A recent study published in JAMA Pediatrics has explored the relationship between glucagon-like peptide 1 receptor agonists (GLP1R) and suicidal thoughts among adolescents dealing with obesity. The research suggests that adolescents prescribed these medications may experience lower rates of suicidal ideation and attempts compared to those undergoing lifestyle interventions, indicating potential psychiatric benefits.
Background
Childhood obesity is a growing concern, with over 124 million children and adolescents affected globally. The prevalence has increased eight-fold in the last 40 years among those aged 5 to 19, and projections indicate that more than half of children could face obesity by age 35 if current trends continue. The COVID-19 pandemic has exacerbated outcomes for adolescents diagnosed with obesity.
Obesity in childhood is associated with numerous immediate and long-term health issues, including liver disease, type 2 diabetes, heart disease, and an increased risk of premature death. Genetic factors influencing appetite regulation play a significant role in the development of obesity. However, treatment options are often limited, as lifestyle modifications alone may yield insufficient results. While GLP1R medications have shown efficacy in promoting weight loss and improving metabolism in adolescents, their psychiatric implications remain underexplored.
Previous studies in adults have indicated that those using GLP1R medications may have a lower risk of suicidal thoughts compared to individuals using alternative weight-loss drugs.
About the Study
With the rising use of GLP1R medications among adolescents and the mental health risks tied to pediatric obesity, researchers sought to investigate the connection between GLP1R use and suicidality in this population. They utilized data from a healthcare network, employing a retrospective cohort design that included American adolescents aged 12 to 18 diagnosed with obesity and prescribed either semaglutide or liraglutide—both GLP1R medications.
The study compared adolescents using GLP1R medications to a control group receiving behavioral or lifestyle interventions, such as dietary changes or exercise. A matching method ensured that each participant in the GLP1R group was paired with a similar participant in the control group based on psychiatric history, race, sex, and age.
The primary outcome measured was the incidence of suicidal thoughts or attempts over a 12-month follow-up period.
Findings
The initial analysis included 77,854 adolescents diagnosed with obesity, with 4,052 ultimately in the GLP1R group and 50,112 in the control group after exclusions. Following the matching process, 3,456 individuals from each cohort were analyzed.
Before matching, adolescents in the GLP1R group were older (average age 15.5 vs. 14.7) and more likely to be female (59% vs. 49%). They also had a higher body mass index (BMI), were more frequently diagnosed with diabetes (40% vs. 4%), and had a higher prevalence of psychiatric diagnoses (17% vs. 9%) and antidepressant use (18% vs. 7%).
After adjusting for these variables, adolescents receiving GLP1R medications demonstrated a 33% lower risk of suicidal ideation and attempts compared to those in the control group. While those on GLP1R experienced more gastrointestinal symptoms, they had fewer instances of acute pancreatitis. The study found no significant differences in the incidence of upper respiratory infections between the two groups.
Additionally, researchers noted that 69% of adolescents on GLP1R medications received at least one follow-up prescription for the same medication. These individuals were also more likely to be prescribed phentermine, an appetite suppressant, while the control group more frequently received recommendations for bariatric surgery.
Conclusions
This study assessed 6,912 adolescents with obesity, focusing on the risk of suicidal ideation and attempts while comparing those prescribed GLP1R medications to those who were not. The results indicated that semaglutide exhibited fewer psychiatric side effects and improved weight-related quality of life compared to liraglutide or placebo treatments.
The findings suggest that adolescents receiving GLP1R medications faced a reduced risk of suicidal thoughts and attempts, although they also experienced more gastrointestinal symptoms—a common side effect of these treatments.
While these results contribute to the understanding of the psychiatric implications of obesity medications, the study’s observational design and retrospective nature limit the ability to establish causal relationships, highlighting the need for further research. Given the significant mental health challenges associated with adolescent obesity, continued exploration in this area could prove invaluable.
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