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GLP-1 therapy in patients over 65 — July 2024

andrew_nyc Sun, Apr 6, 2025 at 4:10 AM 9 replies 1,617 viewsPage 1 of 2

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andrew_nyc

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Apr 6, 2025 at 4:10 AM#1

Collecting this in one place because it comes up every few weeks and the answer is always assembled from scratch. It is about mood and mental health, and it is deliberately narrow — everything I am not confident about is marked as such.

What is actually established

The mental-health dimension is under-measured in the trial literature and the reports here are consistent enough to take seriously. On the positive side: reduced anxiety around food, better self-image, more confidence. On the difficult side: grief for the years lost, identity disruption, relationships built around eating, and the loss of food as a coping mechanism with nothing put in its place. Rarer but real: anhedonia and emotional flatness. Regulators have started asking for validated patient-reported outcomes in this class; the existing data gap is not evidence of absence.

The condition it depends on

For anyone with an eating-disorder history this needs a clinician in the loop rather than a forum. The same drug can be therapeutic in binge-eating disorder and actively harmful in a restrictive disorder.

What I am not sure about

What I am trying to establish is how people separated a drug effect from the ordinary consequences of a large deficit and disrupted sleep, because I cannot. Practical detail welcome, however dull — the duller the better.

— andrew_nyc · corrections welcome and will be edited into this post with credit

40 18Dr.KarenChen, Dr.NateNeph, PharmD_Rodriguez and 37 others

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NeuroNate

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Apr 6, 2025 at 5:18 AM#2

andrew_nyc said:
The mental-health dimension is under-measured in the trial literature and the reports here are consistent enough to take seriously.

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

I'd say therapy should be AVAILABLE to all GLP-1 patients, but requiring it as a precondition for treatment would create an access barrier.

Not everyone can afford therapy. Not everyone needs it. Some people do just fine with medication + lifestyle changes. But for those with emotional eating, body image issues, or disordered eating history, therapy is extremely valuable.

My recommendation: make mental health screening part of the initial assessment, offer therapy as a recommended adjunct, but don't gatekeep medication access behind it.

41 19wendy_avl, jason_paloalto, Dr.LeslieOBGYN and 38 others

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HPLC_Greg

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Apr 6, 2025 at 6:26 AM#3

andrew_nyc said:
The mental-health dimension is under-measured in the trial literature and the reports here are consistent enough to take seriously.

Filing a mild objection. Mild because I might be wrong; an objection because nobody has addressed the case that does not fit. 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.

Last edited: Apr 6, 2025 at 12:26 PM

42 20RetaRick_CA, JenPlateau, SallyK_inj and 39 others

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