What is your approach to GLP-1 agonists as a psychiatrist in patients who are overweight or have eating-related disorders?
More and more of my patients have been asking for these medications in the past 12 months. For context, my niche is psychotic and bipolar disorders. Most (if not all) of my patients are on a combination of mood stabilizers and antipsychotics that are notorious for causing significant weight gain. Co...
The usual meds we prescribe often cause significant weight gain. It seems reasonable to me that we must account for that side effect and help our patients deal with it. I don't think it's too much to ask of us that we educate ourselves on GLP-1 agonists and prescribe them thoughtfully.
GLP-1 dropped alcohol drinks in severe alcoholics by 50%. That is the same fraction as in eating. It definitely messes with the head, not just the gut. No treatment for addiction comes close. It should be tried in all addictions, including behavioral addictions.
Being board-certified in both psychiatry and obesity medicine, I find that patients in my practice who are suffering from depression, anxiety, insomnia, and especially patients who have been willing to gain weight on their psychiatric meds, want to get to a normal weight for the same reasons as anyo...
If the patient has metabolic syndrome (and in some cases, some substance use disorder), GLP-1 agonists can be very effective.
I have had a patient with BED who has had significant benefit with vyvanse after she started on semaglutide by PCP. She experienced vyvanse as helping with the obsessive thinking about food, which persisted even when she could not physically eat due to nausea and vomiting from semaglutide.
I hope some data comes out regarding Binge Eating Disorder. I had one patient who had good reduction on binge eating with GLP-1 medication, but couldn't afford it, and then the response to non-GLP1 medications was not as good (i.e., SSRIs, vyvanse, topiramate).