Can early drug intervention prevent weight gain in children with mental illness?

A University of Houston pharmacological researcher believes that prescribing the drug Metformin for children and teens as soon as they are diagnosed with mental illnesses, like bipolar disorder and schizophrenia, may save them from gaining an enormous amount of weight. In up to 80% of cases, the use of atypical/second generation antipsychotic (SGA) drugs – tranquilizers – causes antipsychotic-induced weight gain (AIWG) with children gaining up to 120 pounds in a single year.

“Our prior work found that most of the AIWG in children and adolescents happened during the first three months of SGA treatment, and SGA discontinuation only reversed a quarter of the weight patient gained during the treatment within one year of SGA cessation,” said Hua Chen, professor of pharmaceutical health outcomes and policy. Chen’s new project, financed by a $455,000 grant from the National Institutes of Health, zeroes in on that beginning stage, and she will examine the effectiveness of Metformin given early.

Not only can childhood onset obesity carry a greater risk for type 2 diabetes and cardiovascular diseases than adult onset, that much weight gain typically causes children and teens to stop taking their medicine.

“Children and teens who cannot accept such side effects stop taking their medicine and that causes tremendous consequences since these medicines are meant to be taken for years, sometimes even for the patient’s lifetime. We have seen many cases where the discontinuation of the needed medicine leads to a patient becoming hospitalized due to a suicidal attempt or other mental health crisis,” said Chen.

Metformin, the typical frontline medication for diabetes, is the most extensively studied adjuvant intervention for the management of AIWG in adults. In children and adolescents, the data are consistent but much more limited. Hua will examine the beneficial effect of metformin in real-world SGA recipients. Using a large national electronic medical record database, Chen will identify children and adolescents aged 6 to 19 years who were treated with Metformin during the first 24 months of SGA treatment.

“We believe receiving it earlier will be more beneficial and help them manage the weight. Prevention will prove more effective because we found that most patients are not able to lose the weight they gained once they discontinue the medicine,” said Chen, who adds that conventional weight loss therapies like exercise and journaling have proven to have no effect on youngsters with mental illnesses.

Chen will also identify patient subgroups following certain weight development trajectories, who are most likely to benefit from the use of Metformin, and from its early intervention.

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