Diabetes drugs could prevent anxiety and depression from worsening, according to research.
Type 2 diabetes affects more than 800 million people globally and research shows that those with the condition are about twice as likely to have depression as the wider population.
GLP-1 receptor agonists such as semaglutide are commonly prescribed for diabetes and obesity. While studies have found other health benefits beyond weight loss and better blood sugar levels, the medications’ effects on mental health have been unclear.
International researchers examined Swedish health records of almost 95,000 people with a diagnosis of depression or anxiety who were also taking various diabetes medications between 2009 and 2022.
The study compared periods when patients were taking GLP1s, or other second-line diabetes medications, with when they were not taking them. Worsening mental health was assessed through data on psychiatric hospital admissions, sick leave from work due to mental health reasons, hospitalisation owing to self-harm and death by suicide. Published in the Lancet Psychiatry, the research also examined data on new diagnoses of anxiety and depression.
The authors found that semaglutide, the active ingredient in the drugs Ozempic for diabetes and Wegovy for weight loss, as well as liraglutide (Saxenda) were associated with a lower risk of worsening mental illness in those with anxiety and depression.
Semaglutide had a 42% lower risk of worsening mental health, while liraglutide was linked to an 18% lower risk. Other GLP-1 drugs, including exenatide and dulaglutide, did not show the same benefit.
Semaglutide was associated with a 44% lower risk of worsening depression, a 38% lower risk of worsening anxiety and a 47% lower risk of worsening substance use disorder.
“For anxiety and depression that co-occur with diabetes and obesity, semaglutide and, to a lesser extent, liraglutide might be useful dually effective therapeutic options,” the authors concluded.
Dr Markku Lähteenvuo, a research director at the University of Eastern Finland, said: “It is possible that, in addition to factors such as reduced alcohol consumption, weight loss-related improvements in body image, or relief associated with better glycaemic control in diabetes, there may also be direct neurobiological mechanisms involved, for example, through changes in the functioning of the brain’s reward system.”
Responding to the findings, experts urged caution, including Prof David Nutt, who is the head of the neuropsychopharmacology unit at Imperial College London and chair of the independent scientific committee Drug Science.
He said: “It is well established that better mental health tends to follow from better physical health and since the 1880s we have known that diabetes is associated with depression, although I think it’s unlikely that using GLP-1R agonists alone as treatments for depression or anxiety will work.”
Prof Eduard Vieta, a professor of psychiatry at the University of Barcelona and editor in chief of the European College of Neuropsychopharmacology journal, said: “From a clinical perspective, these findings are reassuring regarding the psychiatric safety of GLP-1 receptor agonists and suggest a potential role not only in preventing worsening but also, possibly, in improving mental health outcomes.
“However, they should not yet be interpreted as evidence of a direct therapeutic effect on depression or anxiety.”
The research came as a separate study found that women taking semaglutide for diabetes before they knew they were pregnant had a 84% higher relative risk of preterm birth, compared with those who did not take GLP-1 medication, while the risk was 70% higher with liraglutide.
Academics looked at Danish health registries for nearly 500,000 women, of whom 529 had been taking liraglutide or semaglutide when they became pregnant.
The study found that inadvertent exposure to GLP-1s in early pregnancy was associated with a higher risk of the baby being born before 37 weeks when the drugs were used for diabetes treatment, but not among those taking them for weight loss.
Taking semaglutide was associated with approximately a 11% higher absolute risk of preterm birth. Liraglutide showed a 9% increased risk.
