GLP-1 Receptor Agonists and Psychiatric Issues: Two Cases of Depression and Suicidal Ideation Linked to Semaglutide

New Jersey, United States United States of America
42-year-old female patient with history of mental health disorders developed behavioral disruptions and attempted self-strangulation after starting semaglutide
72-year-old male patient experienced manic behavior after starting semaglutide for type 2 diabetes treatment
Approximately 60 documented cases of suicidal ideation and 7 suicide attempts reported since 2018
Further research needed to identify specific proteins and enzymes implicated in exacerbating psychological conditions and inducing suicidal ideation
Semaglutide acts on brain stem, lateral septum, and hypothalamus, modulating food intake and reward with GLP-1 receptor stimulation promoting dopaminergic neuron activity
Two cases of depression and suicidal ideation linked to semaglutide reported at APA annual meeting
GLP-1 Receptor Agonists and Psychiatric Issues: Two Cases of Depression and Suicidal Ideation Linked to Semaglutide

In recent studies, a potential link has emerged between the use of GLP-1 receptor agonists like semaglutide and an increased risk of psychiatric issues such as depression and suicidal ideation. This connection was highlighted in several presentations at the American Psychiatric Association (APA) annual meeting.

One case involved a 42-year-old female patient who had a history of bipolar I disorder, post-traumatic stress disorder (PTSD), morbid obesity, and type 2 diabetes. She was started on semaglutide for weight loss but just three weeks into the treatment developed behavioral disruptions, protracted nihilistic delusion, and attempted to self-strangulate. Her symptoms reversed after stopping the medication.

Another case reported a male patient, age 72, who experienced manic behavior after starting semaglutide for type 2 diabetes treatment. His symptoms included goal-directed activities and an almost nihilistic delusion that neighbors were dead.

These cases raised concerns among clinicians about the potential link between GLP-1 receptor agonists and psychiatric issues. Semaglutide acts on the brain stem, lateral septum, and hypothalamus, modulating food intake and reward with GLP-1 receptor stimulation promoting dopaminergic neuron activity at the ventral tegmental area and increased expression of dopamine transporters on neuronal cell surfaces.

Approximately 60 documented cases of suicidal ideation and 7 suicide attempts have been reported in studies since 2018. Many patients reported significant improvement in depression after discontinuing the medication, suggesting that semaglutide may induce depression which could lead to suicidal ideation.

Three semaglutide products are currently approved by the FDA: Wegovy injection for weight loss, Ozempic injection and Rybelsus tablets for reducing blood sugar in adult patients with type 2 diabetes, and Ozempic to reduce the risk of cardiovascular issues in patients with type 2 diabetes and known heart disease.

Further research is needed to identify specific proteins and enzymes implicated in exacerbating current psychological conditions and inducing suicidal ideation.


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Confidence

85%

Doubts
  • Are the reported cases statistically significant enough to establish a causal link between semaglutide and psychiatric issues?
  • Could other factors, such as pre-existing mental health conditions or concomitant medications, have contributed to the observed symptoms?

Sources

83%

The overall score is a weighted number that takes into account conflict of interest, bias, deception and other practices that undermine the credibility of the source. It is calculated as:
(Site Conflicts Of Interest + Author Conflicts Of Interest) / 2.0 * 0.2 + ArticleBiasScore * 0.20 + UniquePointsScore * 0.05 + DeceptionScore * 0.20 + ReadabilityScore * 0.05 + FallacyScore * 0.20

A score that takes into consideration the content for flow, interruptions with ads, and overt search engine optimization techniques that makes the content hard to understand

GLP-1RAs Linked to Higher Rates of Antidepressant Dispensing

Endocrinology Advisor Lisa Kuhns, Wednesday, 08 May 2024 13:35
  • Unique Points
    • Study published in Diabetes, Obesity, and Metabolism links GLP-1RAs to increased dispensing of antidepressants.
    • Previous studies suggest a link between GLP-1RA therapy and increased depression and anxiety.
    • Among those dispensed a GLP-1RA, 8495 also received an antidepressant (aOR, 1.44; 99% CI, 1.38-1.50).
    • Case-control analyses revealed that 2.11% of individuals dispensed antidepressants in 2022 had received a GLP-1RA between 2012 and 2021 (aOR, 1.52; 99% CI, 1.46-1.59).
    • Longitudinal analyses showed an increased odds for being dispensed an antidepressant following the dispensing of a GLP-1RA (aHR, 1.19; 99% CI, 1.12-1.27).
  • Accuracy
    • Among those dispensed a GLP-1RA, 8495 also received an antidepressant (aOR, 1.44; 99% CI, 1.38-1.50).
    • Case-control analyses revealed that 2.11% of individuals dispensed antidepressants in 2022 had received a GLP-1RA between 2012 and 2021 (aOR, 1.52; 99% CI, 1.46-1.59).
    • Longitudinal analyses showed an increased odds for being dispensed an antidepressant following the dispensing of a GLP-1RA (aHR, 1.19; 99% CI, 1.12-1.27).
  • Deception (30%)
    The article does not clearly state that the study findings are conclusive, which could lead to misunderstanding about the certainty of the results. Additionally, it mentions that there are limitations to the study such as potential prescription and detection biases and confounding factors but does not elaborate on what these limitations mean for the validity of the findings. The article also implies a cause-and-effect relationship between GLP-1RAs and antidepressant dispensing without linking to peer-reviewed studies that support this claim.
    • The primary outcome was the odds of receiving an antidepressant prescription, including selective serotonin reuptake inhibitors and non-selective monoamine reuptake inhibitors.
  • Fallacies (95%)
    The article contains an appeal to authority fallacy in the form of quoting study results published in a journal without providing any context or criticism. The author does not provide any analysis or evaluation of the study findings beyond reporting them. However, no formal logical fallacies were identified in the text provided by the author.
    • ][The researchers conducted a cross-sectional, case-control, and retrospective cohort study using data from the Australian Pharmaceutical Benefits Scheme (PBS) between 2012 and 2022.][] Exposure to glucagon-like peptide-1 receptor agonists (GLP-1RAs) is associated with an increased dispensing of antidepressants, according to study results published in Diabetes, Obesity, and Metabolism.[/
  • Bias (100%)
    None Found At Time Of Publication
  • Site Conflicts Of Interest (100%)
    None Found At Time Of Publication
  • Author Conflicts Of Interest (100%)
    None Found At Time Of Publication

94%

The overall score is a weighted number that takes into account conflict of interest, bias, deception and other practices that undermine the credibility of the source. It is calculated as:
(Site Conflicts Of Interest + Author Conflicts Of Interest) / 2.0 * 0.2 + ArticleBiasScore * 0.20 + UniquePointsScore * 0.05 + DeceptionScore * 0.20 + ReadabilityScore * 0.05 + FallacyScore * 0.20

A score that takes into consideration the content for flow, interruptions with ads, and overt search engine optimization techniques that makes the content hard to understand

Designing a Semaglutide Study in Psychiatry, with Roger S. McIntyre, MD

HCPLive Kevin Kunzmann Saturday, 11 May 2024 15:39
  • Unique Points
    • GLP-1 and GIP receptor agonists like semaglutide have potential to improve both acute and long-term measures of psychiatric disease.
    • GLP-1s are shown to be antioxidant, which is therapeutically significant in the context of psychiatric disease.
    • There is some evidence supporting the hypothesis that GLP-1 dysregulation may be causative in mental illness, as patients on GLP-1 agonists for conditions like diabetes have a lower risk of depression and cognitive issues.
    • A clinical trial assessing a drug like semaglutide for a condition like depressive disorder or alcohol use disorder might include standard outcomes and also explore the potential to prevent worsening psychiatric health.
  • Accuracy
    • The incretin therapy drug classes of GLP-1 and GIP receptor agonists are proving to be a realistic pathway-targeting agent for chronic diseases, including psychiatric ones.
  • Deception (100%)
    None Found At Time Of Publication
  • Fallacies (100%)
    None Found At Time Of Publication
  • Bias (100%)
    None Found At Time Of Publication
  • Site Conflicts Of Interest (100%)
    None Found At Time Of Publication
  • Author Conflicts Of Interest (100%)
    None Found At Time Of Publication

80%

The overall score is a weighted number that takes into account conflict of interest, bias, deception and other practices that undermine the credibility of the source. It is calculated as:
(Site Conflicts Of Interest + Author Conflicts Of Interest) / 2.0 * 0.2 + ArticleBiasScore * 0.20 + UniquePointsScore * 0.05 + DeceptionScore * 0.20 + ReadabilityScore * 0.05 + FallacyScore * 0.20

A score that takes into consideration the content for flow, interruptions with ads, and overt search engine optimization techniques that makes the content hard to understand

Some Patients Suffered Psychiatric Issues After Ozempic Initiation

MedPage Today Kristen Monaco Saturday, 11 May 2024 15:40
  • Unique Points
    • A female patient, age 42, with a history of bipolar I disorder, PTSD, morbid obesity, and type 2 diabetes developed psychiatric symptoms after starting semaglutide (Ozempic) treatment.
    • The patient’s psychiatric symptoms included behavioral disruptions and suicidal ideation which reversed after stopping the medication.
    • Dr. Shahan Syed from Bergen New Bridge Medical Center in Paramus, New Jersey, reported the case at the American Psychiatric Association (APA) annual meeting and expressed concern about potential link between GLP-1 receptor agonists and suicidality.
    • Another case reported at the APA meeting involved a male patient, age 72, who developed manic behavior after starting semaglutide treatment for type 2 diabetes. His symptoms included goal-directed activities and an almost nihilistic delusion that neighbors were dead.
  • Accuracy
    • A female patient developed psychiatric symptoms after starting semaglutide treatment.
    • GLP-1 receptor agonists have potential to improve both acute and long-term measures of psychiatric disease.
  • Deception (30%)
    The author makes editorializing statements and uses emotional manipulation by describing the patients' experiences in a way that elicits sympathy and fear. She also engages in selective reporting by only mentioning cases where patients developed psychiatric symptoms after taking GLP-1 receptor agonists, while ignoring cases where no such symptoms were reported. The author does not provide any peer-reviewed studies to support her claims.
    • This particular patient escalated quickly and within 2 to 3 weeks she was having hypomanic-type symptoms: irritability, mood lability, sleep disturbances.
    • He was admitted for the thought of encephalitis because it was so acute of a change.
    • I suspect that we’re going to see much more of these sorts of cases, unfortunately, just because of how commonplace the prescribing is of these medications.
    • Even those patients who are prescribed [GLP’s] who may not have a [psychiatric] history should be evaluated once a week just to check in on their mood, their sleep, their appetite, and especially their anxiety.
  • Fallacies (85%)
    The article discusses case reports of patients who developed psychiatric symptoms after starting GLP-1 receptor agonist treatment. The author, Kristen Monaco, does not explicitly state her own opinion on the link between these medications and suicidality but reports on the FDA's and EMA's conclusions. There is no appeal to authority or inflammatory rhetoric in the article. However, it does present dichotomous depictions of GLP-1 agonists as a popular and effective treatment with potential serious psychiatric side effects.
    • This is becoming such a popular medication and it has a lot of great effects... but just last month, the EMA issued its final conclusion following a 9-month review of reports and data, clearing this popular class of agents of having a causal link with suicidal thoughts.
    • The author presents dichotomous depictions by stating that GLP-1 agonists are 'a popular and effective treatment with potential serious psychiatric side effects'.
  • Bias (100%)
    None Found At Time Of Publication
  • Site Conflicts Of Interest (100%)
    None Found At Time Of Publication
  • Author Conflicts Of Interest (100%)
    None Found At Time Of Publication

73%

The overall score is a weighted number that takes into account conflict of interest, bias, deception and other practices that undermine the credibility of the source. It is calculated as:
(Site Conflicts Of Interest + Author Conflicts Of Interest) / 2.0 * 0.2 + ArticleBiasScore * 0.20 + UniquePointsScore * 0.05 + DeceptionScore * 0.20 + ReadabilityScore * 0.05 + FallacyScore * 0.20

A score that takes into consideration the content for flow, interruptions with ads, and overt search engine optimization techniques that makes the content hard to understand

Annual Meeting: Poster Investigates the Link Between Semaglutide and Suicidal Ideation

Psychiatric Times Heidi Anne Saturday, 11 May 2024 15:42
  • Unique Points
    • A 42-year-old female patient who experienced suicidal ideation and attempted self-strangulation after taking semaglutide for weight loss.
    • Approximately 60 documented cases of suicidal ideation and 7 suicide attempts associated with semaglutide use have been reported in studies since 2018.
    • Many patients reported significant improvement in depression after discontinuing the medication, suggesting that semaglutide may induce depression which could lead to suicidal ideation.
    • Semaglutide acts on the brain stem, lateral septum, and hypothalamus, modulating food intake and reward with GLP-1 receptor stimulation promoting dopaminergic neuron activity at the ventral tegmental area and increased expression of dopamine transporters on neuronal cell surfaces.
    • Three semaglutide products are currently approved by the FDA: Wegovy injection for weight loss, Ozempic injection and Rybelsus tablets for reducing blood sugar in adult patients with type 2 diabetes, and Ozempic to reduce the risk of cardiovascular issues in patients with type 2 diabetes and known heart disease.
    • Numerous studies have shown complications associated with GLP-1 medication in patients with psychological disorders. Further research is needed to identify specific proteins and enzymes implicated in exacerbating current psychological conditions and inducing suicidal ideation.
  • Accuracy
    No Contradictions at Time Of Publication
  • Deception (30%)
    The article by Heidi Anne Duerr, MPH contains selective reporting and emotional manipulation. The author focuses on a single case study of a patient who experienced suicidal ideation after taking semaglutide, while failing to mention that the patient had a significant psychiatric history of bipolar I disorder and posttraumatic stress disorder. This omission creates an impression that semaglutide may be the sole cause of suicidal ideation, which is not supported by the evidence presented in the article. Additionally, phrases like 'a cautionary tale for clinicians and patients alike' and 'the primary aim [was] to augment awareness' are emotionally manipulative as they create fear around semaglutide without providing sufficient context or evidence. The author also fails to disclose that she did not conduct the research herself, instead relying on a case report by Kakarlapudi et al. and other sources.
    • Approximately 60 documented cases of suicidal ideation and 7 suicide attempts associated with semaglutide use in patients.
    • Within 3 weeks of initiating the medication, the patient began to experience significant psychiatric disturbances including abrupt behavioral alterations and protracted nihilistic delusions. She also attempted self-strangulation more than once.
    • Poster aims to improve awareness of the potential risk of suicidal ideation in patients taking semaglutide.
  • Fallacies (85%)
    The author commits the hasty generalization fallacy by extrapolating the experience of one patient to all patients taking semaglutide. The author also uses inflammatory rhetoric by describing semaglutide as a 'cautionary tale' and 'suitable alternative' that ultimately led to suicidal ideation in this patient. However, the author fails to provide sufficient evidence that the drug caused the patient's psychiatric disturbances rather than exacerbating pre-existing conditions.
    • The primary aim [was] to augment awareness regarding the potential adverse effects associated with Ozempic utilization, both among the general populace and within the psychiatric community.
    • Semaglutide may induce depression in some patients, which could ultimately lead to suicidal ideation.
  • Bias (50%)
    The author expresses a clear bias towards reporting the potential negative side effects of semaglutide, specifically suicidal ideation. She devotes a significant portion of the article to this topic and presents it as a cautionary tale for clinicians and patients. The author also uses language that depicts semaglutide users as experiencing 'significant psychiatric disturbances' and 'protracted nihilistic delusions'. Additionally, the author quotes Kakarlapudi et al. stating that 'numerous studies have illuminated the complications associated with GLP-1 medication in patients with psychological disorders.' These statements demonstrate a bias against semaglutide and suggest that it may be dangerous for patients with psychiatric disorders.
    • Numerous studies have illuminated the complications associated with GLP-1 medication in patients with psychological disorders.
      • Poster aims to improve awareness of the potential risk of suicidal ideation in patients taking semaglutide.
        • She also attempted self-strangulation more than once. These behavioral changes ameliorated after discontinuing the weight loss agent.
        • Site Conflicts Of Interest (100%)
          None Found At Time Of Publication
        • Author Conflicts Of Interest (100%)
          None Found At Time Of Publication

        83%

        The overall score is a weighted number that takes into account conflict of interest, bias, deception and other practices that undermine the credibility of the source. It is calculated as:
        (Site Conflicts Of Interest + Author Conflicts Of Interest) / 2.0 * 0.2 + ArticleBiasScore * 0.20 + UniquePointsScore * 0.05 + DeceptionScore * 0.20 + ReadabilityScore * 0.05 + FallacyScore * 0.20

        A score that takes into consideration the content for flow, interruptions with ads, and overt search engine optimization techniques that makes the content hard to understand

        Ozempic Linked to Increased Use of Antidepressants​

        HealthNews Friday, 10 May 2024 13:56
        • Unique Points
          • The use of Ozempic and similar type 2 diabetes drugs has been linked to increased dispensation of antidepressants, according to a study.
          • ”GLP-1 agonists are most strongly associated with the subsequent dispensing of antidepressants when compared to other medications for diabetes management.”
          • Depression rates in people with type 2 diabetes are nearly twice higher than in those without the condition, with women being more affected.
          • People with diabetes and depression are more likely to experience diabetes burnout, which can result in an individual's complete disregard for their blood sugar levels, neglect of a diet, and participation in self-destructive behaviors.
          • Diabetes patients taking GLP-1 RAs may be under better medical supervision, allowing them to spot depression symptoms earlier.
        • Accuracy
          • About one-third of those dispensed a GLP-1 receptor agonist were also dispensed an antidepressant.
        • Deception (30%)
          The article does not explicitly deceive readers, but it does present selective reporting and can be seen as sensationalist. The author highlights the link between Ozempic use and increased antidepressant dispensation without providing sufficient context on the broader implications of this finding. Additionally, while the study's findings are presented, there is no disclosure of sources for other claims made in the article.
          • The use of Ozempic and similar type 2 diabetes drugs has been linked to increased dispensation of antidepressants, a study shows.
        • Fallacies (100%)
          None Found At Time Of Publication
        • Bias (95%)
          The article mentions the increased use of antidepressants among users of GLP-1 agonists for diabetes management. While it does not explicitly state bias, it does suggest a potential link between the two without providing conclusive evidence. The author also mentions that some psychiatrists prescribe GLP-1 agonists to reduce weight gained while using antidepressants and antipsychotics, implying a possible causal relationship. However, the study cited in the article only shows an association between the use of GLP-1 agonists and increased dispensation of antidepressants, not a causal relationship.
          • Of 24,783 individuals who were dispensed a GLP-1 receptor agonist, about one-third (8,495) were also dispensed an antidepressant.
            • The association with GLP-1 RAs was greater for men than women and did not extend to other psychotropic medicines, such as antipsychotics.
              • ]The use of Ozempic and similar type 2 diabetes drugs has been linked to increased dispensation of antidepressants,[
              • Site Conflicts Of Interest (100%)
                None Found At Time Of Publication
              • Author Conflicts Of Interest (0%)
                None Found At Time Of Publication