Ozempic and similar medications containing semaglutide have gained significant attention as potential "miracle drugs" for weight loss and blood sugar control. These drugs, known as GLP-1 (glucagon-like peptide-1) agonists, mimic a natural hormone released by the small intestine after eating. While primarily approved for treating type 2 diabetes and obesity, some doctors are prescribing them off-label for various addictive disorders. This article explores the potential mental health benefits associated with these medications, as well as the risks and ethical considerations surrounding their use.
How GLP-1 Agonists Work
GLP-1 agonists work through multiple mechanisms. They delay the movement of food through the stomach, leading to a feeling of fullness. More importantly, they target the brain's reward pathway, helping to control appetite. Dopamine, a neurotransmitter crucial in addiction, is also affected by these drugs.
Potential Mental Health Benefits
Addiction Treatment
Early studies suggest that GLP-1s may be effective in treating various addictions, including opioid, alcohol, and nicotine addiction. One small study showed a 40% reduction in opioid cravings among patients with opioid use disorder after three weeks of GLP-1 medication use. Researchers are also investigating their potential in treating addictions to gambling, sex, and shopping.
Luba Yammine suspected a connection between GLP-1 agonists and reduced cravings for cigarettes while working at a primary care clinic in Texas. Other researchers have since explored the impact of GLP-1 agonists on alcohol use disorder and opioid use disorder (OUD). Rodent studies indicated that GLP-1 agonists reduced heroin intake in addicted subjects.
A small, double-blind, placebo-controlled trial by Bunce et al. found that a GLP-1 agonist reduced opioid cravings by 40% compared to standard care. Bunce notes that these medications seem to "silence that noise" of craving.
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Impact on Mood and Cognition
Some experts believe that GLP-1 drugs can transform the health of people with obesity, quiet "food noise," and may level the weight-loss playing field. Ronald Petersen, director of the Mayo Clinic Alzheimer’s Disease Research Center, is intrigued by the possibility that these drugs can impact cognition and aging. A multiyear clinical trial is underway to study the impact of semaglutide on Alzheimer’s patients.
With weight loss comes a notable brightening of mood and lifting of anxiety. As people invariably start to feel better about themselves, we watch them get promoted at work, increase socialization, and improve relationships. Quality of life dramatically improves in many ways. The bottom line is that as GLP-1s produce weight loss, they simultaneously treat the depressive symptoms, shame, and low self-esteem that come from having been discriminated against.
Connection Between Obesity and Mental Health
Mental illness can cause or worsen obesity, and obesity can cause or worsen mental illness. The most common disorders, including depression, anxiety, and PTSD, can all affect eating behaviors, and many of the lifesaving medications to treat these disorders cause significant weight gain. People who are already stigmatized due to mental health diagnoses face double jeopardy when they also have obesity: Social isolation may worsen due to poor self-esteem and shame related to their weight.
Just as using substances of abuse can be a way of self-medicating the symptoms of mental illness, so too can overeating, as the two share some of the same brain biology. As a general adult psychiatrist, Karen hears from her patients that bingeing has a dissociative aspect - numbing or distracting from painful feelings, thoughts, memories, and symptoms.
Neurological and Behavioral Health
A study by scientists at Washington University School of Medicine in St. Louis and the Veterans Affairs (VA) St. Louis Health Care System systematically evaluated health outcomes among more than 2 million people with diabetes taking the popular weight-loss drugs. GLP-1RA drugs were associated with significant benefits to neurological and behavioral health, with reduced risks of seizures and addiction to substances such as alcohol, cannabis, stimulants and opioids.
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According to Ziyad Al-Aly, GLP-1RA drugs act on receptors that are expressed in brain areas involved in impulse control, reward and addiction - potentially explaining their effectiveness in curbing appetite and addiction disorders,
Risks and Side Effects
Physical Side Effects
Every medication has side effects that can vary by individual, and GLP-1s are no exception. In the treatment of diabetes and obesity, patients have reported headaches, upset stomach, dizziness and increased heart rate. Rarely, serious side effects such as pancreatitis and thyroid cancer can occur. Some patients have sued the drugmakers after developing dangerous conditions, such as stomach paralysis and bowel obstructions. The stomach contents are retained sometimes for days on GLP-1s.
While GLP-1RA drugs display effectiveness against a wide array of health problems, the magnitude of associated benefits is modest - about a 10 percent to 20 percent reduction for most outcomes. Al-Aly emphasized that his study also highlighted potential downsides to the medications, including an increased risk of gastrointestinal problems such as nausea, vomiting, diarrhea, and in rare cases paralysis of the stomach. While these adverse effects are uncommon, they can be very serious; physicians must be vigilant for signs of pancreatitis and monitor kidney function among people taking GLP-1RA medications.
Mental Health Concerns
Prescribing guidelines for several GLP-1s warn about risk of suicidal thoughts and self-injury, and the FDA Adverse Event Reporting System (FAERS) identified a “signal” that linked the GLP-1s and suicidality. Figuring out whether the adverse effect is caused by the drug or by the underlying illness the drug is prescribed to treat can be thorny. Obesity itself can lead to depression and anxiety, which can sometimes lead to suicidal thoughts and actions.
The research related to Lavelle’s observations is mixed. One large 2024 study in the journal Scientific Reports found that people with obesity who were on GLP-1s had a slightly elevated risk of anxiety and suicidal behavior when compared with controls, and almost double the risk of major depression. Then, an April 2025 paper demonstrated how GLP-1s might drive depression and suicidal ideation in people with a genetic predisposition toward low dopamine function. Meanwhile, a case report presented at the 2024 American Psychiatric Association annual meeting included the example of a 42-year-old woman who developed “behavioral disruptions, protracted nihilistic delusions,” and an attempted self-strangulation just 3 weeks after beginning Ozempic.
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On the other hand, a 2024 study led by University of Pennsylvania psychologist Thomas A. Wadden, PhD-and funded by Novo Nordisk, the maker of semaglutide-found that GLP-1 takers without known psychopathology weren’t any more likely to develop depression or suicidal thoughts or actions than controls. They even had a “small but statistically significant” reduction in depressive symptoms
A large cross-sectional study conducted by the National Institutes of Health and Case Western Reserve, published in January 2023, showed a lower risk for suicidal ideation in those taking semaglutide compared with non-GLP-1 pharmacotherapy for obesity or diabetes.
Body Image and Eating Disorders
While the medications’ positives include their ability to improve health and relieve the stigma of “failing” to lose weight, they also have the potential to increase weight stigma, medicalize larger bodies, and shame people for both taking the perceived “easy way out”-or not taking it. Some psychologists are concerned about the drugs’ physical side effects, too. Even the most common and seemingly benign side effects, like nausea and constipation, can take a mental and emotional toll, Goldstein has found.
Nagata suggests that patients taking GLP-1s check in regularly with a physician or nutritionist who can monitor their progress and flag unhealthy behaviors. Part of what they look for is too-rapid weight loss - which, in addition to straining vital body functions, can accelerate muscle loss.
Long-Term Use and Weight Regain
The existing studies are clear: People who go off the drugs eventually regain much of their lost weight. Even patients who tolerate GLP-1 treatment just fine don’t necessarily enjoy the medication’s effects. Indulgence is, for better or worse, how many people relax, celebrate, socialize.
Ethical Considerations
Equity and Access
The ethical concerns surrounding drugs like Ozempic, Rybelsus, and Wegovy focus in part on issues of equity and access. The drugs are expensive, ranging from $900 to $1,400 per month-with variable insurance coverage. This means they are likely to be accessible primarily to wealthier individuals or those with comprehensive health insurance. This exacerbates health disparities, leaving those in lower socioeconomic brackets without access to these potentially life-changing treatments.
Focus on Prevention
Reliance on AOMs can divert attention and resources from crucial preventive measures. Public health initiatives that promote healthy diets and physical activity and address the social determinants of health are essential in combating the obesity pandemic. If policymakers and the public perceive AOMs as a panacea, there might be less emphasis on these preventive strategies, which are vital for long-term health and well-being.
Economic Impact
The economic implications are substantial. The high cost of these medications, when considered for a significant portion of the obese population, could lead to a dramatic increase in healthcare expenditures. This might strain public health budgets and shift resources away from other crucial services.
Societal Factors
Societal factors contributing to obesity include poor dietary habits, lack of physical activity, socioeconomic disparities, and the pervasive marketing of unhealthy foods. AOMs primarily address the biological aspect of obesity by regulating appetite and metabolism. However, they do not tackle these underlying societal drivers.
Importance of Lifestyle Changes
To be clear, eating a lot less does drop the numbers on the scale. But exercise is still important - for your heart, bones, brain, and more. And the nutritional quality of your food matters, not just the quantity.
The Role of Psychologists
Psychologists can help patients become more knowledgeable. They can work with the emotional side of things, help support the health behavior change, screen and treat disordered eating behaviors that might develop, or address anxiety or depression that goes alongside it. They can also help patients on GLP-1s strengthen their body image and deal with body dysmorphia as their brains try to “catch up” with what their eyes see in the mirror, Goldman said. She also often helps patients work through grief that can arise when old pleasures-nightly ice cream with a partner, happy hour with coworkers-leave them feeling flat.
Psychologists can help patients with more practical matters, too, like making sure they’re getting enough protein, engaging in resistance exercise, and eating a variety of foods to help prevent muscle loss and malnourishment.
Research on Mental Health Changes and Weight Loss
A study examined changes in mental health symptoms and weight during weight loss treatment. Data were analyzed from a trial of 92 Hispanic women with overweight/obesity and prediabetes, who were randomized to receive intensive lifestyle intervention (ILI), metformin 1,700 mg daily, or standard care. Depression, anxiety and perceived stress were assessed at 0, 6 and 12 months.
In ILI, 12‐month improvement or stability in mental health was significantly associated with weight loss. From baseline to 6 months, ILI participants in I/S and W groups experienced comparable weight loss. However, from 6 to 12 months, W participants regained weight, whereas I/S participants experienced continued weight loss.
Future Directions
Additional observational data and interventional studies will help us understand the complex relationship between GLP-1s and mental health. In the meantime, conversations and close collaborations between doctors who treat the body and doctors who treat the mind will help patients.
Legislative efforts to expand insurance coverage for GLP-1 medications are already underway. Even if those initiatives fail, the cost of the blockbuster weight loss medications is expected to come down in the future. Additional GLP-1s might enter the market in a few years. Several contenders are already in development, as pharmaceutical companies race to find better drugs for weight loss.