“Thin” has been “in” across the United States for more than a century, but in this current age of social media, people’s obsession with achieving a rake-handle frame might be hitting a contemporary-times apex. And while, yes, excess body weight does cause serious health issues for some, the path many people are taking to get skinny today may require a concerning mental health toll.
Either directly or indirectly, you’ve probably heard the joyful refrains of folks who’ve lost considerable weight by taking the alleged wonder drug semaglutide, under the names of Ozempic, Wegovy or Rybelsus. Semaglutide was first developed to battle Type-2 diabetes, but then, two years ago, the FDA cleared its use for treatment of chronic obesity, as it effectively curbs the appetites of many who take it.
With dramatically shrunken waistlines, many praised semaglutide’s positive impact on their life. Demand increased, which generated barriers of cost and availability. That led to ethical questions over whether healthcare providers should prescribe semaglutide to those who take it for weight loss, which meant less access to it for people with diabetes, a disease that may create more immediate health emergencies if not treated.
Still, plenty of people who didn’t need the drug got their hands on the stuff — a number of wealthy celebrities, and others with more modest profiles but equal means. Some are choosing to deal with a range of well-documented unsavory side effects: Nausea, diarrhea, vomiting, abdominal pain, headache, fatigue, a boost in flatulence and other issues can crop up with semaglutide use. These issues have turned some people off to the drug, but there are other, more extreme possible semaglutide side effects that, for the most part, have fallen through cracks in media coverage. They include depression as well as suicidal thoughts and tendencies.
A number of purported semaglutide users have posted on social media that their mental health has suffered since beginning their treatment. Other people on semaglutide have reported to the media that they miss food and the ceremonial act of eating, which then darkens their mood.
Researchers and healthcare providers are enthused about the apparent growing number of applications for semaglutide. It’s not hyperbole to say the drug could transform the health landscape in a country like the United States, the most-obese of all the globe’s wealthy nations, and home to 30.7 million diabetics, the most of any country besides China and India. However, for some, the benefits of semaglutide have too great a cost to their mental health. The problem is widespread enough in the U.K. that the country’s medicine and healthcare regulatory body is launching a probe into semaglutide and its potentially harmful impact.
InsideHook spoke with a number of healthcare providers about the troubling issues many are facing. Based on their responses, consensus seems to be that semaglutide-prompted mental health woes are fairly uncommon and that the depressed turn in mood some people experience while on the drug would likely not be permanent or even long-lasting. It can even be addressed without having to cease dosing.
“It’s not something that I’ve actually really had a patient complaint about,” says David Nazarian, M.D., a Beverly Hills-based internist who’s been prescribing semaglutide to patients as a weight-loss aid for several years, though like many other doctors he’s fielded a rise in requests for it over the past year or so. “I guess it’s all dependent on the dosage that one is taking. These medications start at a starting dose, and then you can increase it as needed to curb your appetite and have weight-loss effects. If you go higher on it, and it’s too much, you can have more side effects.”
He advises people on semaglutide, which he describes as a “powerful” medication, to take it only under strict guidance of a medical professional — multiple ones, actually. At Nazarian’s practice, internists partner with nutritionists to ensure clients continue eating properly.
“I always tell patients that are on these medications, you want to make sure that your intake of protein is adequate enough so that you don’t have muscle breakdown and also some of these other side effects,” Nazarian says. “There’s nutrients that we need for optimal functions. So like the omega three fatty acids, they play a role with neurotransmitters, brain functions. If you’re completely cutting out certain things from your diet, then you’re going to have more of a side effect,” including possible mental health problems.
Sue Decotiis, M.D., a weight loss specialist in New York City, says people taking semaglutide also need to hydrate well. “You need to drink a gallon of water [a day] when you’re doing these drugs,” she says. “Because for every ounce of fat that you burn — and you will be burning fat rapidly — you’re gonna lose water.” From dehydration, Decotiis says, feelings of hunger, fatigue and dizziness may manifest, which is “not going to have a great impact on your mood, potentially.”
“Does Ozempic make anyone else feel depressed, unmotivated and sad?” asked one person in the subreddit r/OzempicForWeightLoss.
“Anyone else start getting anxious/depressed?” posted another in r/Semaglutide.
“Has anyone else’s mental health plummeted while on Ozempic?” asked a third, among a number of other worried semaglutide-taking Redditors.
While few, if any, of these posts have garnered huge upvote tallies, they’ve all gotten a number of responses in the affirmative. A couple comments read: “I have anxiety and Ozempic definitely makes my anxiety worse” and “I am becoming more and more depressed for reasons I don’t know.” One even says: “Yes, I had to go off it because it was intolerable. I never understood why anyone would commit suicide, now I understand. I’m on my third week not injecting but I can still feel the side affects [sic].”
“Kinda a numbness and a lot of fatigue,” one more Redditor posted in response to another’s question about increased depression coming with semaglutide use. “It creeps in slowly and before u know it u get quite depressed well me anyway [sic]. I’ve decided to go off.”
But these sensations and emotions, as well as that aforementioned feeling of “missing food” and the loss of a “zest for life,” that some people taking semaglutide have experienced should pass over time, Decotiis says. The current relatively high frequency of such reports could possibly be due to the fact that there are so many new users of the drug, who are still knee-deep in an expected adjustment period. When I ask Decotiis if there’s maybe a “mourning phase” over the decreased interest in some people’s favorite pastimes — dining out and drinking with friends, for example — she says, “Yeah, a little bit.”
However, she quickly adds: “But when people see that they’re down two pants sizes…” So she’s basically positing an unsettling paradox: “Yes, it might cause depression, but obviously you won’t be depressed if you’re skinny!” Still, Decotiis generally sees semaglutide having an effect on her patients that’s the opposite of those Redditors’ experiences.
She says when insulin levels — which are adversely affected by diabetes, excess fat and a lack of physical activity — are better maintained, so too are levels of cortisol, the body’s primary stress hormone that helps control mood. It’s not much of a surprise to Decotiis, then, that clients of hers on semaglutide say they’ve actually stopped taking antidepressants and anti-anxiety medications. She’s also heard remarks from her patients like, “My therapist says I’m doing so much better.”
Dr. Monica Vermani, a clinical psychologist and author of A Deeper Wellness: Conquering Stress, Mood, Anxiety, and Traumas, says seven out of the nine clients she sees who take semaglutide have experienced “positive effects” from it, including “faster progress in weight loss due to reduced cravings…and an inability to binge eat.” The other two patients continued their unhealthy eating habits, but in terms of their mental health, she says none of the nine reported “a loss of enthusiasm, joy or lust for life.” Instead, she says, “Most of them were very happy with their weight loss, after years of unsuccessful yo-yo dieting.”
Perhaps the best-case scenario for anyone who’s taking semaglutide is to one day be able to stop taking it and maintain a trim physique, which is not out of the realm of possibility for many who are on it.
“I have a few patients who have discontinued using the medication for over a year and have not had significant weight gain,” says Vermani. “[They] have simply fluctuated between five to 10 pounds after a significant weight loss of 50 to 70 pounds.”
Because semaglutide is a peptide drug, and peptides are like messenger systems, Decotiis says the drug might be able to “rewire appetite over time,” giving people struggling with diabetes and weight loss a greater chance of improving their eating habits. In fact, some of her clients, after six months or so of semaglutide use, have told her that they’re craving healthy foods.
“And this is as we taper them off the medication, so I think that’s really exciting,” Decotiis says. “You’ve heard a lot in the press, ‘Oh, once you go off these drugs, you gain the weight back and you have to stay on them for life.’ I think if you go to the right physician who knows how to use the drugs, that is not necessarily the case.”
Vermani says the psychotherapy clients she has who are taking semaglutide and have lost significant weight tell her the challenges they face as they alter their lifestyles have been worth it. “My successful patients shared the motivation to change, and the willingness to engage in healthier eating habits, rather than continue their unhealthy patterns while taking the medication,” she says.
https://www.insidehook.com/article/health-and-fitness/ozempic-semaglutide-depression
