It was Joanna Acevedo’s psychiatrist who first brought up the idea of weight loss drugs. Since 2018, Acevedo has relied on antipsychotic medication to manage his bipolar disorder. Her medication kept her from becoming paranoid – in fact, she said, her medication kept her alive. Also, her weight increased by 70 pounds. By age 26, she was prediabetic.
During a routine doctor’s appointment this winter, Acevedo told her psychiatrist that she no longer felt comfortable in her body. She had brought it up before, but this time he made a proposal that surprised her. Has she heard about the new weight loss drug?
He referred her to a weight loss clinic and prescribed Wigoby, an injectable drug containing the same compound as the popular drug Ozempic.
These drugs have changed the way doctors treat diabetes and obesity. Some psychiatrists are now turning to drugs to control weight gain. often comes with Almost all antipsychotics and Some medications used to treat depression and anxiety. The New York Times heard from 13 major mental health facilities and psychiatric departments in major U.S. health systems. Six said they were already recommending or prescribing drugs such as Ozempic to patients. Seven said they believed it was beyond their authority to prescribe weight-loss drugs and were not prepared to do so, citing concerns about safety and side effects.
Their answers reflect an emerging debate in mental health care about whether to prescribe drugs that patients are likely to take indefinitely. There is limited understanding of how people with severe mental illness take these drugs.
“We’re talking about a very vulnerable population,” says Dr. Mahavir Agarwal, a psychiatrist and scientist at the Center for Addiction and Mental Health in Toronto. Dr. Agarwal: early research To reduce weight in patients taking antipsychotics, he proposed using semaglutide, a substance found in Wegovy and Ozempic. He said there is “very little data” about people with depression, bipolar disorder and other mental illnesses taking semaglutide, adding that until more evidence is found, “you’re flying blind. Something like that.”
But some doctors say patients can’t wait. People often stop taking psychiatric medications or refuse to take them altogether because they don’t want to gain weight.a 2019 review They found that patients gained more than 7 percent of their body weight on antipsychotics and more than 5 percent on certain antidepressants. There is no clear explanation for the link between psychiatric drugs and weight gain, but experts theorize that the drugs may increase appetite and slow metabolism. Not everyone gains weight when taking psychiatric drugs, and it’s difficult to determine what role other factors such as diet, exercise, and health conditions play.
People like Acevedo who gain a lot of weight can face an increased risk of prediabetes, heart disease, and other problems.
“This was a huge disaster for the population,” said Dr. Dost Ongül, head of the mental disorders division at McLean Hospital in Massachusetts, where all mental health providers are now asking patients with mental disorders to He said he was evaluating whether he should take such a drug. Wigovy and Ozempic.
For Acevedo, even the sometimes painful side effects of the weekly Wigovy injections (he vomited five times a day for the first month) were worth it.
“I felt like I had no other choice,” said Acevedo, who later transferred to Ozempic. When she was on antipsychotic medication, she no longer had intermittent delusions that people around her were not who they said they were. “I am not controlled by a disease that is actively trying to kill me,” she said. But she felt like she was trading one aspect of her health for another. As Acevedo, a longtime athlete, gained weight, it became harder for her to move. Since she started taking her weight loss medication, her weight has decreased by 30 pounds and her blood sugar levels have also decreased. She started her weightlifting. “It’s so important to me to be able to feel like my body is strong again,” she said.
“Without Ozempic, I can’t take my psychiatric medication,” she said. “They work hand in hand.”
“Game changer”
In the summer of 2022, Dr. Jennifer Kruse, a psychiatrist at the University of California, Los Angeles, sent an email to colleagues offering to see patients interested in weight loss drugs. “I think these new agents could really be a game changer,” she wrote. Her schedule quickly became packed.
In the past, some psychiatrists prescribed drugs such as metformin and liraglutide to prevent patients from gaining weight. But none have proven to be as powerful as new drugs.
Psychiatrists who prescribe Wigoby, Ozempic, and the similar drug Munjaro stress that they monitor the mood of patients taking the drugs.
Dr. Shebani Sethi, a professor at Stanford University, said this is not a “go-to drug.” metabolic psychiatry program and often see patients on referral from psychiatrists. Before prescribing drugs like Wegovy, she tests people for eating disorders and considers: their medical history and body composition. She requires her patients to do strength training to prevent possible muscle loss from the drug.
But if patients understand the risks, “I’m pretty open,” she says. “I will prescribe it if you wish.”
And patients are demanding it.
Amanda Romero, 35, started taking the antidepressant Lexapro in 2015 after her 4-year-old daughter was diagnosed with cancer and the intrusive thoughts she had experienced over the years intensified. The drug worked, and even after her daughter went into remission, she continued taking her medication and eventually switched to Prozac. But no matter how much she rode on the Peloton or around her North Carolina neighborhood, or how closely she followed her doctor’s dietary recommendations, her weight kept gaining. By last spring, she had gained 70 pounds.
“I felt like, “What happened to me?” she said.
Stopping antidepressants was not an option. She tried it when her daughter finished her chemotherapy. She cried many times a day and panicked every time her phone rang, scaring her that it was bad news.
Thanks to antidepressants, she felt more in control of her brain. Her Wegovy has given her more control over her own body. Romero started taking the drug in February and her nausea became so bad that she took a pregnancy test, but she has since lost all her weight.
What doctors don’t know yet
Some doctors remain concerned. Dr. Ilana Cohen, a psychiatrist at Shepard Pratt in Maryland, said she and other colleagues in her psychiatric hospital system avoid drugs. anecdotal reports The European patient reportedly developed suicidal thoughts during treatment. European health regulators are currently reviewing data on drugs such as Ozempic and the risk of suicidal thoughts.
Wegovy’s clinical trial excluded people who had recently considered suicide, had a history of a suicide attempt, had severe symptoms such as schizophrenia or bipolar disorder, or had depression within the past two years. It was done.
“These drugs haven’t really been well studied and aren’t designed for this population,” Dr. Cohen says. researchers are studying how these drugs may work For people with mental health conditions.
In clinical trials of Saxenda, an older drug approved for weight loss, participants who took the drug compared with participants who took a placebo, although there was insufficient evidence that the drug was to blame. Slightly more participants had suicidal thoughts. The FDA requires weight management drugs that act on the central nervous system (such as Saxenda and later Wigovy) to carry a warning about suicidal ideation.
Other clinicians are concerned that the drug, which drastically reduces how much a patient wants or can eat, could exacerbate problems for patients who may be at higher risk for depression and anxiety. He said he is doing so. anorexia.
“I don’t want to recommend medications that can actually make eating disorders worse or make eating disorders more likely to occur,” says Sophia Ridin-Gray, a clinical psychologist at Duke Psychiatry and Behavioral Sciences. he says.
Some patients are faced with the dilemma of choosing between expensive drugs with sometimes devastating side effects and unwanted weight gain.
Romero recently stopped taking Wigoby. I knew I was at risk of gaining weight back, but the side effects and the more than $1,300 a month I was paying out of pocket were too high.
Kristen Eckhardt, 40, of Hastings, Nebraska, started taking Ozempic in March after gaining 20 pounds and developing prediabetes while taking Vlylar for depression. She said she was grateful for her emotional stability and was less depressed and irritable around her children. However, her weight gain made her anxious. “Your self-image really takes a hit,” she said.
When Ozempic started, she felt exhausted. Her stomach hurt constantly. Although these side effects improved, her blood sugar levels and weight loss plateaued.
“I’m really scared to leave Ozempic because I don’t want to put the weight back on. And I know I’m better off just stopping taking my mental health medication. That’s not the way to go,” Eckhart said. . “So for now, I’m definitely on board with everything.”
