PsychRounds: The Psychiatry Podcast Metformin: Use in Psychiatry and New Guidelines
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Apr 16, 2025 The discussion focuses on metformin's application in psychiatry, particularly in combating weight gain from antipsychotic medications. Recent guidelines emphasize careful monitoring for side effects, like gastrointestinal issues and lactic acidosis. The podcast dives into dosing strategies and the findings from recent studies, highlighting individual patient factors in treatment decisions. Seasonal weight trends and their impact on mental health are also examined, along with metformin's intriguing potential benefits for psychiatric symptoms.
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Metformin’s Psychiatric Role
- Metformin is commonly prescribed by psychiatrists mainly to counteract antipsychotic-induced weight gain.
- This highlights its significant role beyond diabetes management in psychiatry.
Metformin’s Mechanism of Action
- Metformin reduces glucose production and increases insulin sensitivity primarily via mitochondrial complex 1 inhibition and AMP-activated protein kinase activation.
- These mechanisms underpin its utility in type 2 diabetes and weight management.
Metformin Dosing Tips
- Start metformin at 500 mg daily, increase by 500 mg weekly as tolerated to a max of about 2,500 mg per day.
- Extended release forms may reduce gastrointestinal side effects though immediate release is more common due to cost.