Adjunctive berberine for schizophrenia with metabolic syndrome: a systematic review and meta-analysis

Antipsychotic-induced metabolic syndrome complicates the clinical management of schizophrenia. This investigation seeks to examine berberine's efficacy and safety as adjunctive therapy in schizophrenia patients with metabolic syndrome.

A thorough literature search was executed across international (PubMed, Cochrane Library, EMBASE) and Chinese (China National Knowledge Infrastructure, WanFang Data) databases to retrieve randomized controlled trials (RCTs) examining adjunctive berberine for schizophrenia with metabolic syndrome. Data extraction and synthesis were conducted by three independent reviewers employing RevMan 5.3 software.

Three eligible RCTs (n = 233) were incorporated. Adjunctive berberine demonstrated superior efficacy over controls in reducing body weight (standardized mean difference (SMD) = -0.56, I² = 0%; P = 0.0003), body mass index (SMD = -0.51, I² = 0%; P = 0.0001), waist circumference (SMD = -0.31, I² = 20%; P = 0.04), total cholesterol (mean difference (MD) = -0.43, I² = 63%; P = 0.004), triglycerides (MD = -0.31, I² = 0%; P < 0.0001), and fasting plasma glucose (MD = -0.30, I² = 0%; P = 0.005). No significant differences existed in low density lipoprotein cholesterol (MD = -0.27, I² = 75%; P = 0.1), high density lipoprotein cholesterol (MD = -0.02, I² = 31%; P = 0.56), glycated hemoglobin (MD = -0.22, I² = 67%; P = 0.21), systolic blood pressure (MD = -1.62, I² = 0%; P = 0.17), or diastolic blood pressure (MD = -1.68, I² = 39%; P = 0.15).

This systematic review provides preliminary evidence supporting adjunctive berberine as a promising intervention for improving certain metabolic parameters in schizophrenia patients with metabolic syndrome. Larger, high-quality RCTs are needed to confirm these observations.