GLP-1 Medications and Mental Health: What We’ve Learned Since 2023
Updated from our original September 2023 post
In September 2023, I wrote about semaglutide (commonly known by brand names such as Wegovy and Ozempic) in response to a growing number of client questions. At that time, GLP-1 medications were primarily discussed in the context of diabetes management and emerging weight-loss use. Many clients were understandably curious not only about physical effects, but also about how these medications might impact mental health.
Since then, both the science and real-world clinical experience have evolved rapidly. We now have multiple years of additional data, expanded FDA approvals, and a much clearer understanding that GLP-1 medications affect not only metabolism, but also the brain, behavior, and emotional experience.
This updated post reflects what the research and clinical landscape now tell us, while keeping mental health at the center of the conversation.
A brief refresher: what GLP-1 medications do
GLP-1 receptor agonists and dual agonists were originally developed to improve blood sugar control in people with type 2 diabetes. Many are now FDA-approved for chronic weight management. These medications work by increasing satiety, reducing appetite, slowing gastric emptying, and improving insulin signaling.
What has become increasingly clear since 2023 is that GLP-1 receptors are also active in areas of the brain involved in reward, impulse control, motivation, and stress regulation. That brain involvement is central to understanding their mental health effects.
What the last two plus years have shown
GLP-1s and craving, addiction, and compulsive behaviors
One of the most significant developments since 2023 is growing evidence that GLP-1 medications may reduce cravings beyond food. A randomized clinical trial published in JAMA Psychiatry demonstrated reduced alcohol craving and consumption among participants receiving semaglutide, with secondary reductions in cigarette use among smokers (Hendershot et al., 2024).
Subsequent reviews have reinforced this finding, suggesting GLP-1s may dampen reward signaling in the brain’s dopamine pathways, which are involved in addiction and compulsive behaviors (Kalra et al., 2024; Suchankova et al., 2023).
This does not mean GLP-1s are an addiction treatment. However, it does suggest a biologically plausible reason some people report reduced urges related to alcohol, food, or other compulsive patterns.
Mental health and GLP-1s: benefits, risks, and nuance
Mental health responses to GLP-1s vary widely. Below is a balanced view that reflects both research findings and clinical experience.
Potential mental health benefits
Reduced “food noise” and cognitive load Many individuals describe a quieting of constant food-related thoughts. For some, this creates mental relief, improved focus, and reduced anxiety around eating.
Improved confidence and self-esteem Weight loss and improved metabolic health can enhance body confidence, mobility, and self-efficacy. These changes can positively impact mood and social engagement.
Indirect mood improvement Better sleep, improved energy, and reduced inflammation may contribute to mood stability, particularly for individuals whose depression or anxiety was compounded by metabolic stress.
Potential mental health risks and challenges
Anxiety during adjustment Early side effects such as nausea, appetite changes, or fatigue can increase anxiety, particularly in individuals who are already body- or health-focused.
Depression vulnerability during rapid change Rapid weight loss can be emotionally destabilizing for some. Identity shifts, grief related to past coping mechanisms, or unexpected reactions from others can surface.
Eating disorder risk For individuals with a history of disordered eating, GLP-1-induced appetite suppression can unintentionally reinforce restriction or trigger old patterns. This population requires careful screening and close collaboration between medical and mental health providers.
Injection-related anxiety Some individuals experience distress related to self-injection, which can compound anxiety if not addressed with education and support.
Suicidality concerns: what we know now Regulatory reviews by the FDA and EMA have not found evidence that GLP-1s cause suicidal thoughts or behaviors, though monitoring continues (FDA, 2024; EMA, 2024). Large cohort studies have shown no increased risk compared to other metabolic medications (Douros et al., 2025). Ongoing mental health monitoring remains best practice.
Fertility and reproductive health
Improved metabolic health can increase fertility, particularly for individuals with insulin resistance or PCOS. Research since 2023 has shown improvements in ovulation and menstrual regularity for some patients using GLP-1s (Escobar-Morreale et al., 2024).
Two important cautions deserve emphasis:
GLP-1 medications are not recommended during pregnancy, and planned discontinuation prior to conception is advised.
Tirzepatide may reduce the effectiveness of oral contraceptives due to delayed gastric emptying, making backup contraception important during dose changes (Eli Lilly and Company, 2024).
Brain health and dementia risk: promising but evolving
Large observational studies have associated GLP-1 use with a lower risk of Alzheimer’s disease compared to some other diabetes treatments (Xie et al., 2023). Meta-analyses suggest potential cognitive protection at a population level (Cukierman-Yaffe et al., 2025).
Early clinical trials exploring direct neuroprotective effects have shown mixed results. Some pilot studies suggest preservation of brain metabolism, while others have not demonstrated meaningful cognitive improvement. At this time, GLP-1s should not be viewed as dementia treatments, but their role in long-term brain health remains an active area of research.
Final thoughts from a mental health perspective
Compared to 2023, the conversation around GLP-1s is more grounded and more complex. These medications can be life-changing for some individuals, physically and psychologically. For others, they may introduce emotional challenges that require additional support.
The most successful outcomes tend to occur when GLP-1 use is paired with:
thoughtful medical supervision
adequate nutrition and protein intake
realistic expectations
attention to mood, anxiety, and identity shifts
ongoing mental health support when indicated
Clinical disclaimer
This content is intended for educational purposes only and does not replace individualized medical or mental health care. GLP-1 medications should be prescribed and monitored by a qualified medical provider. Individuals with a history of eating disorders, depression, anxiety, trauma, or substance use concerns are encouraged to consult both medical and mental health professionals when considering GLP-1 treatment.
By Wendy Galyen, LCSW, BC-TMH Owner, Thrive for Life Counseling LLC
Works Cited
GLP-1s, Alcohol Use, Addiction & Reward Pathways
Hendershot, C. S., Wardell, J. D., Samokhvalov, A. V., et al. (2024). Semaglutide and alcohol consumption in adults with overweight or obesity: A randomized clinical trial. JAMA Psychiatry, 81(7), 623–632. https://jamanetwork.com/journals/jamapsychiatry
Kalra, S., Sahay, R., & Gupta, Y. (2024). GLP-1 receptor agonists and addiction: Emerging neurobiological mechanisms. Diabetes Therapy, 15(2), 345–357. https://link.springer.com/journal/13300
Suchankova, P., et al. (2023). GLP-1 receptor agonists reduce alcohol intake: Evidence from preclinical and clinical studies. Frontiers in Endocrinology, 14, 1184302. https://www.frontiersin.org/journals/endocrinology
Mental Health, Depression & Suicidality
U.S. Food & Drug Administration. (2024). Update on FDA’s evaluation of reports of suicidal thoughts in patients treated with GLP-1 receptor agonists. https://www.fda.gov
Douros, A., et al. (2025). Glucagon-like peptide-1 receptor agonists and risk of suicidality: A multinational cohort study. BMJ, 388, e079421. https://www.bmj.com
European Medicines Agency. (2024). EMA safety review of GLP-1 receptor agonists and psychiatric adverse events. https://www.ema.europa.eu
Fertility, PCOS & Reproductive Health
Escobar-Morreale, H. F., et al. (2024). Effects of GLP-1 receptor agonists on reproductive outcomes in women with polycystic ovary syndrome. Human Reproduction Update, 30(1), 67–85. https://academic.oup.com/humupd
Novo Nordisk. (2024). Wegovy (semaglutide) prescribing information. https://www.novonordisk-us.com
Eli Lilly and Company. (2024). Zepbound (tirzepatide) prescribing information and contraceptive considerations. https://www.lilly.com
Brain Health, Cognition & Dementia
Xie, Y., et al. (2023). Comparative effectiveness of GLP-1 receptor agonists and risk of Alzheimer’s disease. JAMA Neurology, 80(7), 730–738. https://jamanetwork.com/journals/jamaneurology
Cukierman-Yaffe, T., et al. (2025). GLP-1 receptor agonists and dementia outcomes: A meta-analysis of randomized trials. Diabetes, Obesity and Metabolism, 27(1), 45–56. https://dom-pubs.onlinelibrary.wiley.com
Gejl, M., et al. (2023). Liraglutide effects on brain glucose metabolism in Alzheimer’s disease: A randomized controlled trial. Nature Medicine, 29, 198–206. https://www.nature.com/naturemedicine
Metabolic Health & Broader Clinical Context
Wilding, J. P. H., et al. (2021). Once-weekly semaglutide in adults with overweight or obesity. New England Journal of Medicine, 384, 989–1002. https://www.nejm.org
Jastreboff, A. M., et al. (2022). Tirzepatide once weekly for the treatment of obesity. New England Journal of Medicine, 387, 205–216. https://www.nejm.org