GLP-1 drugs, like Ozempic, Wegovy and Zepbound, are being used more in specialties to treat a number of medical conditions, but behavioral health providers are taking a cautious approach to the drugs.
“Behavioral health providers are exploring this space and watching the data closely,” Moira Rynn, MD, interim co-division director of behavioral medicine and neurosciences and chair of psychiatry and behavioral sciences at Durham, N.C.-based Duke Health, told Becker’s. “There’s a suggestion that GLP-1s may offer benefits across various mental health conditions, but it’s still very new.”
A recent study found patients with opioid use disorder who were taking a GLP-1 drug had a 40% lower incidence of overdose than patients not taking the drugs. It also found patients with alcohol use disorder taking GLP-1 drugs had a 50% lower rate of alcohol intoxication than those not prescribed the drugs.
More research is underway, but in the meantime, behavioral health providers are keeping an eye on how these drugs impact patients.
What providers are seeing
Leaders also told Becker’s that many of their patients are prescribed GLP-1 medications to manage their obesity and diabetes, and for the most part, this does not impact the psychiatric treatment plans. There are only a few considerations providers keep in mind. First, GLP-1s can cause gastrointestinal side effects like nausea and vomiting, which can be a side effect of some psychiatric medications, so providers try to avoid combining medications that could amplify this issue. Second, they also track patient weight to ensure the patient is receiving the proper dose of medication. tThird, for patients with eating disorders, GLP-1s come with a few extra concerns in how it impacts eating habits.
Currently, mental health providers are not prescribing GLP-1s to treat behavioral health conditions, but they have noticed differences among patients who are prescribed the drugs by their physicians. Anecdotally, these differences include patients reporting GLP-1s help quiet their cravings for substances and alcohol, reduce depression and anxiety levels, and improve their mood.
Although patients are not yet broadly asking providers for GLP-1s as treatment for behavioral health disorders, it’s a trend they are bracing for.
“I have had patients come to me asking about these medications,” Dr. Rynn said. “Often, they’ve been referred by a physician treating them for other medical concerns. For example, I have a patient with alcohol use disorder who asked if GLP-1s might be an option if first-line treatments don’t work. My response is always: Let’s try evidence-based treatments first, and if those don’t succeed, we can certainly revisit it as a potential next step.”
Although providers are shying away from prescribing GLP-1s to treat behavioral health conditions, they are using them to counteract some psychiatric mediation side effects.
Where GLP-1s are being used
Philadelphia-based Penn Medicine is working to create a coordinated effort to address a common side effect of psychiatric medications: significant weight gain.
“For the past three decades, we’ve found ourselves in a tough position,” Katharine Dalke, MD, vice chair for clinical operations in the department of psychiatry at Penn Medicine, told Becker’s. “We can reduce depression, manage mania, improve psychosis, but at the cost of creating other serious medical problems. And until recently, our interventions to mitigate those effects have been fairly crude.”
This is where GLP-1s could play a crucial role. GLP-1s have shown promise in addressing metabolic side effects, potentially helping patients stay on psychiatric medications longer and more comfortably.
“A few of our providers have already been exploring this, but starting this summer, we’re hiring a psychiatrist whose primary focus is on this intersection: how psychiatric medications contribute to obesity and other metabolic issues,” Dr. Dalke said. “GLP-1s will be a key part of his clinical work, and we’re very excited to see what we learn. It’s still early, but the potential is definitely there.”
The balance that systems must strike
GLP-1s are an exciting new drug in the field, with research on their use evolving almost by the day. But like all treatments, there are concerns that need to be weighed.
“From a systems perspective, we really need to weigh the cost-benefit, accessibility and evidence base as we think about integrating GLP-1s more broadly into behavioral healthcare,” Akhil Anand, MD, addiction psychiatrist at Cleveland Clinic, told Becker’s. “We don’t yet have solid, long-term data on how effective these medications are for psychiatric or addiction-related conditions. These drugs are expensive and many patients — especially those in vulnerable populations — don’t have access to them. And once patients stop taking them, many of the benefits tend to reverse. That’s something providers and systems need to think about when evaluating long-term feasibility.”
There are also important nutritional and lifestyle considerations for adolescent and pediatric patients who are currently the fastest growing population using the drug.
“One area where we need to be particularly careful is in adolescents,” Dr. Rynn said. “These compounds affect appetite and caloric intake, which are critical for proper growth and development. There’s concern that young people might be prescribed GLP-1s in a vacuum without a broader lifestyle plan or support system in place. Pediatric providers are rightly concerned that the media attention around these drugs could lead to inappropriate use, especially if it overshadows the importance of balanced nutrition, physical activity and developmental needs in this population.”
