Blockbuster obesity drugs have transformed the way we treat the condition, but doctors warn they can cause potentially serious psychiatric effects.
Two new case reports reveal how two American patients became psychotic after taking semaglutide, the key ingredient in Ozempic and Wegovy.
A 42-year-old morbidly obese woman had been taking the medication for three weeks when she began to suffer delusions that she was dead and attempted to strangle herself.
The symptoms disappeared after he stopped the medication.
Another man, aged 72, who was described as “highly functional”, became manic after six weeks of taking the drug. He began compulsively cleaning the house and was convinced that all of his neighbors were dead.
Patients taking weight loss medications such as semaglutide, the main ingredient in Wegovy and Ozempic, have reported behavioral changes, such as manic episodes, as well as impulsive behaviors leading to suicide attempts.
The case reports were raised at a recent meeting of the American Psychiatric Association (APA).
A large number of reports like these have been reported around the world.
Doctors who treated the patients have asked that patients receiving the new anti-obesity drugs be monitored once a week, even if they have no history of mental health problems.
For patients who do, they want healthcare providers to do a thorough check of their family history to assess their risk.
Zepbound and Wegovy include warnings on their labels about possible suicidal behavior, while Ozempic lacks warnings about psychological effects.
None of its labels include warnings or contraindications for people with bipolar disorder, warning them that they could see worsening depression or manic episodes.
A new KFF survey found that one in eight American adults has used the new obesity medications, meaning millions could be susceptible to potentially serious psychiatric problems.
Dr. Shahan Syed, of Bergen New Bridge Medical Center in New Jersey, described how the 42-year-old woman had a history of post-traumatic stress disorder and bipolar 1 disorder.
He was also morbidly obese, meaning his body mass index was above 40, and type 2 diabetes.
Due to her psychiatric history, she was deemed not a candidate for bariatric surgery and began taking Ozempic.
According to Dr. Syed, the medication increased her anxiety, which pushed her to impulsive behaviors, such as attempting to take her own life.
Just three weeks later, the patient suddenly developed “behavioral disturbances,” including the feeling that she had died. She also tried to strangle herself, Dr. Syed said.
He said: “I suspect we are going to see many more cases of this type, unfortunately, simply because of how common the prescribing of these drugs is.”
Doctors generally don’t yet know why semaglutide would cause mania and other behavioral changes. Semaglutide acts on brain receptors involved in regulating appetite.
Activation of these receptors can influence the activity of other neurotransmitters involved in mood, such as serotonin and dopamine.
Disrupted dopamine levels, which are associated with motivation, reward, and pleasure, can contribute to manic symptoms such as impulsivity, restlessness, high energy, and reduced inhibitions.
And serotonin plays a huge role in mood regulation, so unbalancing levels of this neurotransmitter can lead to severe mood instability typical of manic episodes.
«It acts mainly on fat cells, but it also acts on muscles. And the brain is essentially all of that. Would this be affecting the brain? We do not know.’
An evaluation by the FDA of Ozempic and similar drugs found no evidence that they cause suicidal thoughts after conducting “detailed reviews.”
Meanwhile, the 72-year-old, who was otherwise described as “highly functional,” was prescribed semaglutide for his type 2 diabetes.
He also had a history of depression, dementia-like symptoms after a neurological procedure, a benign tumor in his pituitary gland, and hypothyroidism.
About six weeks after starting his regimen, the man’s wife noticed marked changes in behavior. She would suddenly go from an existential crisis to goal-directed activities like deep cleaning the house in the blink of an eye.
He had been admitted to the hospital thinking he had encephalitis, or inflammation in the brain, “because it was such an acute change,” according to Dr. Jodie Nghiem of Weill Cornell Medicine in New York City.
But blood tests came back normal, and because of the man’s advanced age (psychotic and bipolar disorders usually appear in early adulthood), psychiatrists ruled out mania and psychosis.
Still, doctors prescribed him an antipsychotic, the main class of medications used to treat schizophrenia and psychosis and sometimes to treat bipolar disorder.
About 18 percent of American adults, roughly 45 million people, are treated for depression, which can worsen obesity and prompt someone to reach for Wegovy, Ozempic, Zepbound or its sister drug Mounjaro.
Dr. Sayed, who has called for a warning to be added for people with certain psychiatric conditions, including bipolar disorder, said: “I would really like all healthcare providers, regardless of psychiatry, neurology and endocrine , do a thorough family history and psychiatric history.
