Summary: GLP-1 medications are likely safe for most people, but those with a psychiatric history may need closer monitoring, and sexual side effects are common but mixed.
Key Points:
1.) Clinical trials show no psychiatric risk; some real-world studies do – the difference is likely pre-existing mental health conditions.
2.) Half of users report sexual changes, split between positive and negative effects.
3.) The FDA (January 2026) found no suicide link and removed those warnings.
Part of my job as a therapist is to notice patterns. These days, GLP-1 medications like Ozempic and Wegovy are everywhere, and I understand why people are excited. For many people, these medications have been truly life-changing. But I want to talk about an important conversation that might not be happening when GLPs are prescribed.
What I’m Seeing in My Therapy Practice
Over the past year, I’ve noticed something that I’m now starting to see in some medical studies. Some clients are coming in with mood changes that nobody connected to their new weight loss medication.
One partner went from being their usual self to experiencing severe mood swings, irritability, and what I can only describe as emotional flatness. Another became depressed with behavioral disruptions that affected the entire household. When they reduced their dosage or came off the medication entirely, these symptoms slowly started to improve.
The Research Everyone Should Know About
Observational Studies Show Elevated Risks
A 2024 study published in Scientific Reports analyzed data from over 162,000 patients and found some concerning associations. Patients on GLP-1 receptor agonists (that’s the technical term for these medications) showed:
- higher risk of major depression
- increased risk for anxiety disorders
- elevated risk for suicidal behaviors
These statistics are for patients with obesity taking these medications – and notably, these were folks using them for weight loss, not for diabetes management.
Important context on these numbers: While these relative risk increases sound alarming (like the 195% higher risk of major depression in the study), the absolute risk increases are more modest. For perspective, if the baseline risk of developing major depression in this population were 2%, a 195% increase would mean the risk rises to approximately 6%. The numbers warrant attention but should be understood in proper context.
But Clinical Trials Tell a Different Story
Here’s where the science gets more nuanced. A 2025 meta-analysis published in JAMA Psychiatry – one of the most rigorous reviews to date – analyzed 80 randomized controlled trials involving 107,860 patients and found no significant increase in psychiatric adverse events compared to placebo.
Why the discrepancy? Clinical trials typically exclude people with existing psychiatric conditions, while real-world observational studies include everyone. This suggests that people with a history of mental health issues may be more vulnerable to mood-related side effects, while those without such history may face little to no additional risk.
FDA Adverse Event Reports
When researchers analyzed FDA adverse event data from 2004 to 2023, they found that the top psychiatric events reported among GLP-1 users were:
- Insomnia (11.7% of psychiatric reports)
- Anxiety (11%)
- Nervousness (9.2%)
- Depression (7.5%)
- Stress (7.5%)
What About Diabetes Patients?
Something to note. Multiple studies show that for people with Type 2 diabetes taking these medications for their actual medical condition, the results often show reduced anxiety and depression. There may be something different happening when you’re taking it solely for weight loss versus managing a metabolic condition your body actually needs help with. We’ll have to see what further studies show.
The Science Behind What’s Happening
Here’s a way to understand what’s happening. GLP-1 medications work by dampening dopamine-driven reward signals in your brain. That’s how they reduce your cravings for food. But your brain doesn’t have separate reward systems for different things. The same pathways that make you want to eat that cookie are involved in other reward-driven activities, like intimacy, sex, and feeling pleasure from everyday experiences.
These medications cross the blood-brain barrier. That means they’re not just working in your stomach; they’re affecting your brain chemistry. When you block the reward signals that make food appealing, you’re potentially affecting everything else that triggers dopamine and pleasure responses.
If your main coping mechanism has been food (and suddenly that reward system is blocked) what happens? You get depressed. You get anxious. Your primary coping tool is out the window, and you haven’t developed new ones yet.
The Intimacy Factor No One’s Talking About
This is where my work as a sex therapist comes in. I’ve had some clients and their partners report changes in sexual desire since starting these medications.
Research on Men’s Sexual Health
A 2024 study from the University of Texas Medical Branch found that men taking semaglutide had 4.5 times higher risk of erectile dysfunction and nearly double the risk of testosterone deficiency compared to men not taking the drug.
Important context: The absolute numbers were still relatively small – 1.47% of men on semaglutide developed ED compared to 0.32% of controls. So while the relative risk is significantly elevated, the vast majority of men (over 98%) did not develop these issues.
The Brain Chemistry Connection
It’s not just about physical functions. A recent analysis in the Journal of Sexual Medicine proposed that GLP-1 agonists might reduce sexual desire by enhancing serotonergic activity in the brain, similar to how SSRIs (antidepressants) affect libido. Research theorizes that while these medications might improve body image, they simultaneously dampen the brain’s reward and pleasure systems that drive sexual desire.
The Kinsey Institute Survey
A Kinsey Institute survey (2025) found that about 52% of GLP-1 users reported the medication impacted their sex lives – some positively, some negatively:
- 18% said their sexual desire increased
- 16% said it decreased
- 16% felt more comfortable with how they look naked
- 14% felt less comfortable
The mixed results make sense when you think about it. Yes, losing weight can make you feel sexier and more confident. But if the medication is literally numbing your brain’s reward systems and pleasure responses, it doesn’t matter how good you look – you’re not going to feel that desire the same way.
Case Reports on Anorgasmia
There have been case reports of women experiencing anorgasmia (inability to orgasm) that resolved after stopping the medication. The proposed mechanism? GLP-1 agonists may cause vasoconstriction, reducing blood flow to the genitals, and they may decrease dopamine and norepinephrine signaling – neurotransmitters that are crucial for pleasure and orgasm.
The Warning Signs to Watch For
If you’re taking or considering these medications, here’s what you need to watch for:
Mental Health Red Flags:
- New onset of anxiety or depression
- Worsening of previously managed mental health conditions
- Mood changes: irritability, anger, emotional numbness
- Changes in sleep patterns or insomnia
- Feeling “flat” or disconnected from emotions
Physical and Sexual Health Changes:
- Significant changes in sexual desire or function
- Difficulty with arousal or orgasm
- Eating only once a day or extreme appetite suppression
- Hair loss or other signs of nutritional deficiency
- Feeling numb to pleasure or rewards in general
Timeline Matters:
Research shows that psychiatric adverse events typically emerge with a median onset of 31 days after starting the medication, though it can vary. Some symptoms appear within the first week, others take months to develop.
FDA’s Current Position (Updated January 2026)
In January 2026, the FDA completed a comprehensive review and requested the removal of suicidal behavior and ideation warnings from GLP-1 medication labels. Their meta-analysis of 91 placebo-controlled trials (107,910 patients) found no increased risk of suicidal ideation, behavior, or related psychiatric adverse events.
This doesn’t mean mood changes can’t occur – it means that at a population level, the evidence doesn’t support a causal link to suicidality specifically. Individual experiences may still vary, particularly for those with pre-existing mental health conditions.
How I Work With Clients on This
When I see someone for intake and they’re on one of these medications, I always ask: Was this symptom present before you started the medication? If you’ve had anxiety or depression in the past, was it manageable, and has it gotten worse since starting this?
I don’t assume the medication is the cause, but I explore the correlation. Because you’re coming to therapy for a reason, right? Something brought you here. Let’s figure out what changed.
I’ll walk through it all with them:
- When did you start the medication?
- When did you first notice the mood changes or intimacy issues?
- Have you talked to your prescribing doctor about this?
- Do they know about your mental health history?
I’m not a medical doctor. I don’t tell someone to stop taking their medication. What I can do is help them connect the dots, give them the information, and encourage them to have a conversation with their prescribing physician.
Sometimes clients will track their symptoms in a journal or use other tools to monitor patterns. When they see it written down – “Started medication Week 1, felt fine. Week 3, anxiety increased. Week 5, couldn’t get out of bed” – the pattern becomes obvious.
To Wrap Things Up
I’m not anti-GLP-1 medication. I’m anti-uninformed use of any medication that crosses the blood-brain barrier and affects complex neurological systems – systems that control not just your appetite, but your mood, your sense of pleasure, and your sexual desire.
The key takeaway from current research is that for most people without psychiatric history, these medications appear to be psychiatrically safe. But for individuals with a history of depression, anxiety, or other mental health conditions, closer monitoring may be warranted.
If you’re considering starting one of these medications? Make sure your doctor knows your complete mental health history and talk to him or her if you experience adverse reactions.
And if you’re struggling with intimacy issues in general, please talk to a therapist. Don’t just assume this is your new normal.
About Me
I’m Chelsea Koutroulis, M.Ed., LPC-Associate, CST. I work with adults and couples — mostly around identity, transitions, anxiety, and sex therapy. My approach is person-centered, solutions-focused, and rooted in helping people understand their own stories. I’m supervised by Megan Pollock, MS, LPC-S, CST, and I see clients both in person and via telehealth.
References & Further Reading
- Kornelius E, et al. (2024). The risk of depression, anxiety, and suicidal behavior in patients with obesity on glucagon like peptide-1 receptor agonist therapy. Scientific Reports, 14(1), 24433. https://www.nature.com/articles/s41598-024-75965-2
- Chen W, et al. (2024). Psychiatric adverse events associated with GLP-1 receptor agonists: a real-world pharmacovigilance study based on the FDA adverse event reporting system database. Frontiers in Endocrinology, 15, 1330936. https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2024.1330936/full
- Pierret ACS, et al. (2025). Glucagon-like peptide 1 receptor agonists and mental health: a systematic review and meta-analysis. JAMA Psychiatry, 82(7), 643-653. https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2833558
- Able C, et al. (2024). Prescribing semaglutide for weight loss in non-diabetic, obese patients is associated with an increased risk of erectile dysfunction: a TriNetX database study. International Journal of Impotence Research. https://pubmed.ncbi.nlm.nih.gov/38778151/
- Kinsey Institute & DatingAdvice.com (2025). State of Us: National Study on Modern Love & Dating in 2025. https://news.iu.edu/kinseyinstitute/live/news/46263-survey-shows-glp-1-weight-loss-drugs-are-changing
- Tveit M, et al. (2025). GLP-1 Agonist Weight Loss Medications Decrease Sexual Desire: A Biopsychosocial Model. Journal of Sexual Medicine, 22(Supplement_1). https://academic.oup.com/jsm/article/22/Supplement_1/qdaf068.136/8119644
- FDA Drug Safety Communication (January 2026). FDA Requests Removal of Suicidal Behavior and Ideation Warning from GLP-1 RA Medications. https://www.fda.gov/drugs/drug-safety-and-availability/fda-requests-removal-suicidal-behavior-and-ideation-warning-glucagon-peptide-1-receptor-agonist-glp
- Anorgasmia following initiation of GLP-1 agonist (Case Report). PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC12260840/
