Obesity medication and anxiety, panic attacks or depression

If you are being treated for an anxiety disorder or depression, you may worry that obesity medication will make your anxiety worse, trigger panic attacks or lower your mood. In clinical trials, people taking semaglutide (Wegovy) or tirzepatide (Mounjaro) were no more likely to have anxiety, depressive symptoms or suicidal thoughts than those on placebo (1, 2). However, these trials did not include people with severe mental illness, people who had attempted suicide or people who had had major depression in the previous 2 years, so less is known about the safety of these medicines in this group (1). This is why, if you are receiving psychiatric treatment, the doctor will go through your symptoms and current medicines before deciding on obesity medication.

In 2024, the European Medicines Agency (EMA) concluded that the available data do not support a causal link between GLP-1 medicines and suicidal thoughts (3). Reports of panic attacks after semaglutide have increased in the US adverse event reporting database (FAERS) since 2023, but according to a 2026 analysis, this rise is more likely due to publicity than to the effect of the medicine (4). Suicidal thoughts need immediate medical help. If you develop anxiety or your mood gets worse during treatment, tell your doctor.

In brief

• The summaries of product characteristics (SmPCs), the official product information for semaglutide (Wegovy) and tirzepatide (Mounjaro), do not list anxiety, depression or suicidal thoughts among the side effects. The only contraindication to either medicine is hypersensitivity to its ingredients (5, 6). The SmPC for naltrexone/bupropion (Mysimba), on the other hand, does list anxiety, panic attacks and suicidal thoughts (7).
• In semaglutide trials, an anxiety disorder or anxiety symptoms were reported by 3.3% of people taking the medicine and 4.2% of people on placebo (1). In FAERS, a panic attack was mentioned in 6.7 per 10,000 reports concerning semaglutide from 2018 to 2022, and in 42.0 per 10,000 reports from 2023 to 2024 (4).
• The European Medicines Agency in 2024 and the US Food and Drug Administration (FDA) in 2026 found no causal link between the GLP-1 medicines they assessed and suicidal thoughts and behaviour. The EMA review did not cover tirzepatide, whereas the FDA review included it (3, 8).
• Thoughts of harming yourself need immediate medical help. If, during treatment, you develop new or worsening anxiety, panic attacks or low mood, you need to tell your doctor (8).

Do obesity medicines cause anxiety or panic attacks?

In trials in people without serious mental illness, anxiety and panic attacks were no more common with semaglutide or tirzepatide than with placebo (1, 2). Naltrexone/bupropion (Mysimba) is different: anxiety is a common side effect of this medicine, and panic attacks have also been reported (7). However, the authors of a 2026 review point out that a link between semaglutide and panic attacks cannot be completely ruled out (4).

In four trials of semaglutide injections (STEP 1, 2, 3 and 5), participants took semaglutide 2.4 mg or placebo for 68 or 104 weeks. In STEP 1, 2 and 3, an anxiety disorder or anxiety symptoms were reported by 75 of 2,116 people taking semaglutide (3.3%) and 50 of 1,261 people on placebo (4.2%). In the two-year STEP 5 trial, such symptoms were reported by 7.2% of people in the semaglutide group and 9.2% in the placebo group (1). In an analysis of three tirzepatide trials (SURMOUNT-1, -2 and -3) involving 4,056 people, psychiatric and nervous system side effects occurred at similar rates in the medicine group and the placebo group (2).

The authors of a meta-analysis pooled 86 trials in which more than 133,000 participants were randomly assigned to a GLP-1 medicine, placebo or another medicine. The analysis did not show that GLP-1 medicines increase the risk of anxiety disorders, depression or suicide (9).

What does the product information for obesity medicines say about anxiety, mood and sleep?

The summary of product characteristics (SmPC) is the official product information for a medicine, approved when the medicine is authorised. Among other things, it lists the side effects and how often they occur.

Can semaglutide side effects feel like a panic attack?

Yes. Symptoms of a panic attack include a fast or pounding heartbeat, dizziness, nausea, sweating and shaking (11). Some of these symptoms can also be side effects of semaglutide. Nausea and headache are very common in people taking semaglutide, and dizziness is common, mainly while the dose is being increased. In trials, the heart rate of people taking semaglutide was on average 3 beats per minute faster than before treatment, and in 67% of them it rose by at least 10 beats per minute at some point during treatment. In the placebo group, heart rate rose by at least 10 beats per minute in 50.1% of participants (5).

Someone who has panic attacks may interpret these sensations as the start of an attack. This is why, before starting treatment, it helps to discuss with your doctor what to expect in the first weeks and after each dose increase. If you have diabetes and take insulin or a sulfonylurea, bear in mind that feeling nervous or anxious, cold sweats, a faster heartbeat and shaking can be symptoms of hypoglycaemia. In that situation, you need to follow your doctor's instructions for hypoglycaemia (5).

Where did the reports of panic attacks after semaglutide come from?

The suspicion that semaglutide causes panic attacks came from FAERS, the US adverse event reporting database. Reports of panic attacks in FAERS rose from mid-2023 onwards, when regulators and the media began looking at the possible effects of GLP-1 medicines on mental health. A 2026 analysis attributes this increase more to publicity than to the medicine itself (4).

In July 2023, the EMA's safety committee (PRAC) began reviewing GLP-1 medicines after the Icelandic medicines agency reported cases of suicidal thoughts and self-harm in people taking liraglutide and semaglutide (3). Canadian researchers analysed FAERS reports from 2018 to 2024 and compared those from before July 2023 with later ones. A panic attack was recorded in 87 of 33,267 reports concerning semaglutide (0.26%) and in 0.05% of reports concerning dulaglutide and empagliflozin, the two diabetes medicines with which semaglutide was compared. Once age, sex and the reason for treatment were taken into account, the difference shrank considerably, and in reports from before July 2023 it was not statistically significant, meaning it could have been due to chance. For every 10,000 reports concerning semaglutide, there were 6.7 panic attacks between 2018 and 2022 and 42.0 between 2023 and 2024 (4).

The researchers also brought together the results of 12 other studies. Trials in which participants were randomly assigned to the medicine or placebo did not provide consistent evidence that panic attacks or anxiety are more common with semaglutide. Nor did observational studies, based on data from routine treatment, in which people taking semaglutide were compared with people treated with another medicine. According to the authors, these data do not indicate that semaglutide causes panic attacks, although such a link cannot be ruled out (4).

Why can't side effect reports show how often panic attacks occur on a medicine?

An analysis of side effect reports can reveal a possible problem that then has to be checked in other studies, but it does not prove that the medicine causes the event in question. This kind of analysis has several limitations (4):

• The database does not show how many people took the medicine, so it cannot be used to calculate what proportion of those treated had a panic attack.
• The result of such an analysis shows whether an event was reported more often with one medicine than with others. It does not say by how much the medicine increases the risk.
• When a possible side effect gets a lot of media attention and regulators issue statements about it, people report it more often. Specialists call this notoriety bias.
• Reported panic attacks are usually not verified by anyone, so it is not known whether they met the diagnostic criteria.
• People taking different medicines differ in age and medical conditions, and more than half of the reports do not say why the medicine was prescribed.

The results of observational studies are also inconsistent. In a 2024 study, people with obesity taking liraglutide or semaglutide were compared with people who did not take these medicines. In those taking them, the risk of being diagnosed with an anxiety disorder was more than twice as high (108% higher), and the risk of being diagnosed with major depression almost three times as high (195% higher) (12). However, the authors of the 2026 review judged this study to be at serious risk of bias, mainly because of differences between the groups compared, the way participants were selected and the way outcomes were measured (4). In a study based on Swedish and Danish medical registers, in which GLP-1 medicines were compared with another diabetes medicine, people taking GLP-1 medicines did not develop depression or anxiety disorders more often (13).

Do semaglutide and tirzepatide increase the risk of depression and suicidal thoughts?

According to the European Medicines Agency, the available data do not point to a link between the GLP-1 medicines it assessed, including semaglutide, and suicidal thoughts or behaviour. The EMA review did not cover tirzepatide (3). The US FDA also included tirzepatide and found no increased risk of such events (8). In clinical trials, semaglutide and tirzepatide did not worsen symptoms of depression either (1, 2).

In April 2024, PRAC completed its review of dulaglutide, exenatide, liraglutide, lixisenatide and semaglutide, including the semaglutide brands Ozempic, Rybelsus and Wegovy and the liraglutide brand Saxenda. It took into account laboratory and animal studies, clinical trials, side effect reports and two studies based on electronic health records. It concluded that the data do not support a causal link between these medicines and suicidal thoughts and behaviour or self-harm, and it did not change the product information. The manufacturers continue to monitor such reports (3).

In January 2026, the FDA asked the manufacturers of Wegovy, Saxenda and Zepbound to remove information about the risk of suicidal thoughts and behaviour from the US prescribing information. Zepbound is the name under which tirzepatide for obesity is sold in the US. The agency analysed 91 trials comparing a medicine with placebo (with 107,910 participants in total) and data from more than 2.2 million people with type 2 diabetes. It found no increased risk of suicidal thoughts and behaviour or of other psychiatric disorders, including anxiety and depression (8). In the European Union, the SmPCs for Wegovy and Mounjaro do not contain such a warning (5, 6).

In the analysis of semaglutide trials, depressive symptoms were measured with the PHQ-9 questionnaire. After 68 weeks, depressive symptoms were slightly milder in people taking semaglutide than in people on placebo, but the authors considered the difference too small to matter in practice. Suicidal thoughts or behaviour during treatment were reported by no more than 1% of participants, with no difference between the groups (1). In the tirzepatide trials, suicidal thoughts were reported by 0.6% of participants in both the medicine group and the placebo group, and suicidal behaviour by 0.1% of people taking tirzepatide and by no one in the placebo group (2).

In a review of 27 trials comparing GLP-1 medicines with placebo (more than 59,000 people with diabetes or obesity), suicide, suicide attempts, suicidal thoughts and self-harm were very rare. For every 10,000 people treated for a year, there were 4.7 such events with a GLP-1 medicine and 4.2 with placebo. The difference was not statistically significant (14). A study based on Swedish and Danish medical registers, mainly of people with type 2 diabetes, did not show that people taking GLP-1 medicines died by suicide more often than people treated with another diabetes medicine (13).

When should you contact a doctor urgently during obesity treatment?

Thoughts of harming yourself or taking your own life need immediate medical help, without waiting for your next appointment. In an emergency, you can go to a psychiatric hospital without a referral (15).

Contact the doctor managing your obesity treatment without delay if:

• during treatment you develop new or worsening anxiety, panic attacks, markedly low mood or unusual changes in behaviour (8)
• you have diabetes, take insulin or a sulfonylurea and have symptoms of hypoglycaemia, such as feeling nervous or anxious, cold sweats, a faster heartbeat or shaking (5)
• you cannot replace lost fluids because of vomiting or diarrhoea, because dehydration can impair kidney function (5)

Difficulty breathing, swelling of the face, throat, arms or legs, dizziness, a fast heartbeat, sweating and loss of consciousness may mean a severe allergic reaction to the medicine. These symptoms need immediate medical help, even if they resemble a panic attack (5). Other symptoms that mean you need to stop the medicine and contact a doctor straight away are described in our article on side effects of obesity medication. If you develop anxiety or low mood, it is the doctor who decides, after discussing your symptoms, whether to stop the obesity medicine or a psychiatric medicine (8).

Can you take obesity medication if you have an anxiety disorder or depression?

Anxiety disorders and depression are not contraindications to semaglutide or tirzepatide. The only contraindication listed in the SmPCs for these medicines is hypersensitivity to their ingredients (5, 6). The doctor assesses whether the medicine is suitable, taking into account your current symptoms, the medicines you take and any other conditions.

However, the safety of obesity medicines in people with mental health conditions has not been fully studied. The semaglutide trials did not include people who had had major depression in the 2 years before the trial, or people with other severe mental illnesses, such as schizophrenia or bipolar disorder. Nor did they include people who scored at least 15 points on the PHQ-9 depression questionnaire or who had ever attempted to take their own life. The authors regard this as a limitation of their analysis, because these are the very people who may be most at risk of their mental health getting worse (1). The tirzepatide analysis was likewise limited to people without a diagnosed serious mental illness (2).

The trials did, however, include people with milder mental health problems. In STEP 1, 2 and 3, one in four participants had a diagnosed mental health condition when they entered the trial (1), and in four STEP trials, 539 of 3,683 participants were taking antidepressants. In people taking antidepressants, body weight fell to a similar extent as in the other participants, and side effects were about as common in the semaglutide group as in the placebo group (16).

A 2026 Swedish study analysed data from more than 95,000 people with diagnosed depression or anxiety disorders who were taking diabetes medicines. During periods when they were taking semaglutide, their mental health worsened less often than during periods without GLP-1 medicines. Worsening was defined as psychiatric hospital admission, sick leave for mental health reasons lasting more than 14 days, hospital admission for self-harm, or suicide (17). This is an observational study, so it does not prove that semaglutide improves mental health. The authors write that the results need to be checked in trials in which participants are randomly assigned to the medicine or placebo.

What should you tell your doctor before obesity treatment if you have anxiety or depression?

According to the guidelines of the Polish Society for the Treatment of Obesity (PTLO), the doctor managing obesity treatment assesses the patient's mental state at every appointment and checks for symptoms of depression or eating disorders. If the result suggests depression or an eating disorder, or if the symptoms make treatment difficult, the doctor refers the patient to a psychiatrist or a clinical psychologist (18). Before your first consultation, it helps to prepare information about:

• your psychiatric diagnoses and current symptoms, for example how often you have panic attacks
• all the medicines you take and their doses, including those you take only when needed, for example for anxiety or sleep
• suicidal thoughts and suicide attempts, both current and past
• eating disorders, current or past, such as binge eating, bulimia or anorexia
• current or past bipolar disorder

Semaglutide and tirzepatide slow down stomach emptying, so they may delay the absorption of medicines taken by mouth. The manufacturers advise caution when a patient also takes medicines that need to work quickly (5, 6). This may also apply to a medicine you take when you have an anxiety attack, which is why the doctor managing your obesity treatment should know about it. Likewise, your psychiatrist should know about the obesity medicine. You should keep taking your psychiatric medicine unless your psychiatrist decides to change it.

Why does naltrexone/bupropion call for caution in people with anxiety or depression?

Naltrexone/bupropion (Mysimba) is an obesity medicine in tablet form that works differently from semaglutide and tirzepatide. In some countries, bupropion is used as an antidepressant, which is why the Mysimba SmPC contains warnings similar to those for antidepressants (7).

Anxiety and insomnia are common during treatment with Mysimba. Panic attacks have also been reported, especially in people with a history of mental health conditions, most often while the dose was being increased and after it had been changed. There were no suicides or suicide attempts in the trials of the medicine in people with obesity, but after it came onto the market, suicidal thoughts and behaviour were reported in patients of all ages. This is why patients and their families should watch for changes in mood and behaviour, especially at the start of treatment and after each change of dose. If you have suicidal thoughts, your mental health gets worse or your behaviour changes in an unusual way, see a doctor immediately (7).

Bupropion slows down the breakdown of some antidepressants and antipsychotics, such as paroxetine and risperidone. Serotonin syndrome, a condition that can be life-threatening, has been reported when Mysimba was combined with SSRI and SNRI antidepressants. The medicine is contraindicated in people with current or past bipolar disorder and in people who have or have had bulimia or anorexia (7). We describe more contraindications to naltrexone/bupropion in our article on weight gain from medication and how obesity is treated in that case.

How does obesity treatment work at Nasz Gabinet?

In the obesity treatment programme at Nasz Gabinet, the doctor diagnoses obesity based on BMI and waist circumference, assesses blood test results and decides, according to the PTLO criteria, whether an adult patient can take medication. The programme lasts 12 months and includes video consultations with a doctor and a psychologist, as well as monthly medical check-ups based on data from the app. After each medical review, if treatment is to continue, the doctor issues an e-prescription and the patient buys the medicine at a pharmacy. Patients who are receiving psychiatric treatment continue it alongside the programme. Our article on eligibility for obesity medication describes the criteria the doctor uses to decide whether a patient is eligible for treatment. This article does not replace a consultation with a doctor.

Frequently asked questions

Can Mounjaro cause anxiety or depression?

The SmPC for tirzepatide (Mounjaro) does not list anxiety or depression among its side effects (6). In tirzepatide trials in people without diagnosed serious mental illness, psychiatric side effects occurred at similar rates in the medicine group and the placebo group, and depressive symptoms did not get worse (2). Tirzepatide was also included in the FDA's 2026 review, which found no increased risk of suicidal thoughts (8).

Can obesity medication improve mood or reduce anxiety?

This has not been established. In semaglutide trials, depressive symptoms eased slightly more in people taking the medicine than in people on placebo, but the authors considered the difference too small to matter in practice (1). In the Swedish study of people with depression or anxiety disorders, mental health worsened less often during periods on semaglutide, but an observational study cannot prove that this was due to the medicine (17). Semaglutide and tirzepatide are not licensed to treat depression or anxiety disorders and do not replace psychiatric treatment or psychotherapy (5, 6).

Can you take antidepressants with semaglutide?

In semaglutide trials, 539 participants were taking antidepressants and lost weight to a similar extent as the others (16). The semaglutide SmPC does not describe any interactions with antidepressants. However, semaglutide may affect the absorption of medicines taken by mouth, so the doctor managing your obesity treatment must know about all the medicines you take (5). Naltrexone/bupropion, on the other hand, does interact with some antidepressants (7).

Sources

1. Wadden TA, Brown GK, Egebjerg C et al. Psychiatric Safety of Semaglutide for Weight Management in People Without Known Major Psychopathology: Post Hoc Analysis of the STEP 1, 2, 3, and 5 Trials. JAMA Intern Med. 2024;184(11):1290-1300. PMID 39226070, DOI
2. Wadden TA, Oquendo MA, Kushner RF et al. Psychiatric Safety of Tirzepatide in People With Obesity and No Known Major Psychopathology: A Post Hoc Analysis of SURMOUNT. Obesity (Silver Spring). 2026;34(3):565-578. PMID 41537305, DOI
3. European Medicines Agency. Meeting highlights from the Pharmacovigilance Risk Assessment Committee (PRAC) 8-11 April 2024. Press release, 12.04.2024. ema.europa.eu
4. Melamed B, Parsi-Zahabi M, Omrani MA et al. Semaglutide and Panic Attacks: Active-Comparator Disproportionality Analysis, Temporal Assessment of Notoriety Bias and Evidence Triangulation in Post-Marketing Pharmacovigilance. Pharmacoepidemiol Drug Saf. 2026;35(11):e70517. PMID 42946127, DOI
5. European Medicines Agency. Wegovy (semaglutyd) - charakterystyka produktu leczniczego i ulotka dla pacjenta: roztwór do wstrzykiwań oraz tabletki (summary of product characteristics and patient leaflet: solution for injection and tablets). ema.europa.eu
6. European Medicines Agency. Mounjaro (tirzepatyd) - charakterystyka produktu leczniczego (summary of product characteristics). ema.europa.eu
7. European Medicines Agency. Mysimba (naltrekson i bupropion) - charakterystyka produktu leczniczego (summary of product characteristics). ema.europa.eu
8. U.S. Food and Drug Administration. Drug Safety Communication, 13.01.2026: request to remove the warning about suicidal thoughts and behaviour from the prescribing information for GLP-1 receptor agonists (Saxenda, Wegovy, Zepbound). fda.gov
9. Han S, Yang Y, Liu Z et al. Association of Glucagon-Like Peptide-1 Receptor Agonist Use With Risk of Psychiatric Disorders: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Diabetes Obes Metab. 2026;28(6):5011-5019. PMID 41852258, DOI
10. European Medicines Agency. Saxenda (liraglutyd) - charakterystyka produktu leczniczego (summary of product characteristics). ema.europa.eu
11. NHS. Panic disorder. Page last reviewed 22.08.2023. nhs.uk
12. Kornelius E, Huang JY, Lo SC et al. The risk of depression, anxiety, and suicidal behavior in patients with obesity on glucagon like peptide-1 receptor agonist therapy. Sci Rep. 2024;14(1):24433. PMID 39424950, DOI
13. Ueda P, Söderling J, Wintzell V et al. GLP-1 Receptor Agonist Use and Risk of Suicide Death. JAMA Intern Med. 2024;184(11):1301-1312. PMID 39226030, DOI
14. Ebrahimi P, Batlle JC, Ayati A et al. Suicide and Self-Harm Events With GLP-1 Receptor Agonists in Adults With Diabetes or Obesity: A Systematic Review and Meta-Analysis. JAMA Psychiatry. 2025;82(9):888-895. PMID 40105856, DOI
15. Rzecznik Praw Pacjenta (Patient Ombudsman). Leczenie psychiatryczne i wsparcie psychologiczne - kiedy potrzebne jest skierowanie? (Psychiatric treatment and psychological support - when do you need a referral?) 07.10.2022. gov.pl
16. Kushner RF, Fink-Jensen A, Frenkel O et al. Efficacy and safety of semaglutide 2.4 mg according to antidepressant use at baseline: A post hoc subgroup analysis. Obesity (Silver Spring). 2024;32(2):273-280. PMID 37989717, DOI
17. Taipale H, Taylor M, Lähteenvuo M et al. Association between GLP-1 receptor agonist use and worsening mental illness in people with depression and anxiety in Sweden: a national cohort study. Lancet Psychiatry. 2026;13(4):327-335. PMID 41862258, DOI
18. Bąk-Sosnowska M, Białkowska M, Bogdański P et al. Zalecenia kliniczne dotyczące postępowania u chorych na otyłość 2024 - stanowisko Polskiego Towarzystwa Leczenia Otyłości (Clinical guidelines for the management of patients with obesity - position statement of the Polish Society for the Treatment of Obesity). Medycyna Praktyczna, special edition, September 2024. ptlo.org.pl