Some patients experienced psychiatric problems after initiation of Ozempic

NEW YORK CITY – Some patients who had just started a GLP-1 receptor agonist rapidly developed psychiatric symptoms, some case reports are detailed here.

One case involved a 42-year-old woman with a history of bipolar I disorder, posttraumatic stress disorder (PTSD), morbid obesity, and type 2 diabetes. Because of her psychiatric history, she was considered not a candidate for bariatric surgery and was started on semaglutide (Ozempic).

Just 3 weeks after semaglutide treatment, the patient suddenly developed behavioral disturbances, prolonged nihilistic delusion, and then attempted self-strangulation, reported Shahan Syed, MD, of Bergen New Bridge Medical Center in Paramus, New Jersey. , at the American Psychiatric Association. APA) annual meeting.

But after the patient stopped semaglutide, suicidal ideation and behavior slowly reversed.

“I suspect we’re going to see a lot more of these types of cases, unfortunately, just because of the fact that these drugs are so commonly prescribed,” Syed said. MedPage today. “Even those patients who are prescribed [GLP’s] which may not have a [psychiatric] The history should be assessed once a week just to check your mood, your sleep, your appetite and most importantly your anxiety.”

“This is becoming such a popular drug and has so many great effects,” he continued. “It works mainly in fat cells, but also in muscle. And the brain is essentially all of that. Would that affect the brain? We don’t know.”

A large number of reports like this case have been reported, prompting the FDA and the European Medicines Agency (EMA) to look into the link between LPG and suicide. But just last month, the EMA issued its final conclusion after a nine-month review of reports and data, eliminating this popular class of agents from having a causal link with suicidal thoughts. The FDA is still reviewing the issue, but released its preliminary assessment in January saying these drugs “probably” do not cause suicides.

Agents in the GLP-1 agonist class include exenatide (Byetta, Bydureon BCise), liraglutide (Victoza), dulaglutide (Trulicity), lixisenatide (Adlyxin), semaglutide (Ozempic, Rybelsus, Wegovy), and tirzepatide (Mounjaro, Zepbound) , a dual GIP/GLP-1 receptor agonist. These agents have indications for treating type 2 diabetes, obesity, or both.

While there aren’t currently any, Syed said he believes those officers should carry a boxed warning for bipolar disorder. He also said doctors should ultimately prescribe these agents on a case-by-case basis.

“I would really like every health care provider, regardless of psychiatry, neurology, endocrine, to do a thorough family and psychiatric history,” Syed advised.

“This particular patient escalated rapidly and within 2 to 3 weeks had hypomanic-type symptoms: irritability, mood lability, sleep disturbances, not sleeping for about 2 to 3 days,” he explained. “That worked out [what] it could be akathisia, it could be restlessness, but then anxiety is the biggest factor that pushes us over the edge doing something impulsively, which this patient in particular did.”

This was not the only case report at the meeting linking LPG to psychiatric behaviors.

A 72-year-old male patient who was previously described as “highly functional” was started on semaglutide for type 2 diabetes, explained Jodie Nghiem, MD/MBA candidate at Weill Cornell Medicine in New York City. . In addition to diabetes, she also had a significant history of depression, normal-pressure hydrocephalus status after ventriculoperitoneal shunt (VPS), prolactinoma on cabergoline, and hypothyroidism.

But six weeks into semaglutide treatment, his wife noticed a drastic change in his behavior, described as manic. This involved a sudden shift to goal-directed activities such as cleaning the house and an “almost nihilistic delusion” that the neighbors were dead.

“[It was] it’s very different from their core business,” Nghiem said MedPage today. “They admitted him thinking it was encephalitis because it was such a sharp change.”

But her hospital workup was notable for normal prolactin, thyroid hormone, with a functioning VPS and an unremarkable autoimmune panel. A primary psychiatric disorder such as psychosis or mania was also considered unlikely because of the patient’s age, although he was eventually discharged from the hospital on an antipsychotic.

Nghiem echoed a similar sentiment to Syed, agreeing that as GLP-1 receptor agonists continue to grow in popularity, health care providers in all specialties should be aware of potential adverse effects. Providers should also be aware of any patient-specific factors, such as age in this case, that may make patients more vulnerable to adverse effects, he suggested.