The Mental Health Impact of Weight Loss Medications

With millions of Americans taking GLP-1 medications for weight loss, the thought of taking one of these medications might have crossed your mind.

Maybe you’ve heard some of the more extreme stories in the media about gastroparesis (delayed emptying of the stomach) or people vomiting in workout classes, and you’re terrified that will be you. Or you’re worried about being on medication for the rest of your life. All of your concerns are valid.

It’s also important to be sure you feel confident in whoever is managing your care while on one of these medications. With the growing popularity of GLP-1s, there are plenty of less-than-scrupulous practitioners just trying to make a buck off a trend.

What You Might Feel Pre-GLP-1

For starters, if you’re considering taking a GLP-1, there are two crucial things you need to know: you are not a failure, and taking this medication (or not!) doesn’t change anything about who you are as a person.

Similarly to an antidepressant, statin (cholesterol-lowering drugs), or blood pressure medication, it is just one more tool to help you improve your health.

And if you’re reading this particular article on this website, maybe either you or a loved one deals with a mental health condition. You may be judging yourself about your weight, your mental health condition, or both. 

The Metabolism and Mental Health Connection

But you might find some comfort in knowing how interconnected metabolic and mental health issues can be. In so-called modern healthcare, our different body systems are often treated as totally separate entities that don’t interact at all, when that couldn’t be further from the truth. Metabolism and mental health have a bidirectional influence on each other.

So, if you’ve struggled with your weight, it’s likely that you’ve also dealt with one or more mental health conditions. And if you were affected by childhood adversity—already putting your health at risk for other conditions— metabolism was likely altered at a young age as a result.

Even controlling for other risk factors such as gender, race, family history, or lifestyle choices like diet and exercise, those exposed to childhood adversity were predisposed to obesity over their peers who weren’t.

Similarly, a major study of more than 100,000 women showed that those who experienced post-traumatic stress disorder (PTSD) symptoms also had their BMIs increase more rapidly than those who hadn’t.

Behaviorally, these changes can also lead to trouble controlling appetite and using food and alcohol to cope with their symptoms of PTSD.

In terms of treating both, it doesn’t necessarily matter which caused the other, says Hui “Christina” Wang, LCSW, clinical social worker in the Center for Weight Management and Metabolic Health at Cedars-Sinai. “We usually tackle it all at once. Patients who have had metabolic issues and issues with their body also often find their depression harder to handle.”

And depression—particularly treatment-resistant depression (TRD)—and obesity have shared biological mechanisms. Though there are still few biomarkers for TRD, C-reactive protein is typically elevated in people with TRD, similarly to people dealing with obesity.

What Happens To Your Mental Health When You Take a GLP-1 Medication?

While you’re on a GLP-1 medication, you may experience some mental health benefits—and that’s not just because you’re happy with reaching your health goals. Since GLP-1 medications regulate metabolic hormones, it tracks that those more stable hormone levels would also lead to an increase in our feel-good hormones, too.

“I’ve seen the joy that folks have had,” says Wang. ”Body image may be a big change, but what I hear more of is the increase in energy levels and improving other conditions. It actually rarely is about appearance.” 

Although most of the research linking GLP-1 medications with positive mental health outcomes is still in its infancy, researchers are learning that these medications can play a role in the management of conditions including depression, PTSD and preventing cognitive decline.

Anecdotally, people on GLP-1 medications report less desire for alcohol, and some research also shows that these medications could play a role in the treatment of alcohol use disorders and other addictions. Partially, this is because alcohol may cause nausea while on these medications, but also because the reward-seeking signals in the brain are turned down. It may even prevent relapse drinking.

And as someone who started one of these medications myself partially to deal with my own treatment-resistant depression and its associated weight gain, I’m finding this personally true. 

But saying no to the second drink that turns into a third that turns into…well, you get the picture…has been an act of mind over matter. Being on one of these medications has made it so much easier for me to decide whether I actually want the taste of the alcohol or not—and I usually don’t now, something that would have absolutely shocked me 10 years ago. 

However, it’s not all puppies and sunshine for everyone. While many people experience anti-depressant-like effects, others will find an increase in anxiety because of how GLP-1 medications affect serotonin, similarly to how some people will experience this uptick after starting a selective serotonin reuptake inhibitor (SSRI) for depression.

What Happens to Your Mental Health After You Stop Taking a GLP-1 Medication?

At this writing, there is no consensus on whether everyone who starts a GLP-1 medication needs to take it for the rest of their lives to maintain their weight, but studies suggest a lifetime maintenance dose might be required.

“Obesity is a disease that needs to be managed for the rest of your life,” says Rachel Goldman, PhD, FTOS, “and that management may include a GLP-1, another medication, another form of treatment, or even a combination of treatments.

However, for many, the decision may be out of your hands due to finances/insurance or even supply issues. Either way, whether you’re on one of these medications or considering it, you’re likely wondering about how your body and brain will react after you stop taking them.

The cravings may come back, according to preliminary research, though it seems like the longer you have been on the medication, the less likely/less intense this may be. Additionally, Wang says that she’s seen that patients who are honest—with both themselves and her—about their weight loss hurdles pre-medication are the ones who tend to do the best after they have discontinued the medication.

How to Cope With the Different Stages

As someone who’s on one of these GLP-1 drugs myself, I understand all too well some of the things you may be feeling before, during, and after this process, and I want you to know that you’re not alone.

Just the idea of taking this medication may be bringing up many feelings—and the process can be gratifying and also emotionally complicated—so I advise finding a trusted mental health professional (preferably one who specializes in the treatment of obesity, health behavior change, body image, or disordered eating behaviors) to help you work through these changes and stages: 

• Before: Be sure you have a good support system in place, including both personally and with your clinical support team. Wang says that she sees her patients with the best outcomes are those who have strong habits in place and who are in psychotherapy to work on body image and confidence 
• During: Have realistic goals and expectations. Wang says a big factor she needs to work on with her patients is expectation management. “A lot of folks feel like they’re not losing weight fast enough,” she says. Especially as these medications become more popular and widely-taken, it is human nature to want to achieve similar results to our peers. However, we’re all starting from different places both physically and mentally.
• Post: If you do find yourself gaining some weight back or some cravings returning, be gentle with yourself as well as being honest and upfront with your healthcare providers about your concerns.