KevinCompounds said:

Anxiety increase on mental health: counterintuitive, but losing weight rapidly triggered anxiety for me.

I read this differently from KevinCompounds, on substance rather than tone. I would be careful about how confidently the flatness reports get attributed. Rapid weight loss, a large deficit and disrupted sleep produce low mood on their own, and separating that from a drug effect is genuinely hard.

Dr.ReproEndo said:

My mood has been flatter since about month four and I genuinely cannot work out whether that is the drug, the deficit, or the fact that I no longer…

One year anniversary on mental health — reflections:

What I wish I'd known: the side effects are temporary, the benefits compound over time, protein is more important than I thought, and the mental health aspect needs as much attention as the physical.

What surprised me: how much my relationship with food changed, the cascade of health improvements beyond weight, and how supportive this community is.

What I'd do differently: start therapy earlier, prioritize resistance training from day 1, and stop comparing my progress to others. Everyone's journey is unique.

Dr.BariatricHTX said:

I would be careful about how confidently the flatness reports get attributed.

Therapy insights from my mental health journey: my therapist introduced me to the concept of "identity updating" — the psychological work of becoming a new version of yourself.

Key realizations: I used food to manage emotions, I had internalized fatphobia that I'm still unpacking, my social identity was partly built around being "the big guy/girl," and learning to accept compliments is surprisingly hard when you've been invisible for years.

Physical transformation without emotional processing is unstable. Do both.

One thing that is still open after gary_naperville’s answer:

Did your prescriber agree with that reading, and if not what was their objection?

Closing the loop on my own question.

Follow-up — I put something in the gap where food used to be rather than waiting for the gap to close on its own. That was the part nobody told me.