If you're wondering if GLP-1s could be impacting your emotions, specialists suggest these potential elements might be involved.
Some individuals using semaglutide and tirzepatide injections, marketed as Wegovy and Mounjaro for weight loss, have been raising concerns about increased feelings of anxiety, depression, and suicidal thoughts. This has led to an examination by the US Food and Drug Administration this year.
Both semaglutide and tirzepatide fall under the category of GLP-1 receptor agonists or GLP-1 agonists. Originally used to manage type 2 diabetes (like Ozempic and Mounjaro), these medications are gaining popularity for weight loss purposes.
A study published on September 3 in the journal JAMA Internal Medicine revealed no significant differences in mental health scores between users of semaglutide and non-users, according to the study's lead author Dr. Thomas Wadden, an expert in obesity treatment and professor of psychology in psychiatry at the Perelman School of Medicine at the University of Pennsylvania. The FDA investigation, however, has not discovered any evidence indicating an increased risk of suicidal thoughts.
The relationship between these medications and mental health is intricate, with multiple factors involved, emphasized Dr. Davide Arillotta, a resident doctor in the department of neurosciences, psychology, drug research, and child health at the University of Florence in Italy. Arillotta was not associated with the September study.
If you observe a change in your mood during GLP-1 medication use, several possibilities could be in play.
Antidepressant effects
GLP-1 medications might alleviate some anxiety or depressive symptoms for some individuals, as per Dr. Arillotta. GLP-1 receptors exist in various parts of the brain, the gut, and the pancreas, which are all involved in mood regulation. These receptors can influence the release and activity of neurotransmitters like dopamine and serotonin, which are vital to emotional well-being. Consequently, GLP-1 receptor agonists (RAs) are believed to have antidepressant effects. Dopamine and serotonin are well-known for boosting mood and are often referred to as the "feel-good" hormones.
Researchers suggest that since type 2 diabetes and depression sometimes share underlying causes, GLP-1 drugs potentially effective in managing diabetes symptoms might also improve mental health outcomes, according to Dr. Peter Ueda, assistant professor and resident physician in endocrinology at the Karolinska Institutet and Centre for Diabetes in Stockholm, Sweden. Ueda was not connected to Wadden's study but co-authored a September study on GLP-1 drugs and their association with suicidality risk.
Blood sugar
Feelings of mood swings while using GLP-1 medications could be due to food and drink intake, suggested Dr. Amira Guirguis, professor of pharmacy and MPharm program director at Swansea University in Wales.
These medications aid in regulating blood sugar, which can have an impact on mood. Extreme fluctuations in blood sugar can negatively affect mood, and individuals with low blood sugar (hypoglycemia) may experience irritability or anxiousness. Frequent highs and lows related to food consumption might also trigger negative moods, as suggested by Tara Schmidt, lead dietitian at the Mayo Clinic Diet.
Schmidt and Guirguis were not associated with Wadden's study, but Guirguis and Arillotta have previously researched the topic of GLP-1 medications and mental health with Dr. Giuseppe Floresta, assistant professor in the department of drug and health sciences at the University of Catania in Italy, and Dr. Fabrizio Schifano, a professor of clinical pharmacology and therapeutics at the University of Hertfordshire in the United Kingdom.
In addition to modifying blood sugar control, these medications can reduce hunger levels. If hunger suppression results in missing essential nutrients, it could negatively impact health and well-being, Wadden explained.
“Being undernourished can contribute to low mood,” Schmidt stated. “This is likely to affect someone on a GLP-1 who is not meeting their calorie and nutrient needs due to side effects or lack of hunger.”
Disrupted routine
Many individuals anticipate improved happiness, increased connection, and heightened confidence following body size or shape changes, but they may realize that the accompanying lifestyle changes are challenging.
While medication-assisted weight loss can boost confidence for some people, it can worsen symptoms of body dysmorphic disorder in others, resulting in increased anxiety, depression, and suicidal thoughts, according to Dr. Amira Guirguis, professor of pharmacy and MPharm program director at Swansea University in Wales.
Body dysmorphic disorder, or body dysmorphia, is characterized by excessive preoccupation with an imagined or minor defect in appearance, as defined by the American Psychological Association.
Compliments following weight loss are not always uplifting, Wadden pointed out.
“Societal approval that often follows weight loss can create pressure to maintain the new body size, potentially encouraging harmful practices like restrictive dieting, excessive exercise, or prolonged use of weight-loss medications,” Guirguis explained.
Unconsciously or consciously, food and weight may serve as protective factors for some individuals, particularly those who have encountered trauma or abuse, Wadden stated.
Despite your desire to shed pounds and feeling healthier, there might come a point where you feel exposed or vulnerable, as pointed out.
The fast and significant weight loss that frequently accompanies GLP-1 medications might necessitate adjustments in other aspects of your life, such as your coping mechanisms or relationships, according to Wadden. And this shift can be overwhelming.
Prior to losing weight, your relationship dynamics with your partner, family, and friends might have been comfortable and steady, Wadden stated.
"Now you’ve lost it," Wadden added.
No concrete evidence supporting the claim that GLP-1 medication increases anxiety in individuals without a pre-existing mental health concern has been found, Wadden stated. Life is full of challenges, he said.
"At any given moment, someone is experiencing stress," Wadden said. "They might be dealing with the loss of a loved one, they could have lost their job, or people may develop depression. However, this appears to be equally prevalent among those on the drugs versus those taking a placebo, as evidenced by my September study," Wadden stated, referring to the study.
Safeguarding Your Emotional State
As a weight-loss medication reduces your hunger, it might be beneficial to adopt a planned approach to fulfilling your calorie, nutrient, and hydration needs, Schmidt suggested.
"Treat this like a schedule," she said. "I'll have something for breakfast by 9 a.m., and four hours later, if I haven't had anything, I'll have something else."
Your blood sugar levels will fluctuate throughout the day, but to keep them within a healthy range, Schmidt recommends "consuming well-balanced meals, avoiding high-sugar ultra-processed foods and beverages, and eating meals at regular intervals."
Regular exercise and ensuring adequate sleep can also shield you from potential negative effects of the medications, Wadden stated.
For individuals dealing with severe depression and suicidal ideation, it's crucial to closely monitor mood changes when starting any medication, including GLP-1 drugs, according to Ueda.
Prior to beginning the medications, those with a history of major depressive disorder, bipolar disorder, or post-traumatic stress disorder should share this information with their doctor, Wadden added.
Even individuals without such a history should maintain regular communication with their healthcare team, Wadden said. Mention any mood changes to your practitioner, regardless of how slight they may seem.
"Don't go it alone," Wadden said. "Social media can be a valuable source of support and wisdom, but it's also important to regularly consult with healthcare professionals."
The FDA investigation has not discovered any evidence suggesting an increased risk of suicidal thoughts due to the use of GLP-1 medications for weight loss. GLP-1 medications, like GLP-1 receptor agonists, might alleviate some anxiety or depressive symptoms for some individuals due to their influence on neurotransmitters like dopamine and serotonin.
