Some psychiatrists have started prescribing Ozempic

It was Joanna Acevedo’s psychiatrist who first proposed the idea of ​​a weight-loss drug. Since 2018, Ms. Acevedo has relied on antipsychotic medications to treat her bipolar disorder. The drugs kept her paranoia at bay — actually keeping her alive, she said. They also caused her to gain 70 pounds. At age 26, she had become prediabetic.

During a routine appointment this winter, Ms. Acevedo told her psychiatrist that she simply no longer felt comfortable with her body. She had brought it up before, but this time he made a suggestion that surprised her. Had she heard of the new weight-loss drugs?

He referred her to a weight-loss clinic to get a prescription for Wegovy, an injectable drug that contains the same substance as the sought-after drug Ozempic.

These drugs have changed the way doctors treat diabetes and obesity. Now some psychiatrists are turning to drugs to combat weight gain often comes along almost all antipsychotics and some medicines used to treat depression and anxiety. The New York Times heard from 13 leading mental health facilities and psychiatric units of major health care systems in the United States. Six said they were already recommending or prescribing medications like Ozempic to their patients. Seven said they were not ready to do so, citing concerns about safety and side effects and the belief that prescribing weight-loss drugs was outside their authority.

Their answers reflect a new debate in the mental health field about prescribing a drug that patients will most likely continue taking indefinitely. with only a limited understanding of how people with serious mental illness fare on these medications.

“We’re talking about a very vulnerable population,” says Dr. Mahavir Agarwal, a psychiatrist and scientist at the Center for Addiction and Mental Health in Toronto. Dr. Agarwal leads some of the earliest research in the use of semaglutide, the substance in Wegovy and Ozempic, to help patients taking antipsychotics lose weight. “There is virtually no data” about people with depression, bipolar disorder or other mental health conditions taking semaglutide, he said — and until there is more evidence, “you’re kind of flying blind.”

However, some doctors argue that patients cannot wait. People often stop taking psychiatric medications or refuse to start them altogether because they don’t want to gain weight. a 2019 review found that patients gained more than seven percent of their body weight from antipsychotics, and five percent from certain antidepressants. There is no clear-cut explanation for the link between psychiatric medications and weight gain, but experts theorize that the drugs may increase appetite and slow metabolism. Not everyone gains weight from psychiatric medications, and it is difficult to isolate the role that other factors – such as diet, exercise and health conditions – may play.

Those who gain significant weight, like Ms. Acevedo, may face an increased risk of prediabetes, heart disease and other problems.

“This has been a major scourge on our population,” said Dr. Dost Öngür, chief of the department of psychotic disorders at McLean Hospital in Massachusetts, where, he said, all mental health providers now assess whether patients with psychotic disorders should take medications such as Wegovy and Ozempic.

For Ms. Acevedo, even the sometimes painful side effects of the weekly Wegovy injections — she vomited five times a day in the first month of taking the drug — were worth it.

“I felt like I had no other options,” said Ms. Acevedo, who later transferred to Ozempic. Thanks to the antipsychotics, she no longer had periodic delusions that the people around her were not who they said they were. “I am not ruled by a disease that is actively trying to kill me,” she said. But she felt like she was trading one aspect of her health for another. The more weight Ms. Acevedo, a longtime athlete, gained, the harder it was to move. Since starting a weight-loss medication, she has lost 30 pounds and her blood sugar levels have dropped. She started lifting weights. “Being able to feel like I can be powerful in my body again — that’s really important to me,” she said.

“Without the Ozempic, I can’t take my psychiatric medications,” she said. “They kind of work hand in hand.”

A ‘game changer’

In the summer of 2022, Dr. Jennifer Kruse, a faculty psychiatrist at the University of California, Los Angeles, emailed colleagues, offering to see patients interested in weight-loss medications. “I think these new agents could really be a game changer,” she wrote. Her agenda quickly became full.

In the past, some psychiatrists have prescribed medications such as metformin and liraglutide to help patients combat weight gain. But none have proven as powerful as the new drugs.

Psychiatrists who prescribe Wegovy, Ozempic and a similar drug, Mounjaro, emphasize that they monitor their patients’ mood using the drugs.

It’s not a “go-to drug,” said Dr. Shebani Sethi, director of Stanford’s Metabolic psychiatry program and often sees patients referred by psychiatrists. Before prescribing a drug like Wegovy, she screens people for eating disorders and considers them their medical history and body composition. She requires patients to do resistance training to counteract the potential loss of muscle mass from the drugs.

But if a patient understands the risks, “I’m pretty open,” she said. “If they want it, I will prescribe it.”

And patients insist on it.

Amanda Romero, 35, started taking the antidepressant Lexapro in 2015 after her 4-year-old daughter was diagnosed with cancer and the intrusive thoughts she had been experiencing for years increased. The drug helped, and she continued taking it after her daughter went into remission, eventually switching to Prozac. But no matter how many miles she logged in her Peloton or in her North Carolina neighborhood, or how strictly she adhered to her doctor’s dietary recommendations, her weight kept rising. By last spring, she had gained 70 pounds.

“I just thought, what happened to me?” she said.

Stopping antidepressants was not an option; she had tried that when her daughter finished chemotherapy. She cried several times a day and panicked when her phone rang, terrified that it was bad news.

The antidepressant gave her more control over her brain. Wegovy gave her more control over her body. The drug, which Ms. Romero started in February, made her so nauseous that she took a pregnancy test, but she has since lost all the weight.

What doctors don’t know yet

Some doctors remain concerned. Dr. Ilana Cohen, a psychiatrist at Sheppard Pratt in Maryland, said she and other colleagues in the psychiatric hospital system avoid the drugs, in part because anecdotal reports that patients in Europe had suicidal thoughts while taking them. European health regulators are currently assessing data on drugs like Ozempic and the risk of suicidal thoughts.

Clinical trials of Wegovy have excluded people with recent suicidal thoughts, a history of suicide attempts, serious conditions such as schizophrenia or bipolar disorder and those who have had depression in the past two years.

“These medications are really not well studied or designed for this population,” said Dr. Cohen. Researchers study How these medications can work in people with mental illnesses.

In clinical trials of Saxenda, an older drug approved for weight loss, slightly more participants taking the drug had suicidal thoughts compared to those given a placebo, although there was insufficient evidence that the drug was the cause. The FDA requires weight management drugs that act on the central nervous system — including Saxenda and later Wegovy — to carry a warning about suicidal ideation.

Other doctors said they were concerned that the drugs, which significantly reduce how much patients are willing or able to eat, could worsen problems for people with depression and anxiety, who may be at higher risk for cancer. anorexia.

“I don’t want to encourage a drug that could actually make it worse or easier for someone to have disordered eating,” says Sofia Rydin-Gray, a clinical psychologist at Duke Psychiatry and Behavioral Sciences.

Some patients are also torn between a drug that comes with high costs and sometimes unpleasant side effects, and the alternative: unwanted weight gain.

Ms. Romero recently stopped using Wegovy; the side effects and the more than $1,300 a month she paid out of pocket were too much, even though she knew she was at risk of regaining the weight.

Kristen Eckhardt, a 40-year-old from Hastings, Neb., started taking Ozempic in March after gaining 20 pounds and developing prediabetes while taking Vraylar for depression. She was grateful that she felt more stable, she said — less despondent and less irritable around her children. But the weight gain confused her. “Your self-esteem really takes a hit,” she said.

She felt left out when she started Ozempic; her stomach ached constantly. Those side effects have improved, but her blood sugar levels and weight loss have remained stable.

“I’m really scared to go off Ozempic because I don’t want to gain the weight back. And I know better than to just stop taking mental health medications. That is not the right way,” Ms. Eckhardt said. “So for now I’m definitely on all of them.”