In this video, we explore the rising use of GLP-1 drugs like Ozempic and Wegovy, which were initially developed for managing conditions such as type 2 diabetes. These medications have now gained widespread attention for their use in weight loss. We discuss the potential benefits, concerns, and side effects, including the latest research on their possible effects on mental health and the risk of suicide.
Transcript:
Introduction
GLP-1 weight loss drugs like Ozempic and Wegovy have taken the medical world by storm being used for weight loss in patients for whom there’s an FDA indication. And for many who don’t have an approved indication. And they’re used because they work, right? Let’s be honest, they work incredibly well for weight loss, but could they also increase the risk for suicidal thoughts and suicide attempts? That’s obviously a critical question to answer, and a new study suggests that semaglutide the generic name for Wegovy and Ozempic might increase the risk for individuals who are also taking antidepressants. It’s not strong data, but is it enough of a concern?
Let’s get into the details. Welcome to Metabolic Mind, a nonprofit initiative Baszucki Group, transforming the study and treatment of mental disorders by exploring the connection between metabolism and brain health. Thank you for joining us on this journey. Now before we get started, this video is about the risk of suicidal thoughts and attempts. So if this is triggering for you, please take care watching this video. Also, please remember our channel is for informational purposes only. We’re not providing individual or group medical or healthcare advice or establishing a provider patient relationship. Many of the interventions we discuss can have potentially dangerous effects of done without proper supervision. Consult your healthcare provider before changing your lifestyle or medications. In addition, please recognize that people may respond differently to ketosis and there isn’t one universal response.
Does Ozempic Impact Mental Health? What the Data Shows
So we did a video last year when the European Medicines Agency, the EMA, reviewed the risk of suicidal thoughts and attempts with these GLP-1 weight loss drugs. There wasn’t much data at the time, but there were enough reports, enough of a signal to warrant an investigation. And remember the original trials that helped semaglutide get approval for weight loss excluded anyone with a psychiatric diagnosis or a history of suicidal thought. So there isn’t much data at all on this topic. But it’s clearly a moving target as GLP-1s have been used for, you know, a decade or more in low doses for type two diabetes. But over the past two years, they’re being used in much higher doses in over 20 million people for weight loss with or without type two diabetes. And here’s what makes this subject so difficult. There are published case reports as well as clinical and individual experience suggesting that GLP-1s may help with depression or may help with overall mental health. And there are reports of the opposite. So which is it? Does it help or does it hurt? Well, I mean, there’s likely the potential for both. So the question is how do we know who’s at risk for worsening depression and suicidality with these medications?
New Study: Increased Risk of Suicidality with Semaglutide
Well, a new study examined post-marketing data from the World Health Organization and ran what’s called a disproportionality analysis, which is essentially a method to see if an adverse effect is more likely when someone’s taking a specific medication. And what they found is, frankly, pretty concerning. I mean, they found an increased risk for suicidality for those taking semaglutide, Wegovy and Ozempic, but not liraglutide, interestingly which is the name for Victoza and Saxenda which are the lower doses versions of GLP-1s just for type two diabetes. But importantly, the findings were more likely for those taking antidepressants. Now, statistically, you know, the increased risk is so small it’s a small risk in an absolute sense, and a study like this doesn’t prove causation, but obviously the magnitude of the risk from the behavior, suicide, is monumental. So something to be taken very seriously.
Should People with Depression or on Antidepressants Avoid Semaglutide?
And this is likely just the beginning of all this data coming in. So many more studies will undoubtedly follow, but it raises the question, what should we, you know, the royal we, individuals and healthcare practitioners, what do we do with this information now? Should people with a history of depression or people taking antidepressants just completely avoid GLP-1s? Or is there a safer, but still effective alternative to explore in these individuals? So I mean, these are challenging questions when it comes to medicine. There’s a widely popular drug with a potential benefit, but it also has sort of this ill-defined potential for severe harm. So in situations like this, I mean, I like to fall back on the medical oath. First, do no harm. I mean, that’s vitally important here. And when you think about first do no harm, you think about alternatives. So I would suggest that alternatives exist.
Alternatives to Ozempic and Semaglutide
Ketogenic therapy could be considered a safe and effective alternative for treating overweight and obesity in someone with depression. You can look at studies from Virta Health and others which have demonstrated dramatic and sustainable weight loss, metabolic health improvements and mood benefits with ketogenic therapy. And other studies like from Dr. Sethi and others have demonstrated safety and efficacy in mixed psychiatric populations, including depression and bipolar disorder and schizophrenia. Now, unfortunately, we do live in a sort of this drug first medical society where the quick fix is often felt to be the best choice. But given the concerns with GLP-1 medications in patients with depression, the quick fix can also be the quick harm. And it’s a prime example of how doing the work with lifestyle changes, entering and sustaining the physiologic state of ketosis and working with an experienced healthcare provider may not be the quickest path, but it may be the safest and most effective path.
Conclusion
But let us know what you think. Should we be using GLP-1s in this setting? Should there be a black box warning? We’d love to hear your thoughts. And as always, thank you for watching. If this was helpful, please like and subscribe and please share our content with others who may benefit from it. I’m Dr. Bret Scher, and we’ll see you here next time at Metabolic Mind, a nonprofit initiative of Baszucki Group.
