Can GLP1s help with depression and cognition too?

The miracle drug just keeps miracling.

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Terrible news for anyone hoping semaglutide and friends would become a little less popular and therefore a little less hard to get.  

Since the diabetes and weight-loss drugs became top of everyone’s to-do list, thanks somewhat to TikTok, the health media has been breathlessly waiting for the other shoe to drop, looking for the cloud to go with the silver lining.   

Does semaglutide have terrible side effects? Yes, but pretty rarely.  

Does it stop working when you stop taking it? Yes, like most drugs.  

Does it increase suicidal thinking? No – the reverse. It seems to improve users’ outlook.  

Now, if a Canadian trial supports the hypothesis that the drug can treat depression and cognitive impairment, its popularity could go from gold to platinum.  

As STAT reports, psychiatrist Rodrigo Mansur, an associate professor at the University of Toronto, has been testing the effects of semaglutide on overweight people with depression and cognitive problems. He’s previously run a small trial of liraglutide (Saxenda, Novo Nordisk) that improved memory and attention in people with depression and bipolar disorder.  

It is unclear whether the GLP1s act directly on the brain to improve cognition, such as by reducing inflammation, or whether the psychiatric improvements are as a result of weight loss and improved insulin sensitivity.  

It could be a case of porque no los dos? as there is evidence supporting both options.  

The latter suggests insulin resistance could be a target for psychiatric treatment, which as the STAT story reports is already being investigated by another Canadian psychiatrist, Associate Professor Cindy Calkin at Dalhousie University. In her studies, inducing insulin sensitivity with either metformin or semaglutide reduced symptoms of depression and anxiety.  

Here the mechanism is also unknown, but it’s hypothesised that insulin resistance weakens the blood-brain barrier and restoring sensitivity can repair the leaks.  

Finally, on top of cognitive and psychiatric benefits, semaglutide et al. could help patients by reversing the weight gain that comes as an unwanted side dish with many psychiatric drugs.  

At the very least, the potential of this research to improve our understanding of mental illness is another huge plus. All up, incretins continue to be a good news story with a barely discernible downside.  

But happy endings are boring. Send story tips with terrible stings in their tails to penny@medicalrepublic.com.au.