Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), such as semaglutide and liraglutide (AKA. Ozempic, Wegovy) have gained prominence for their efficacy in managing type 2 diabetes and aiding weight loss. However, prescribing these medications necessitates a comprehensive evaluation of various psychological factors as well as physical factors, to ensure optimal patient outcomes.
Psychological Factors Influencing GLP-1 RA Prescription
When considering GLP-1 RAs for patients, many doctors assess several psychological aspects:
•Mental Health History: Emerging evidence suggests a potential association between GLP-1 RAs and psychiatric adverse events, including depression and suicidal thoughts. A study analysing adverse event reports indicated a higher percentage of psychiatric issues among GLP-1 RA users, particularly women. Consequently, a thorough mental health evaluation is crucial before initiating treatment.
•Eating Behaviours: GLP-1 RAs influence appetite and satiety, making it essential to understand a patient’s relationship with food. Research has shown that individuals with disordered eating patterns may experience exacerbation of symptoms or misuse the medication. The National Eating Disorders Association has raised concerns about the potential impact of GLP-1 RAs on eating disorder symptomatology, emphasising the need for careful assessment. This can include assessing for eating disorder risk using a screening questionnaire like the Eating Disorder Examination – Questionnaire.
Positive Psychological Traits Favouring GLP-1 RA Therapy
Certain psychological characteristics can enhance the effectiveness of GLP-1 RA treatment, and be safer:
•High Motivation Levels: Patients committed to lifestyle modifications, such as balanced nutrition and regular physical activity, are more likely to achieve sustained benefits from GLP-1 RAs.
•Strong Support Systems: Access to robust social or familial support can bolster adherence to treatment regimens and facilitate necessary lifestyle changes.
•Capacity: Patients who are able to effectively weigh up the personal risks and benefits of the treatment for them.
Psychological Contraindications to GLP-1 RA Therapy
Conversely, specific psychological factors may contraindicate the use of GLP-1 RAs:
•Active Eating Disorders: The appetite-suppressing properties of GLP-1 RAs can be detrimental to individuals with active eating disorders. The Eating Recovery Center advises providers to exercise caution when prescribing these medications to such populations, as they may harm individuals in eating disorder recovery. While there is emerging evidence to support the use of GLP-1 RAs for Binge Eating Disorder, it is important that these prescriptions are supplemented with support from a psychologist and/or dietitian to address the underlying mechanisms of the disorder.
•Severe Depression or Suicidal Ideation: Given reports linking GLP-1 RAs to increased risks of depression and suicidal behaviour, patients with these conditions require meticulous evaluation. A study highlighted a significant association between GLP-1 RA treatment and an increased risk of psychiatric disorders, including major depression and suicidal behavior.
GLP-1 RAs and Eating Disorders: Research Insights
The interaction between GLP-1 RAs and eating disorders is complex:
•Potential Benefits: Some studies suggest that GLP-1 RAs may reduce binge eating episodes and body weight in patients with binge eating disorder (BED). For instance, a pilot study reported that dulaglutide reduced binge episodes in type 2 diabetic patients with BED.
•Risks of Misuse: Conversely, there is concern about the misuse of GLP-1 RAs among individuals without medical supervision. There are also concerns that GLP-1 RAs are unlikely to address the underlying mechanisms of an eating disorder. The Butterfly Foundation has warned against such practices, highlighting the dangers of unprescribed medication leading to potentially fatal consequences.
ReadyMind’s Role in Supporting GLP-1 RA Therapy
At ReadyMind, our psychologists offer tailored services to guide patients considering or undergoing GLP-1 RA treatment. We accept referral from doctors seeking support with psychological assessment of patients before, during or after GLP-1 treatment:
•Comprehensive Assessments: We conduct in-depth evaluations to identify any psychological factors that may influence treatment outcomes, ensuring that GLP-1 RAs are appropriate for each individual.
•Therapeutic Support: Our team provides counselling to address underlying issues related to eating behaviors, body image, and mental health, fostering a holistic approach to weight management.
•Collaborative Care: We work closely with medical professionals to monitor patients’ psychological well-being throughout their treatment journey, promptly addressing any emerging concerns.
ReadyMind also has a range of brief, automated screening tools available which can be used to assess a patient’s initial suitability for GLP-1 treatment, or the need for further assessment. These include the Eating Disorder Examination Questionnaire, the Eating Attitudes Test and measures of body dysmorphia, such as the Dysmorphic Concern Questionnaire.
By integrating psychological expertise into the management of GLP-1 RA therapy, ReadyMind ensures that patients are well-prepared and supported, maximising the potential benefits of treatment while mitigating risks.
