Dr.CardioMD said:

AmyNC_wife said: ...mental health should only be used alongside therapy...

Pushing back on Dr.CardioMD here. I would be careful about how confidently the flatness reports get attributed. Rapid weight loss, a large deficit and disrupted sleep produce low mood on their own, and separating that from a drug effect is genuinely hard.

AmyNC_wife said:

The weight came off and the harder part started, which is not what any of the material I read had prepared me for.

Before/after narrative for mental health — one year in:

Before (271 lbs): Winded climbing stairs, chronic back pain, pre-diabetic, on 3 medications, dreaded mirrors, avoided photos, social anxiety about my weight.

After (186 lbs): Run 3 miles regularly, pain-free, A1C normal, down to 1 medication, bought a swimsuit for the first time in a decade, actually enjoy being photographed.

Total weight lost: 86 lbs. Total life gained: immeasurable. This isn't just about weight — it's about reclaiming your identity.

Dr.BariatricHTX said:

I would be careful about how confidently the flatness reports get attributed.

When to call your doctor about mental health side effects — a reference I wish I'd had:

Call immediately:

• Severe abdominal pain (could be pancreatitis)
• Vision changes (thyroid concern)
• Lump in neck (thyroid nodule)
• Severe vomiting/can't keep fluids down for 24h+

Schedule an appointment:

• Persistent nausea beyond 4 weeks
• Significant hair loss
• Mood changes or depression
• Gallbladder symptoms (RUQ pain after eating)

One thing that is still open after Dr.LeslieOBGYN’s answer:

What did you change at the same time, and can you separate the two now?

Closing the loop on my own question.

Follow-up — I put something in the gap where food used to be rather than waiting for the gap to close on its own. That was the part nobody told me.