Does Ozempic Cause Suicidal Thoughts? Here's What To Know

• Ozempic, Wegovy, and Saxenda are under investigation by the European Medicines Agency for possibly causing consumers to self-harm or experience suicidal thoughts.
• Clinical trials of the drug did not see this to be a large risk factor, but experts note a changing population of those taking the drugs may have shifted risk levels.
• Experts recommend individuals with pressing mental health issues avoid going on a new weight loss drug.

European regulators are reviewing data on suicidal thoughts in people taking GLP-1 receptor agonists (GLP-1 RA), including Ozempic, Wegovy, and Saxenda.  

The European Medicines Agency started the review—which includes 150 reports of potential cases of self-injury and suicidal thoughts of people on the medications—earlier this month. The organization is expected to have a conclusion in November.

The investigation was prompted by three cases of suicidal thoughts and thoughts of self-harm reported to the Icelandic Medicines Agency.

The agency is reviewing adverse effects and said that the presence of reports of self-harm or thoughts about self-harm, “does not necessarily mean that a medicine caused the adverse event.”

In the United States, only Wegovy and Saxenda are approved by the Food and Drug Administration (FDA) for weight loss. Ozempic is approved to treat type 2 diabetes (as is Wegovy) but is sometimes prescribed off-label as a weight loss medication.

Andrew Kraftson, MD, director of the Weight Navigation Program at Michigan Medicine, explained that if the agency does find an association between the medications and self-harm or suicidal thinking, the risk is likely low.

The medications are not new, he said. The first GLP-1 RA medications were approved by the FDA in 2005, and he’s been prescribing them to patients for 18 years.

Kraftson also noted that the change in patient population, from those with type 2 diabetes to those with either diabetes or obesity, could trigger changes in side effects, though it’s unlikely these changes would be drastic in this case.

“We should acknowledge that obesity is a complex disease and so the incidence of coexisting mental health disorders is quite high,” he told Health. “Sometimes we do a better job of treating the weight number and not as robust of a job treating the mental health issues related to weight.”

Where to Get Help

If you or a loved one are struggling with suicide, call 988. You also can contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

(800) 662-4357

Weight Management and Mental Illness Are Often Connected

According to Kraftson, Wegovy does have a boilerplate warning of a potential increased risk of suicide that most, if not all, weight loss medications have. But the clinical trials of the drug did not show this to be a risk. 

Adverse side effects of drugs are monitored during clinical trials, but it’s normal for new ones to pop up once a drug is approved for use by the general public.

Clinical trial enrollment criteria are typically very stringent, so it doesn’t always represent everyone who will use the medication, Jaime Almandoz, MD, medical director of the Weight Wellness Program at UT Southwestern Medical Center in Dallas told Health.

“Given that over half of adults in the U.S. are living with obesity, the likelihood that there are going to be physical or mental health side effects that were not seen in the clinical trials is a reality,” he said.

When adverse events do arise, agencies around the world, including the FDA, track the incidences and launch such investigations as this one if there appears to be a pattern.

Kraftson pointed out that while risk is always a factor in taking medications, the drugs in question are not new.

“The number of individuals with diabetes is not small and a large number of them have been [on these drugs] for years,” he said. “The fact that we are not seeing this come up in our diabetes population is of note.”

Although type 2 diabetes and obesity are unique conditions, they do often overlap, he added. As much as 90% of people with type 2 diabetes may also have overweight or obesity.

“I don’t want to minimize the experience of those that report symptoms,” Kraftson said, “but with any medications, there are risks and benefits and in medicine, we are constantly weighing those risks and benefits.”

He emphasized that the benefits of the medications have been high.

“Still, it’s always good to have thoughtful discussions with your medical professional and there should be an appropriate safety monitoring plan,” he said.

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Mental Health Is Part of Obesity Care

Both Almandoz and Kraftson said that including mental health care is paramount in obesity treatment, whether or not a link is found between thoughts of self-harm and the GLP-1 RA medications.

Almandoz recommends that people who are prescribed these medications should first be given a mental health screening.

“We need to treat people as people, not a lab value or a number on the scale,” he said. “That includes adequate risk screening at baseline, before someone starts a drug.”

For now, Kraftson said the investigation is not changing his prescribing practices.

“If someone has unstable mental health issues, I’m typically not starting them on a weight loss regime,” he said. “I’m encouraging them to have their mental health issues addressed first, then getting [approval] from the mental health team to start a weight loss regimen.”

All providers that prescribe weight loss medications should do a complete and thorough history of a patient, including their mental health history, Almandoz added.

Comparing information about a person’s weight gain and loss patterns throughout their lives to their life circumstances may also reveal triggers that play a role in a person’s obesity.

“Life is very stressful and people with obesity may face a variety of challenges as their obesity increases, including not being treated fairly or kindly because of their weight, which adds to their stress,” said Almandoz, adding that sometimes, people with mental health conditions are prescribed medications that cause weight gain.

“Knowing your patient is key, as is making sure you have an open dialogue where if things change, patients have the opportunity to talk about it,” he said.

Almandoz also recommends that practitioners should be checking in on patients’ stress, sleep, and mood as they progress through weight loss journeys.

“It’s a more holistic way of treating obesity,” he said, “and we can monitor people who may be at risk for people who are at higher risk for suicide ideation.”

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