GLP-1 therapy may reduce suicidal ideation risk for adolescents with obesity
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Key takeaways:
- Adolescents with obesity were less likely to have suicidal ideation or a reported suicide attempt if they were prescribed a GLP-1.
- A lower risk for pancreatitis was observed for adolescents prescribed a GLP-1.
Adolescents with obesity prescribed a GLP-1 receptor agonist are less likely to have suicidal ideation or a suicide attempt than those with obesity treated with lifestyle intervention, according to new data.
“There have been isolated reports suggesting a link between GLP-1 receptor agonist treatment and suicidal behavior, yet no comprehensive studies have been conducted, particularly in adolescents,” Liya Kerem, MD, MSc, pediatric endocrinologist at Hadassah Hebrew University Medical Center in Jerusalem, Israel, told Healio. “Given that obesity in adolescence is already associated with an increased risk of depression and suicidal ideation, and considering the rise in GLP-1 receptor agonist prescriptions since FDA approval in 2020, it was crucial to investigate whether this treatment impacts psychiatric outcomes. Our study aimed to fill this gap in understanding the safety profile of these medications in adolescents.”
In a study published in JAMA Pediatrics, researchers collected data from TriNetX health record database of adolescents aged 12 to 18 years diagnosed with obesity between December 2019 and June 2024. Youth were considered to have used a GLP-1 if they were prescribed liraglutide (Saxenda, Novo Nordisk) or semaglutide (Wegovy, Novo Nordisk) within 12 months of an obesity diagnosis. Adolescents using a GLP-1 were compared with those with obesity treated only with lifestyle intervention. Suicidal ideation and suicide attempts were obtained up to 1 year after GLP-1 or lifestyle intervention initiation.
There were 4,052 adolescents who were prescribed a GLP-1 and 50,112 treated only with lifestyle intervention in the TriNetX database. Propensity-score matching was used to match 3,456 adolescents using a GLP-1 (mean age, 15.4 years; 59% girls) with 3,456 control youths treated with lifestyle intervention (mean age, 15.6 years; 62% girls).
The incidence rate of suicidal ideation or attempts was lower among adolescents using a GLP-1 vs. controls at 1 year (1.45% vs. 2.26%; HR = 0.67; 95% CI, 0.47-0.95; P = .02).
Adolescents using a GLP-1 were more likely to experience gastrointestinal symptoms (6.9% vs. 5.4%; HR = 1.41; 95% CI, 1.12-1.78; P = .003), but had lower risk for acute pancreatitis (0.29% vs. 0.67%; HR = 0.41; 95% CI, 0.19-0.88; P = .02) than the control group. There was no significant difference in risk for upper respiratory tract infection between the two groups.
The results were consistent across sex, race and ethnicity group, medication type and diabetes status. There were also no changes to the findings when follow-up was extended to 3 years and in an analysis beginning 1 year prior to therapy initiation.
“While individual cases of increased suicidality following GLP-1 receptor agonist use have been reported, our large cohort study found no such association and instead suggested a decreased risk of suicidal behavior in adolescents receiving this treatment,” Kerem told Healio. “Clinicians should assess each patient’s needs individually when deciding whether to prescribe GLP-1 receptor agonists, but based on our findings, there is no indication that the treatment poses an increased risk of suicidality in adolescents with obesity.”
Kerem said the findings reveal the need for future studies to examine the impact of GLP-1 receptor agonist on psychiatric measures.
“Simultaneously, investigations into the underlying physiological mechanisms potentially contributing to psychiatric benefits are also necessary,” Kerem told Healio.
For more information:
Liya Kerem, MD, MSc, can be reached at liya.em@gmail.com.
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