TrialNerd_Beth said:

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

Filing a mild objection. Mild because I might be wrong; an objection because nobody has addressed the case that does not fit. 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.

sean_dublin said:

The weight came off and the harder part started, which is not what any of the material I read had prepared me for.

Before/after narrative for mental health — one year in:

Before (265 lbs): Winded climbing stairs, chronic back pain, pre-diabetic, on 3 medications, dreaded mirrors, avoided photos, social anxiety about my weight.

After (175 lbs): Run 3 miles regularly, pain-free, A1C normal, down to 1 medication, bought a swimsuit for the first time in a decade, actually enjoy being photographed.

Total weight lost: 95 lbs. Total life gained: immeasurable. This isn't just about weight — it's about reclaiming your identity.

kate.chem said:

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

kate.chem 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 pam_stl — and this may be the naive question:

Was that from a primary source or from a summary of one?

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.