Study links semaglutide and tirzepatide to fewer anxiety and depression diagnoses in obesity care

IN CONTINUATION OF MY UPDATE ON semaglutide and tirzepatide 

In a recent study published in the journal Communications Medicine, a group of researchers examined associations between initiation of tirzepatide or semaglutide and incident neuropsychiatric diagnoses in adults with obesity, compared with other weight-loss treatments, with separate analyses for individuals with and without type 2 diabetes.

Background

Currently, obesity affects more than 650 million adults globally, with implications for physical and mental well-being. People with obesity are more likely to suffer from psychiatric conditions, including anxiety and depression, than people without obesity. Moreover, mental illness can increase the chances of developing obesity. Newer incretin-based medications like semaglutide and tirzepatide have changed obesity treatment by producing substantial weight loss, but their effects on neuropsychiatric health remain uncertain in routine clinical practice. 

About the study

Researchers conducted a retrospective cohort study using de-identified electronic health records from the TriNetX United States Collaborative Network between January 2020 and November 2025. Adults meeting the study’s obesity criteria, who newly initiated tirzepatide or semaglutide, were identified and compared with matched individuals who started naltrexone-bupropion, phentermine, or phentermine-topiramate. The study included two separate analyses based on whether or not the participants had type 2 diabetes, and bariatric surgery recipients and a non-pharmacological weight-loss cohort were also evaluated as contextual comparison groups.

To increase comparability between treatment groups, propensity score matching was performed using demographic features, body mass index (BMI), glycated hemoglobin (HbA1c), medical history, co-existing treatments, healthcare utilization, and results of laboratory investigations. Patients with type 1 diabetes, prior bariatric surgery, history of organ transplantation, human immunodeficiency virus (HIV) infection, and end-stage renal disease were not included. Patients were monitored for a maximum of 24 months from treatment initiation until the initial diagnosis of a neuropsychiatric outcome, death, loss to follow-up, or end of study.

The primary outcome was a new diagnosis of anxiety disorder. Secondary outcomes included diagnoses of depression, mood disorder, insomnia, broadly defined cognitive deficits, nerve disorders, peripheral neuropathy, and substance-related disorders. Hazard ratios with 95% confidence intervals (CIs) were obtained using Cox proportional hazards models, adjusted for possible confounders, and various sensitivity analyses were also performed.

Study results

Before matching, individuals initiating incretin-based therapies differed considerably from comparator groups, particularly regarding psychiatric illnesses and psychotropic medication use. After matching on propensity scores, the groups had very similar baseline demographic characteristics, cardiometabolic health issues, laboratory measures, and health care use, allowing for more reliable comparisons between the treatment groups.

 

Individuals receiving semaglutide and tirzepatide generally had lower hazards of several recorded neuropsychiatric diagnoses when compared to bariatric surgery recipients.

Among individuals with obesity and type 2 diabetes, both medications were associated with lower hazards of anxiety disorders, broadly defined cognitive deficits, mood disorders, and depression. Similar results were seen for individuals without type 2 diabetes, but the neurological outcomes were less consistent between the groups. 

Semaglutide was associated with a higher hazard of nerve disorders in participants without diabetes, while tirzepatide showed lower hazards of substance-related disorders and peripheral neuropathy compared with bariatric surgery. The negative control analyses did not find any clinically meaningful differences, providing some reassurance about the analytical approach.

Compared with naltrexone-bupropion, semaglutide was associated with lower hazards of anxiety disorders, depression, cognitive deficits, and insomnia in adults with type 2 diabetes. Tirzepatide also showed lower hazards of anxiety disorders, depression, mood disorders, and cognitive deficits within this group.

Similar reductions were observed among adults without diabetes, indicating that both medications were consistently associated with lower rates of several recorded psychiatric diagnoses than this comparator.

Among adults without type 2 diabetes, a direct comparison between tirzepatide and semaglutide showed that tirzepatide was associated with higher hazards of anxiety disorders and insomnia than semaglutide, while no consistent differences were observed for most neurological outcomes after statistical adjustment. However, the authors noted that absolute and relative estimates differed for anxiety and insomnia in this head-to-head comparison, so these small differences should be interpreted cautiously.

Absolute risk differences indicated larger reductions in anxiety disorders among individuals with type 2 diabetes than among those without diabetes when tirzepatide or semaglutide was compared with naltrexone-bupropion.

Sensitivity analyses generally supported the primary findings. Per-protocol and as-treated analyses showed similar directions of association for anxiety and depression, although the strength of some associations varied depending on treatment persistence. Lower use of psychiatric medications, particularly selective serotonin reuptake inhibitors (SSRIs), was also observed among incretin-based therapy recipients compared with matched comparator groups.

Subgroup analyses suggested that the associations were generally consistent across age, BMI, and clinical characteristics, with some stronger associations observed among older adults and individuals with severe obesity.

Exploratory analyses generally showed greater reductions in body weight and HbA1c over 24 months in the incretin-based therapy groups than in the conventional anti-obesity medication groups, although some comparisons varied by diabetes status and outcome measure.

Additional sensitivity analyses using stricter outcome definitions and alternative cohort criteria yielded findings that were directionally similar, though some estimates became less precise due to smaller sample sizes. Importantly, cognitive findings were sensitive to outcome definition, and the broad cognitive endpoint included codes that could reflect acute or transient altered mental status rather than dementia or progressive cognitive decline.

Conclusion

The findings suggest that initiation of tirzepatide and semaglutide is associated with different neuropsychiatric outcome patterns depending on the comparator treatment and the presence of type 2 diabetes. Compared with naltrexone-bupropion, both medications were generally associated with lower hazards of anxiety and depression. In contrast, tirzepatide showed higher hazards of anxiety and insomnia than semaglutide among adults without type 2 diabetes.

These findings provide clinicians and patients with important real-world evidence to inform treatment decisions, while underscoring the need for continued patient monitoring. However, the results should not be interpreted as evidence that these medications prevent dementia, progressive cognitive decline, or psychiatric disease, because the study relied on diagnosis codes and remains vulnerable to residual confounding and misclassification.

In addition, as this study was observational, prospective studies with standardized neuropsychiatric assessments are needed to confirm these associations. Further research is needed to understand how these medications may influence mental health outcomes across different patient populations.

Study links semaglutide and tirzepatide to fewer anxiety and depression diagnoses in obesity care

Acetaminophen reaffirmed as first-line medication for treating pain and fever during pregnancy

In continuation of my update on acetaminophen 

Acetaminophen remains the recommended first-line medication to treat pain and fever during pregnancy, according to an updated statement from the Society for Maternal-Fetal Medicine (SMFM). A comprehensive review of the available scientific evidence does not establish a causal relationship between acetaminophen taken during pregnancy and an increased risk of autism spectrum disorders and attention deficit and hyperactivity disorder (ADHD) in children, according to SMFM. The work is published in the journal Pregnancy.

SMFM's statement is based on a thorough review of recent studies and earlier research on acetaminophen during pregnancy. The newest studies vary in their findings on the potential association between prenatal acetaminophen exposure and risk of childhood neurobehavioral issues and have significant limitations in their study design.

"After another careful review of the existing research, we continue recommending acetaminophen as a safe treatment for our pregnant patients who need it for pain relief and to reduce fever," said Judette M. Louis, MD, MPH, chair of the SMFM Publications Committee.

Acetaminophen is a commonly used non-opioid analgesic during pregnancy. An estimated 65% of pregnant women use acetaminophen at some point during pregnancy, mostly to treat headache and fever. Acetaminophen is the active ingredient in many over-the-counter and prescription medications, including Tylenol.

"Both untreated fever and pain during pregnancy carry potential health risks, so you shouldn't just 'tough it out,'" said Louis. "Untreated fever, particularly in the first trimester, is known to be linked to birth defects and miscarriage. We also know that maternal fever during labor can be associated with poor neonatal outcomes."

Along with acetaminophen, SMFM recommends nonpharmacological interventions, including hydration and physical therapy, to help manage pain during pregnancy.

Nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids are not recommended to treat fever and pain during pregnancy. NSAIDs increase the risk of fetal renal impairment, premature closure of the ductus arteriosus, oligohydramnios, and maternal bleeding. Opioid medications taken during pregnancy are associated with neonatal abstinence syndrome, addiction, and sedation, and are also not recommended as first-line treatments for pain during pregnancy.

https://en.wikipedia.org/wiki/Paracetamol

Acetaminophen reaffirmed as first-line medication for treating pain and fever during pregnancy

FDA Proposes to Exclude Semaglutide, Tirzepatide, and Liraglutide on 503B Bulks List.

The U.S. Food and Drug Administration announced the  proposal  to exclude semaglutide, tirzepatide, and liraglutide on the 503B bulks list, finding no clinical need for outsourcing facilities to compound these drugs from bulk substances. 

The 503B bulks list identifies bulk drug substances that outsourcing facilities may use in compounding under the conditions of section 503B of the Federal Food, Drug, and Cosmetic Act (FD&C Act). In most cases, outsourcing facilities cannot compound drugs using bulk drug substances unless the substance appears on the 503B bulks list, or the compounded drug is on the FDA’s drug shortage list at the time of compounding, distribution, and dispensing. 

After evaluating the nominations for these three substances, the FDA did not identify a clinical need for outsourcing facilities to compound semaglutide, tirzepatide, and liraglutide from bulk drug substances. 

“When FDA-approved drugs are available, outsourcing facilities cannot lawfully compound using bulk drug substances unless there is a clear clinical need,” said FDA Commissioner Marty Makary, M.D., M.P.H. “This action reflects our responsibility to protect patients and preserve the integrity of the drug approval process while continuing to provide a transparent, science-based pathway for public input.”

The FDA carefully reviewed the nominations it received and did not identify sufficient evidence to include semaglutide, tirzepatide and liraglutide on the 503B bulks list. A determination of clinical need is based on patient safety and medical necessity under the law. 

The FDA is now inviting interested parties to submit comments electronically through the docket by June 29, 2026. The agency will consider submitted comments before making a final determination. 

https://en.wikipedia.org/wiki/Liraglutide

https://en.wikipedia.org/wiki/Tirzepatide

https://en.wikipedia.org/wiki/Semaglutide

More : 

FDA Proposes to Exclude Semaglutide, Tirzepatide, and Liraglutide on 503B Bulks List | FDA

Praxis Precision Medicines Announces FDA Acceptance and Priority Review of New Drug Application for Relutrigine in Patients with SCN2A and SCN8A DEEs

Praxis Precision Medicines, Inc. (NASDAQ: PRAX), a fully integrated, leading central nervous system (CNS) precision neuroscience biopharmaceutical company, today announced that the U.S. Food and Drug Administration (FDA) has accepted for priority review its New Drug Application (NDA) for relutrigine, for the treatment of SCN2A and SCN8A developmental and epileptic encephalopathies (DEEs). The FDA has set a target action date under the Prescription Drug User Fee Act (PDUFA) of September 27, 2026.

• FDA assigned PDUFA target action date of September 27, 2026

“Our first FDA acceptance of an NDA submission marks a significant milestone in our evolution to a commercial-stage company and an important step toward delivering innovative, precision neuroscience therapies to patients in need. SCN2A/8A DEEs have no currently approved targeted therapies and relutrigine, if approved, would be the first disease-modifying therapy for children suffering from these devastating and fatal conditions. We look forward to working closely with the FDA during the review process while continuing to advance our launch preparations,” said Marcio Souza, president and chief executive officer.

Relutrigine for treatment of SCN2A/8A DEEs

The NDA is supported by positive results from the EMBOLD study, which was stopped early for efficacy following a successful interim analysis and recommendation from the Data Monitoring Committee. Relutrigine has an Orphan Drug Designation, as well as a Rare Pediatric Disease Designation and a Breakthrough Therapy Designation. If granted approval, relutrigine will be the first FDA-approved therapy for SCN2A/8A DEE as well as be eligible for a Pediatric Review Voucher.

Relutrigine is also being investigated in broad DEEs through the EMERALD trial, which is expected to be completed by the end of 2026.

About Relutrigine

Relutrigine is a first-in-class small molecule in development for the treatment of developmental and epileptic encephalopathies (DEEs) as a preferential inhibitor of persistent sodium current, shown to be a key driver of seizure symptoms in severe DEEs. Relutrigine’s mechanism of precision sodium channel (NaV) modulation is consistent with superior selectivity for disease-state NaV channel hyperexcitability. In vivo studies of relutrigine have demonstrated dose-dependent inhibition of seizures up to complete control of seizure activity in SCN2A, SCN8A and other DEE mouse models. Relutrigine has been generally well-tolerated in three Phase 1 studies and has demonstrated biomarker changes indicative of NaV channel modulation. Data from cohort 1 of the Phase 2 EMBOLD study demonstrated a well-tolerated, robust, short- and long-term improvement in motor seizures in a heavily pre-treated population, alongside maintained seizure freedom in some patients with SCN2A- and SCN8A-DEE. Relutrigine has received Orphan Drug Designation (ODD) and Rare Pediatric Disease Designation from the FDA for the treatment of SCN2A-DEE, SCN8A-DEE and Dravet syndrome; as well as Breakthrough Therapy Designation (BTD), and ODD from the European Medicines Agency for the treatment of SCN2A-DEE and SCN8A-DEE.

Praxis Precision Medicines Announces FDA Acceptance and Priority Review of New Drug Application for Relutrigine in Patients with SCN2A and SCN8A DEEs

How statins harm muscles—and how to stop it

In continuation of my update  on statin 

Statins have transformed heart health, saving millions of lives by lowering cholesterol and reducing the risk of heart attacks and strokes. But for many patients, these drugs come with a troubling downside: muscle pain, weakness and, in rare cases, severe muscle breakdown that can lead to kidney failure.

University of British Columbia researchers and their collaborators at the University of Wisconsin-Madison have now pinpointed the cause. Their findings, published last week in Nature Communications, could pave the way for a new generation of statins without these side effects.

How statins affect muscle cells

The team used cryo-electron microscopy, a powerful imaging technique that reveals proteins at near-atomic detail, to capture how statins interact with a critical muscle protein called the ryanodine receptor (RyR1). This protein acts like a gatekeeper for calcium inside muscle cells, opening only when muscles need to contract. When statins bind to it, they force the gate open, causing calcium to leak continuously—a toxic effect that can damage muscle tissue.

"We were able to see, almost atom by atom, how statins latch onto this channel," said lead author Dr. Steven Molinarolo, a postdoctoral researcher in UBC's department of biochemistry and molecular biology. "That leak of calcium explains why some patients experience muscle pain or, in extreme cases, life-threatening complications."

Implications for future statin development

The study focused on atorvastatin, one of the most widely prescribed statins, but the findings suggest the effect may be common across the drug class. The researchers discovered that statins bind in a highly unusual way: Three molecules cluster together inside a pocket of the protein. The first molecule attaches when the channel is closed, priming it to open. Two more molecules then wedge in, forcing the channel wide open.

"This is the first time we've had a clear picture of how statins activate this channel," said Dr. Filip Van Petegem, senior author and professor at UBC's Life Sciences Institute. "It's a big step forward because it gives us a roadmap for designing statins that don't interact with muscle tissue."

By adjusting only those parts of the statin molecule that are responsible for the negative effects, scientists could preserve the part that lowers cholesterol while reducing the risk.

https://en.wikipedia.org/wiki/Statin

How statins harm muscles—and how to stop it