Dr.RaviCardio said:

Anxiety increase on mental health: counterintuitive, but losing weight rapidly triggered anxiety for me.

I read this differently from Dr.RaviCardio, on substance rather than tone. 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.

That is the short version; the long version is somebody else's post.

AussieAnna said:

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

Therapy insights from my mental health journey: my therapist introduced me to the concept of "identity updating" — the psychological work of becoming a new version of yourself.

Key realizations: I used food to manage emotions, I had internalized fatphobia that I'm still unpacking, my social identity was partly built around being "the big guy/girl," and learning to accept compliments is surprisingly hard when you've been invisible for years.

Physical transformation without emotional processing is unstable. Do both.

Dr.NateNeph said:

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

Dr.NateNeph 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.

Following on from Dr.SportsMedIN — and this may be the naive question:

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

Closing the loop on my own question.

Update: I got the sleep and the intake sorted before deciding it was the drug, and most of the flatness went with them. Not all of it, and I am watching the rest.