Recently, semaglutide drugs such as Ozempic and Wegovy have skyrocketed in popularity for their ability to induce weight loss in patients both with and without diabetes. With reports of unexpected side effects, such as breast deflation (dubbed ‘Ozempic breasts’), changes in taste perception (aka, ‘Ozempic tongue’), and more, both physicians and consumers are now noting unexpected mental health changes as another (primarily negative) treatment side effect.

‘Ozempic personality’ represents the hidden psychological toll of semaglutide medications prescribed for weight loss, with reports of patients experiencing things like worsening anxiety and depression, among other psychiatric effects.

Peeples J. 'Ozempic Personality': Why You May Not Act Like Yourself on Weight Loss Drugs. Healthline. April 23, 2024.

 

 

Dosage matters

 

While Wegovy’s prescribing label lists potential mental health side effects, Ozempic’s does not—at least not yet. The clinical dose of semaglutide in Wegovy is higher than that in Ozempic, leading some experts to question whether the higher dose also leads to a higher risk of negative mental health effects.

Wegovy [prescribing information]. Plainsboro, NJ: Novo Nordisk; 2023.

Arillota D, Floresta G, Guirguis A, et al. GLP-1 receptor agonists and related mental health issues; insights from a range of social media platforms using a mixed-methods approach. Brain Sci. 2023;13(11):1503.

It's also worth noting that Wegovy is specifically prescribed for weight loss—not for diabetes management, per Ozempic’s label.

 

 

Further, Wegovy should be discontinued “in patients who experience suicidal thoughts or behaviours [and] should be avoided in patients with a history of suicidal attempts or active suicidal ideation.”

Wegovy [prescribing information]. Plainsboro, NJ: Novo Nordisk; 2023.

 

This appears to be only a precautionary measure in Wegovy’s prescribing information related to mental health concerns, due to the history of similar risks with other weight-management drugs in the past. However, the label does not note any adverse mental health effects in its clinical trials summary (Section 6.1) or in its postmarketing experience section (Section 6.2).

Wegovy [prescribing information]. Plainsboro, NJ: Novo Nordisk; 2023.

 

 

Mental health impacts, per social media

 

Ozempic has been used off-label for weight loss even in patients without diabetes, particularly before the approval of Wegovy. In a rather unique mixed-methods approach, Arillotta and colleagues collected data from social media posts about Ozempic, specifically.

Arillota D, Floresta G, Guirguis A, et al. GLP-1 receptor agonists and related mental health issues; insights from a range of social media platforms using a mixed-methods approach. Brain Sci. 2023;13(11):1503.

 

The study authors note the challenges in “establishing a clear cause-and-effect link between metabolic diseases, depression, and medications,” due to the potential reciprocity and common underlying mechanisms, as well as differences among individual patients.

Arillota D, Floresta G, Guirguis A, et al. GLP-1 receptor agonists and related mental health issues; insights from a range of social media platforms using a mixed-methods approach. Brain Sci. 2023;13(11):1503.

 

 

Additional research needed

 

Further research is needed to better determine and understand the safety profile of GLP-1 agonists such as semaglutide, particularly when used for weight loss. This includes potential mental health side effects across a wide range of patients.

One such study, currently underway, is examining specifically the long-term effects of add-on treatment with semaglutide on metabolic status in patients with pre-diabetes and diabetes who have been diagnosed with schizophrenia spectrum disorder and have initiated treatment with clozapine or olanzapine within the last 5 years.

Sass MR, Danielsen AA, Kohler-Forsberg O, et al. Effect of the GLP-1 receptor agonist semaglutide on metabolic disturbances in clozapine-treated or olanzapine-treated patients with a schizophrenia spectrum disorder: study protocol of a placebo-controlled, randomized clinical trial (SemaPsychiatry). BMJ Open. 2023;13(1):e068652.

 

Given the popularity of these agents, there will no doubt be further studies on the horizon to delineate the potential mental health effects, and post-marketing surveillance will continue to be needed as real-world experience grows.