LipidDoc_ATL said:

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

This is where I part company with the consensus forming above. 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.

PharmD_Rodriguez said:

My mood has been flatter since about month four and I genuinely cannot work out whether that is the drug, the deficit, or the fact that I no longer…

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)

Dr.RenalNash said:

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

One year anniversary on mental health — reflections:

What I wish I'd known: the side effects are temporary, the benefits compound over time, protein is more important than I thought, and the mental health aspect needs as much attention as the physical.

What surprised me: how much my relationship with food changed, the cascade of health improvements beyond weight, and how supportive this community is.

What I'd do differently: start therapy earlier, prioritize resistance training from day 1, and stop comparing my progress to others. Everyone's journey is unique.

Following on from SteveThurs — and this may be the naive question:

How long did you give it before you decided it was working?

OP back with an update, since a thread like this is useless without one.

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.