Step therapy requirements — looking for input

newstart_MO 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…

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.

HPLC_Greg said:

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

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.

newstart_MO 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…

Same experience, arrived at from the opposite direction. Posting only so the count is not one.

Adding the clinical framing, because it changes how the question reads.

newstart_MO 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.