GLP-1 therapy in patients over 65 — July 2024 — Public Square

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Apr 6, 2025 at 4:10 AM#1

This is the version of the explanation I wish somebody had given me, written down before I forget what confused me. It is about mood and mental health, and it is deliberately narrow — everything I am not confident about is marked as such.

What is actually established

The mental-health dimension is under-measured in the trial literature and the reports here are consistent enough to take seriously. On the positive side: reduced anxiety around food, better self-image, more confidence. On the difficult side: grief for the years lost, identity disruption, relationships built around eating, and the loss of food as a coping mechanism with nothing put in its place. Rarer but real: anhedonia and emotional flatness. Regulators have started asking for validated patient-reported outcomes in this class; the existing data gap is not evidence of absence.

The condition it depends on

For anyone with an eating-disorder history this needs a clinician in the loop rather than a forum. The same drug can be therapeutic in binge-eating disorder and actively harmful in a restrictive disorder.

What I am not sure about

The bit I cannot resolve on my own is how people separated a drug effect from the ordinary consequences of a large deficit and disrupted sleep, because I cannot. Not looking for reassurance. Looking for the part I have got wrong.

— andrew_nyc · corrections welcome and will be edited into this post with credit

40 18Dr.KarenChen, Dr.NateNeph, PharmD_Rodriguez and 37 others

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LibrarianMeg

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Apr 6, 2025 at 5:18 AM#2

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

andrew_nyc 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.

41 19PharmD_Rodriguez, julia.endo, JessicaM_2024 and 38 others

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Dr.GastroMayo

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Apr 6, 2025 at 6:26 AM#3

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

Pushing back on andrew_nyc here. 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.

Last edited: Apr 6, 2025 at 11:26 AM

42 20COA_Karl, MikeFit_NJ, InsuranceTom and 39 others

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LipidDoc_ATL

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Apr 6, 2025 at 7:34 AM#4

Dr.GastroMayo said:
I would be careful about how confidently the flatness reports get attributed.

Mood changes on mental health: I want to be transparent — I went through a rough patch emotionally around month 4. Not depression exactly, but a weird flatness. Food was my main coping mechanism and without that, I had to develop new ones.

Therapy has been essential. I'd strongly recommend anyone starting GLP-1 therapy also invest in mental health support. The physical transformation is only half the journey.

43 21DebRD_ATL, KristenIndy, MarkLI_maint and 40 others

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