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Countering Weight Gain from Psychiatric Drugs

In observance of Mental Illness Awareness Week October 6 to 12, learn how Kaiser Permanente researchers and clinicians are collaborating to solve real-world behavioral health dilemmas. Pictured, DOR investigators (from left) Catherine Schaefer, Derek Satre, Hannah Jang, Stacy Sterling, Constance Weisner, Nicola Klein, Kelly Young-Wolff, Paola Gilsanz, Ousseny Zerbo, Andrew Avins, Helene Choquet, and Michael Silverberg.

People with serious mental illness are already dealing with distressing and life-altering symptoms, so it’s a real problem when their psychiatric medications cause them to gain weight. That’s counterproductive for psychiatrists hoping to ease their patients’ conditions, not throw new obstacles in their paths.

When Kaiser Permanente psychiatrists in Oakland heard there might be a supplemental medication that could counter weight gain in these patients, they were eager to give it a try, and reached out to their colleagues in the Kaiser Permanente Division of Research (DOR) for answers.

Esti Iturralde, PhD, a new mental health research scientist at DOR, took on the request to explore the use of metformin, a diabetes drug, to reduce the metabolic havoc caused by psychiatric drugs such as quetiapine and risperidone. This use of metformin has appeared in the scientific literature for several years but is not yet common practice. “There is strong evidence psychiatrists should try it, as the risks appear low and the potential benefits significant,” Iturralde said.

Iturralde and colleagues pursued research questions that could lay the groundwork for a potential change in practice. They documented whether metformin was being used for psychiatric patients at risk of metabolic disease and interviewed Kaiser Permanente psychiatrists about their familiarity with combining metformin with antipsychotic medications. The group received funding for the research, which is under way.

Behavioral health researcher Stacy Sterling, DrPH, MSW, MPH, said the division’s investigators welcome the chance to address problems their clinical colleagues wrestle with. “We have a great working relationship that benefits both clinicians and researchers, as well as Kaiser Permanente members, and we are expanding our portfolio of mental health-focused research significantly,” Sterling said.

DOR’s behavioral health section, led by Constance Weisner, DrPH, MSW, includes 10 investigators and recently expanded with the addition of Iturralde and new adjunct investigator Matt Hirschtritt, MD, and Kathryn Ridout, MD, a new member of the Division of Research’s Physician Researcher Program.

“Our section continues to grow with the addition of talented new researchers who extend our reach into important areas of behavioral health investigation,” said Weisner, who is a professor emeritus in the Department of Psychiatry at the University of California, San Francisco. The university and DOR share investigators who have trained and practiced at both institutions.

The DOR investigators provided key support when Kaiser Permanente Northern California established a new psychiatric residency program in Oakland, assisting with accreditation and offering training to residents. This includes teaching skills in evaluating scientific literature, obtaining small grants, and developing community benefit grant work to answer questions important to the residents.

Elsewhere in Kaiser Permanente Northern California, DOR’s researchers work closely with primary care clinicians to support the integration of behavioral health practitioners into primary care settings throughout the region. Behavioral health teams are also embedded in emergency care.

Kaiser Permanente’s commitment to embedding behavioral health care in medical settings in turn gives researchers fodder for investigation of this new direction in health care delivery. “You want to look at the whole person,” noted Sterling. “How to do that brings up a lot of good research questions.”


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