Ozempic and Depression: My Choice of Antidepressants

Ozempic is a very potent medicine indicated for the treatment of diabetes and weight loss. Whether Ozempic use is associated with depression or not is not fully known.

It is understood that if a person who has high hopes for achieving their target blood glucose or weight loss using Ozempic does not succeed, they may experience increased anxiety and depression.

In cases where a person is tolerating Ozempic well, has achieved good glycemic control, and is experiencing weight loss, but develops depression or anxiety, Ozempic may be blamed as a potential factor.

I chose to write about Ozempic and depression because of my recent encounters with several cases. These experiences have prompted me to share my knowledge and insights on the topic.

Ozempic and Palpitations:

One commonly observed symptom associated with Ozempic use is an increase in heart rate and palpitations.

This side effect may sometimes be mistaken for heart disease, and patients may undergo a full cardiologist workup to investigate the symptoms.

In the absence of any identifiable underlying cause, patients may be prescribed antidepressants or anxiolytics to alleviate the symptoms.

However, this approach may add to the patient’s anxiety, as they are not provided with a definitive diagnosis, and may be prescribed unnecessary medication.

Story of a patient with Palpitations when he was put on Ozempic:

Yesterday, a patient came to me for a medication review. He had been living with Ischemic Heart Disease (IHD) for a few years now and had been managing his condition well. But when his doctor prescribed Ozempic to help him lose weight, things started to take a turn.

At first, he didn’t think much of it when he experienced palpitations after starting the medication. But as the weeks went on, the palpitations became more intense and frequent. He became increasingly worried about his condition, thinking he might have developed a heart disease.

He consulted with his cardiologist, who increased his doses of Beta-blockers and Ivabradine to control his heart rate. But even with the increased medication, he continued to experience palpitations.

That’s when his nephew, who is a doctor, brought him to me for a second opinion. After reviewing his medication history, I suspected that his thiazide diuretic might be causing dehydration, especially when combined with Ozempic.

I discontinued the diuretic and reduced the dose of Ozempic from 1 mg to 0.5 mg weekly. Additionally, I advised him to engage in some form of aerobic exercise, as per his tolerance.

To his relief, within a week, his symptoms improved significantly, and the doses of his cardiac medications were reduced back to their previous levels.

It’s a reminder of how important it is to monitor our body’s response to new medications and seek medical attention if we notice any concerning symptoms.

Ozempic Interactions with Antidepressants: Ozempic and Zoloft:

Zoloft (Sertraline) is one of the potent antidepressants. It is associated with weight gain, like most other antidepressants.

When given to depressed patients who are also on Ozempic, it may neutralize the weight loss effects of Ozempic.

Story of a patient on Ozempic and Zoloft:

I recently had a patient with super obesity, who had been struggling to manage his diabetes and obesity. His BMI was a whopping 48.5 kg/m2! But when I prescribed him Ozempic, he saw amazing results.

He was able to stop using basal insulin altogether and was only taking Empagliflozin 25mg and metformin 2g in divided doses. His A1C levels finally reached their target of 7%, which was a huge win after years of struggling.

Not only that, but he was also taking Zoloft for depression, and even though he was on it, he managed to lose 12kgs in just three months! It seemed like things were finally looking up for him.

But then, over the next three months, things took a turn for the worse. His depression symptoms became severe and his psychiatrist had to increase his dosage of Zoloft to 100mg and later 150mg per day.

Unfortunately, this resulted in him regaining the weight he had lost while on Ozempic. He came back to me feeling unhappy with his progress.

After some consideration, we suspected that Zoloft might have been the culprit. So, we switched him to Fluoxetine (Prozac) 20mg twice a day. Within just a month, he started to notice some weight loss again.

But the road to recovery was still bumpy. He was still experiencing depressive episodes, which were hard to manage. On top of that, he was also taking Rivotril (Clonazepam) 0.5mg in the morning, at lunchtime, and 1mg at bedtime.

It’s been a rollercoaster of a journey for my patient, but we’re doing everything we can to help him get to a better place.

Are you getting the wrong injection?

I recently had a patient come to me with a strange request. She had been struggling to manage her weight and blood sugar levels and had heard that Ozempic could help her achieve her goals. But there was a problem – she couldn’t afford to buy the medication on her own.

Undeterred, she went online and managed to purchase a full carton of what she thought were Ozempic injections. She brought the carton to me and asked me to teach her how to inject them.

But as soon as I saw the injections, I knew something was off. Although they were labeled as “Ozempic”, they looked like regular insulin injections with markings of 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, and so on.

My heart sank as I realized what was happening. These were fake injections, and using them could have serious consequences for my patient.

I immediately told her to return the carton and informed the company representative about what had happened. The patient was understandably upset, but also grateful that I caught the problem before she could suffer any adverse reactions.

It’s a strange and scary situation, but unfortunately, it’s not uncommon. Many people try to cut corners when it comes to their healthcare, whether it’s by buying medications from unverified sources or trying to self-diagnose using information they find online.

As healthcare providers, it’s our job to educate our patients and help them make informed decisions about their health.

Ozempic Improves Symptoms of Depression

Most clinical studies have documented an improvement in the symptoms of depression and anxiety in patients who are using a GLP-1 analog such as Ozempic.

In one study, it was concluded that people with diabetes who get treated with GLP1-RA medicine have a bigger chance of feeling less anxious and less depressed than those not treated with a GLP-1 analog [Ref].

The results of this study could be a direct effect of Ozempic on the inflammatory processes in the brain. In addition, Ozempic crosses the blood-brain barrier and might have an effect on neurotransmitters like serotonin and norepinephrine, apart from its anti-inflammatory effects [Ref].

The indirect effects of Ozempic on Depression could be the result of better glucose control and weight loss. Both these factors can improve well-being and self-confidence.

The role of antidepressants in the treatment of depression in patients who are on Ozempic has both positive and negative aspects.

There are good things and bad things that can happen when you take this treatment. The good things are feeling better, keeping up with healthy habits, and having a good attitude toward life and friends.

The bad things are gaining weight, having extra side effects, and spending more money.

Managing Depression in Patients Taking Ozempic:

If you’re taking Ozempic and you feel sad or depressed, it’s really important to tell your doctor right away.

It’s essential to take care of both diabetes and depression because if you don’t treat depression, it can make you really sick and unhappy.

When you feel worried or anxious, your blood sugar levels can go up. But, if you take an antidepressant, it might make it harder to lose weight as you see on social media and TikTok where some people lose a lot of weight using Ozempic.

Antidepressants for Patients Taking Ozempic:

Patients with depression may benefit from antidepressants, but it is essential to choose an antidepressant that does not cause weight gain or impair blood glucose control.

There are different types of antidepressants you can take. One of them is Bupropion, which can help you lose weight. But, it might not be the best one for making you feel better.

Another one is Fluoxetine, which is a powerful antidepressant and doesn’t usually make you gain weight.

A third option is Duloxetine Venlafaxine or Brintillex. These antidepressants can help with diabetic neuropathy, won’t make you gain weight, and are also strong.

The table below lists some antidepressants are listed based on their benefits and risks. These are my choice of antidepressants in patients using Ozempic:

Conclusion

People don’t usually get depressed when they take Ozempic. Actually, studies have shown that Ozempic can even help with mental health and depression.

The three cases I talked about don’t prove that Ozempic made people depressed.

If you need to take an antidepressant while taking Ozempic, it’s better to choose one that won’t make you gain weight and will also help control your blood sugar.