Does the gut microbiome mediate antipsychotic-induced metabolic side effects in schizophrenia?

Second-generation antipsychotics (SGAs) are the most effective treatment for people with schizophrenia. Despite their effectiveness in treating psychotic symptoms, they have been linked to metabolic, cardiovascular and gastrointestinal side-effects. The gut microbiome has been implicated in potentiating symptoms of schizophrenia, response to treatment, and medication-induced side effects and thus presents a novel target mediating second-generation antipsychotic-induced side effects in patients. This narrative review presents evidence from clinical and preclinical studies exploring the relationship between the gut microbiome, schizophrenia, second-generation antipsychotics, and antipsychotic-induced side-effects. It also covers evidence for psychobiotic treatment as a potential supplementary therapy for people with schizophrenia. The gut microbiome has the potential to mediate antipsychotic-induced side-effects in people with schizophrenia. Microbiome-focused treatments should be considered in combination with standard therapy in order to ameliorate debilitating drug-induced side effects, increase quality of life, and potentially improve psychotic symptoms. Future studies should aim to collect not only microbiome data but also metabolomic measures, dietary information, and behavioral data.