Annual Meeting: Poster Investigates the Link Between Semaglutide and Suicidal Ideation

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CONFERENCE REPORTER

Weight gain and weight-associated morbidity including metabolic issues are concerns for many patients with psychiatric disorders. But what role should semaglutide play in patients with serious mental illness?

A new case study presented at the 2024 American Psychiatric Association Annual Meeting may serve as a cautionary tale for clinicians and patients alike. In the poster “Semaglutide-Induced Suicidal Ideation in a Patient with Psychiatric Comorbidities: A Case Report,” Raju Kakarlapudi and colleagues shared the story of a 42-year-old female patient who was morbidly obese with type 2 diabetes mellitus.¹

Because of the patient’s significant psychiatric history of bipolar I disorder and posttraumatic stress disorder, bariatric surgery was contraindicated. Instead, semaglutide (Ozempic) was considered a suitable alternative to assist the patient with her weight loss journey.

Within 3 weeks of initiating the medication, the patient began to experience significant psychiatric disturbances including abrupt behavioral alterations and protracted nihilistic delusions. She also attempted self-strangulation more than once. These behavioral changes ameliorated after discontinuing the weight loss agent.

In producing the poster, Kakarlapudi and colleagues said “the primary aim [was] to augment awareness regarding the potential adverse effects associated with Ozempic utilization, both among the general populace and within the psychiatric community.”

Kakarlapudi et al. conducted a literature review and analysis via Google Scholar, looking at studies since 2018. Studies included patient data obtained from direct clinical interviews and behavioral monitoring. The researchers looked for observable trends among pharmacological interventions.

Kakarlapudi et al. found approximately 60 documented cases of suicidal ideation and 7 suicide attempts associated with semaglutide use in patients. According to the analysis, many patients reported significant improvement in depression after discontinuing the agent. Thus, the authors concluded that the drug may induce depression in some patients, which could ultimately lead to suicidal ideation.

Approved by the US Food and Drug Administration for the treatment of type 2 diabetes in 2017, the glucagon-like peptide-1 (GLP-1) receptor agonist mimics the GLP-1 hormone, which promotes the production of insulin as a result of eating. The authors further explained that GLP-1 receptors “act on the brain stem, lateral septum, and hypothalamus, modulating food intake and reward with GLP-1 receptor stimulation promoting dopaminergic neuron activity at the ventral tegmental area andincreased expression of dopamine transporters on neuronal cell surfaces, thereby reducing free dopamine levels in synapses prompting reduced dopamine levels.”

There are 3 semaglutide products currently approved by the FDA. Wegovy injection was approved for weight loss in 2021 for patients 12 years or older who are obese and adults who are overweight and have a medical condition related to the excessive weight. Ozempic injection and Rybelsus tablets are approved to reduce blood sugar in adult patients with type 2 disease. Additionally, Ozempic is approved to reduce the risk of cardiovascular issues (eg, stroke, heart attack) in patients with type 2 diabetes and known heart disease.²

Semaglutide has garnered interest by clinicians, researchers, and patients alike due to its success in supporting patients lose weight. Additional posters at the meeting explored its usefulness versus potential adverse effects, including low mood.^3,4 Yet, with its neuroprotective properties, there also is speculation that it may have with potential use for Alzheimer disease.⁵ It therefore becomes even more important to better understand its pros and cons, especially for patients with psychiatric disorders.

“Numerous studies have illuminated the complications associated with GLP-1 medication in patients with psychological disorders,” the authors wrote. They adding, “Further research to identify the specific proteins and enzymes implicated in exacerbating current psychological conditions and inducing such ideations [is warranted].”¹

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References

1. Kakarlapudi R, Syed SA, Abbasi M, Jafary Z. Semaglutide-Induced Suicidal Ideation in a Patient with Psychiatric Comorbidities: A Case Report. Poster presented at: 2024 APA Annual Meeting; May 4-8, 2024; New York, NY. Accessed May 5, 2024. https://s7.goeshow.com/apa/annual/2024/poster_search.cfm?session_key=8E8DFE6F-90B1-1C06-DFD2-CA2230FD8375&session_date=Saturday, May 04, 2024

2. Medications Containing Semaglutide Marketed for Type 2 Diabetes or Weight Loss. Accessed May 5, 2024. https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/medications-containing-semaglutide-marketed-type-2-diabetes-or-weight-loss

3. Kuntz L. Semaglutide and Depression: What Is the Relationship? Psychiatric Times. May 5, 2024. Accessed May 5, 2024. https://www.psychiatrictimes.com/view/semaglutide-and-depression-what-is-the-relationship

4. Bhatia GK, Patel S, Ferrer GF. Semaglutide: an opportunity or an obstacle? A literature review and case report exploring the relationship between the popular drug and depression. Poster presented at: 2024 APA Annual Meeting; May 4-8, 2024; New York, NY. Accessed May 5, 2024. https://s7.goeshow.com/apa/annual/2024/poster_search.cfm?session_key=8E8E03C5-90B1-1C06-DFD2-56B4A81EDBC0&session_date=Sunday,%20May%2005,%202024

5. Joshi P, Tampi RR. Can Semaglutide Help in Psychiatry Too? Research Shows Promise for AD and PD. Psychiatric Times. 2024; 41(2):1;8-10.