Efficacy and tolerability of nutraceuticals and phytotherapics for antipsychotic-induced weight gain in schizophrenia spectrum disorders: Systematic review and meta-analysis
In brief
Omega-3s, probiotics and Liuyu decoction each lower antipsychotic weight
In a meta-analysis of 21 trials (1,426 patients), omega-3 fatty acids, probiotic-fiber combos, and the Chinese Liuyu decoction produced modest weight loss compared with placebo, while alpha-lipoic acid consistently lowered triglycerides and berberine reduced systolic blood pressure. Discontinuation rates were similar, but frequent bias and single-study findings limit broad recommendations.
- Journal
- Pharmacopsychiatry (Q1)
- Published
- 13 July 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Antonio Di Francesco, Antonio Munafò, Gaetano Catania, Sofia Francesca Aprile, Salvatore Canonico, Carmen Concerto, et al.
- PMID
- 42442701
- DOI
- 10.1055/a-2869-0635
Why clinicians should know about it
- Picked for Complementary and Alternative Medicine (top studies of the week, 19 July 2026): SR/MA of nutraceuticals for antipsychotic weight gain
Abstract
Antipsychotic drugs frequently cause metabolic complications in people with schizophrenia spectrum disorders, increasing cardiovascular morbidity and contributing to premature mortality; nutraceutical and phytotherapeutic agents may offer accessible adjunctive strategies, but their efficacy in this setting remains uncertain. We conducted a systematic review and meta-analysis (PROSPERO: CRD42024616494) of randomized controlled trials comparing nutraceuticals/phytotherapics with placebo in adults (18-65 years) with schizophrenia spectrum disorders receiving antipsychotics, including interventions lasting at least 4 weeks. Primary outcomes were body weight change and all-cause treatment discontinuation; secondary outcomes included lipid profile, glucose homeostasis, blood pressure, and anthropometric measures. Two independent reviewers extracted data and assessed study quality using the Cochrane Risk of Bias 2 tool, and meta-analyses primarily used random-effects models. Twenty-one trials (1,426 participants) evaluating 16 interventions were included. Omega-3 fatty acids, probiotics combined with dietary fibers, and Liuyu decoction were each associated with reduced body weight versus placebo, while alpha-lipoic acid showed consistent triglyceride reductions across two independent trials and berberine reduced systolic blood pressure. Discontinuation rates did not differ between groups, but risk of bias was frequently substantial, mainly due to blinding limitations and missing data handling. Overall, alpha-lipoic acid for hypertriglyceridemia and berberine for hypertension have the most consistent multi-trial support, whereas single-trial findings for omega-3s, probiotic combinations, and traditional Chinese medicine preparations require replication; heterogeneity and methodological weaknesses currently preclude broad clinical recommendations, though selected nutraceuticals may be considered for specific metabolic targets.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.