Between these two, metformin is our first-line preference as it helps not only with antipsychotic-related weight gain but also with the metabolic side effects of antipsychotics (insulin resistance, fasting glucose, triglycerides, and hyperprolactinemia), earning it a recommendation from the APA for this purpose
2020;doi:10.1161/CIRCULATIONAHA.120.047965), consistent with the results of this study
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However, this comes with a massive caveat that we can't stress enough: there are no large-scale, peer-reviewed human clinical trials published as of 2026 that specifically study the safety and efficacy of this exact combination