NeuroNate said:

The mental-health dimension is under-measured in the trial literature and the reports here are consistent enough to take seriously.

NeuroNate said:

...mental health should only be used alongside therapy...

I'd say therapy should be AVAILABLE to all GLP-1 patients, but requiring it as a precondition for treatment would create an access barrier.

Not everyone can afford therapy. Not everyone needs it. Some people do just fine with medication + lifestyle changes. But for those with emotional eating, body image issues, or disordered eating history, therapy is extremely valuable.

My recommendation: make mental health screening part of the initial assessment, offer therapy as a recommended adjunct, but don't gatekeep medication access behind it.

Following on from VanRx_Mike — and this may be the naive question:

What would you measure differently if you were starting again?

LabKate said:

NeuroNate said: ...mental health should only be used alongside therapy...

Recovering from an eating disorder and using mental health: this is a complex situation and I want to be transparent about it.

I have a history of binge eating disorder. My psychiatrist, therapist, and prescribing doctor all collaborate on my care. The GLP-1 agonist has actually been therapeutic — it removes the biological urgency of binge impulses without relying on restriction.

This is NOT appropriate for all ED patients. Anorexia, bulimia, and restrictive EDs require different approaches. But for BED specifically, the evidence and my personal experience are positive. Always involve your mental health team.

Reporting back.

Update: I got the sleep and the intake sorted before deciding it was the drug, and most of the flatness went with them. Not all of it, and I am watching the rest.

Dr.PeteFamMed said:

Recovering from an eating disorder and using mental health: this is a complex situation and I want to be transparent about it.

When to call your doctor about mental health side effects — a reference I wish I'd had:

Call immediately:

• Severe abdominal pain (could be pancreatitis)
• Vision changes (thyroid concern)
• Lump in neck (thyroid nodule)
• Severe vomiting/can't keep fluids down for 24h+

Schedule an appointment:

• Persistent nausea beyond 4 weeks
• Significant hair loss
• Mood changes or depression
• Gallbladder symptoms (RUQ pain after eating)