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The most efficacious studies resulted when metformin was used in higher doses in conjunction with marked lifestyle and behavioral therapy in children classified as severely obese and when other indications for the use of metformin were present
Presence of other medical conditions: Conditions like liver disease or kidney failure can increase bleeding risk
A1C (if diabetic), fasting lipids, liver enzymes, and TSH every 36 months are common
Pharmacological Support SSRIs for co-occurring depression: Selective serotonin reuptake inhibitors such as sertraline and fluoxetine address the serotonin depletion-related depression that follows MDMA use, though their clinical benefit for MDMA use disorder itself has not been demonstrated in controlled trials
