally struggling more with weight-related issues even before starting treatment.

#Changes in Body Weight Over Time

The study looked at changes in weight over two years for patients on SGAs with and without metformin. Interestingly, those on metformin did not experience weight gain like their counterparts who were only on SGAs. Instead, patients taking metformin maintained or even slightly reduced their weight over a two-year period.

For the SGA-only group, average weight increased by over 4%, while those co-prescribed metformin showed nearly no change in weight. This suggests that metformin may help mitigate some of the weight gain associated with SGAs.

Even with this positive indication, researchers noted that the differences in weight between the two groups were not always huge. After adjusting for other factors, the weight reduction associated with metformin was modest but still promising.

#Why Metformin Is Underutilized

Despite the evident benefits, many patients still aren't being co-prescribed metformin. Several reasons may explain this underutilization. For one, prescribers may be worried about metformin's side effects, which can include stomach troubles and potential vitamin B12 deficiency.

Additionally, many mental health patients may not be the most reliable in keeping up with required doctors' visits for monitoring kidney function or other necessary checks, leading to hesitancy in prescribing metformin. The lack of explicit mention of weight gain as an indication for metformin in standard prescribing guides might also be a barrier, as clinicians may feel uncertain about using it for this purpose.

#Implications for Mental Health Care

The findings of this study emphasize the need for better collaboration between primary care physicians and mental health professionals. If healthcare providers can work together, they may improve awareness regarding metformin's potential benefits, address the barriers to its use, and ultimately help patients manage their weight more effectively.

Future research should be aimed at understanding how metformin can be integrated into regular clinical practice for patients with severe mental illness, especially those facing weight gain challenges linked to antipsychotic medications.

#Conclusion

In the quest to improve treatment for severe mental health conditions, it is crucial to address weight gain linked to medication. While SGAs can be life-changing for many, the side effects can often overshadow the benefits. Metformin stands out as a potentially helpful alternative for managing weight gain associated with these medications.

However, the current reality shows a significant gap in the actual prescription of metformin for weight management in psychiatric care. Transforming these promising findings into real-world practice means overcoming barriers, increasing awareness among prescribers, and fostering better communication across healthcare providers.

The importance of implementing these findings can't be overstated. By actively managing metformin prescriptions, healthcare professionals can help patients not just with their mental health but also with their overall well-being. Keeping an eye on weight is not just a numbers game but a vital part of ensuring longer and healthier lives for those battling severe mental illness.

And who wouldn't want to say goodbye to those extra pounds for good?