Editor’s note: If you or someone you know is experiencing suicidal thoughts or struggling with mental health issues, please call the 988 Suicide and Crisis Lifeline by dialing 988 to connect with a trained counsellor or visit the 988 Lifeline website.
CNN
—
Is it possible that common drugs used to alter the body can also affect mood?
That has raised questions after some users of the weight-loss drugs semaglutide and tirzepatide injections, sold as Wegobee and Zepbound, reported increased anxiety, depression and suicidal thoughts, leading to an evaluation by the U.S. Food and Drug Administration this year.
Semaglutide and tirzepatide are both glucagon-like peptide-1 receptor agonists, or GLP-1 agonists. Semaglutide and tirzepatide were originally prescribed to treat type 2 diabetes (Ozempic and Maunjaro), but have become increasingly popular as weight loss medications.
The report, published Sept. 3 in JAMA Internal Medicine, found “no clinically meaningful differences” in mental health scores between people who used semaglutide and those who didn’t, according to lead author Thomas Wadden, PhD, an obesity treatment researcher and professor of psychiatry and psychology at the University of Pennsylvania’s Perelman School of Medicine. The FDA study also has not yet found evidence of an increased risk of suicidal thoughts.
But the interaction between drugs and mental health is complex, with many factors at play, said Dr. Davide Arillotta, a medical resident in the department of neuroscience, psychology, drug research and child health at the University of Florence in Italy, who was not involved in the September study.
If you notice that your mood is being affected while using a GLP-1 medication, it may be because:
Arillotta said that use of GLP-1 drugs may reduce symptoms of anxiety and depression for some people.
GLP-1 receptors are present in the pancreas, the intestine and several areas of the brain involved in regulating mood, he said.
“These may affect the release and activity of neurotransmitters such as dopamine and serotonin, which play important roles in emotional well-being,” Arillotta added. “For these reasons, GLP-1 RAs are thought to have antidepressant effects.”Dopamine and serotonin are mood-enhancing chemicals and are often referred to as the “feel good” hormones.
The researchers also suggest that because the causes of type 2 diabetes and depression may overlap, GLP-1 drugs that improve diabetes markers may also improve mental health outcomes, said Peter Ueda, M.D., assistant professor and resident of endocrinology at the Karolinska Institutet and Diabetes Center in Stockholm, Sweden, who was not involved in Wadden’s study but was an investigator on another study of GLP-1 drugs and suicide risk, also published September 3 in JAMA Internal Medicine.
If you feel depressed while taking a GLP-1 medication, it may be due to what and how much you eat and drink.
Dr Amira Girgis, professor of pharmacy and MPharm programme director at Swansea University in Wales, said the drugs improve glycemic control – the body’s ability to keep blood sugar levels from getting too high.
But changes in blood sugar can affect your mood.
“Extremely high blood sugar levels can affect mood,” says Tara Schmidt, lead dietitian at the online weight-loss program Mayo Clinic Diet. “For example, someone who is hypoglycemic, or has low blood sugar, may feel irritable or anxious. It’s also thought that frequent highs and lows in blood sugar in relation to food intake can contribute to negative moods.”
Schmidt and Guirgis were not involved in Wadden’s research, but Guirgis and Arillotta have previously published research on GLP-1 drugs and mental health in collaboration with Giuseppe Floresta, PhD, assistant professor in the Department of Pharmacy and Health Sciences at the University of Catania in Italy, and Fabrizio Schifano, PhD, professor of Clinical Pharmacology and Therapeutics at the University of Hertfordshire in the UK.
In addition to altering blood sugar control, these drugs can also suppress hunger — and not feeling hungry and therefore not getting enough nutrition can have negative effects on health and well-being, Wadden said.
“Nutrition deficiencies can be a contributing factor to feeling depressed,” Schmidt said in an email. “This may most affect people taking GLP-1 who are not meeting their caloric or nutrient needs due to side effects or simply not feeling hungry.”
Many people hope that changing the shape and shape of their body will make them feel happier, more connected and more confident, but sometimes they find that making social and lifestyle changes can be difficult.
While medicated weight loss can boost some people’s self-confidence, for others the “sudden change” can worsen symptoms of body dysmorphic disorder and “lead to increased anxiety, depression and suicidal thoughts,” Guirgis said in an email.
According to the American Psychological Association, body dysmorphic disorder, or BDD, is a condition “characterized by excessive preoccupation with perceived defects in one’s physical appearance or markedly excessive concern about minor physical abnormalities.”
And compliments aren’t always clearly positive, she says.
“The social approval that is often achieved after weight loss creates pressure to maintain the new body shape, which may reinforce harmful habits such as restrictive dieting, excessive exercise, and continued abuse of weight-loss drugs,” Girgius added.
Wadden said that whether consciously or not, the relationship with food and weight may have been protective, especially for people who have experienced trauma or abuse.
“You may want to lose weight and feel like you’re getting healthier, but suddenly start feeling anxious,” he added.
The rapid weight loss that often accompanies taking GLP-1 drugs, and the accompanying social and lifestyle changes, may also require changes in other aspects of life, such as coping mechanisms and relationships, Wadden says. And that can be tough.
Before you lost weight, your relationships with your partner, family and friends may have been a comfortable status quo, he says.
“Now you’ve lost it,” Wadden added.
“There’s no clear research to suggest that taking GLP-1 puts people with no history of psychiatric illness at greater risk, but it makes life tough,” Wadden said.
“At any given time, someone is going through a stressful time,” Wadden said, referring to his September study. “Maybe they’re grieving the loss of a loved one, maybe they’ve lost a job, maybe they’re experiencing depression, and that seems to be experienced the same way by people taking the drug and by people taking a placebo.”
Weight-loss drugs reduce hunger, so taking an intentional approach to meeting caloric, nutrient and hydration needs may help, Schmidt said.
“You have to treat it like a schedule,” she says. “If you have breakfast by 9 a.m. and haven’t eaten anything in four hours, eat something else.”
Blood sugar levels fluctuate throughout the day, but to keep them within a healthy range, Schmidt recommends “eating a balanced diet, avoiding ultra-processed foods and drinks that are high in sugar, and eating regular meals.”
Wadden said regular exercise and getting enough sleep can also help reduce the potential negative effects of the medication.
Ueda said it’s important for people with problems such as severe depression or suicidal thoughts to pay careful attention to mood changes when starting any medication, including GLP-1 drugs.
People should also talk to their doctor about any history of serious mental illness, such as depression, bipolar disorder or post-traumatic stress disorder, before taking any medication, Wadden added.
But even people without such a history should work closely with their medical team, he says, and tell your doctor any changes in your mood, no matter how subtle they may seem.
“Don’t do it alone,” Wadden says. “Social media can be a great source of support and wisdom, but sometimes you need to consult with a medical professional.”
Get inspired by our weekly roundup of tips for living simply. Subscribe to CNN’s Life, But Better newsletter for information and tools to improve your health.
