US psychiatrists prescribe Wegovy to battle medication-induced weight gain

[August 03, 2023]  By Elissa Welle

NEW YORK (Reuters) - U.S. psychiatrists are increasingly prescribing the popular weight-loss drug Wegovy to patients who gain weight from medicines used to treat mental disorders, such as schizophrenia or bipolar disorder, according to Reuters interviews with ten prescribers across the country. Many antipsychotic drugs and mood stabilizers can cause patients to gain significant weight and contribute to diabetes and heart disease, the leading cause of death among adults with schizophrenia.

Complicated by other factors such as inadequate access to healthy food and lower physical activity, over half of patients with bipolar depression and schizophrenia are overweight or obese. Novo Nordisk's Wegovy is self-injected once a week and has been shown to help patients lose around 15% of their body weight, making it the most effective treatment available. "It's been a real welcome addition …. for people who truly have endured significant weight gain because of atypical antipsychotics and have doggedly tried their best to overcome that," said Dr. Joseph Goldberg, a professor of psychiatry at Icahn School of Medicine at Mount Sinai in New York. Wegovy received U.S. approval as an obesity treatment in June 2021, while Mounjaro, a similar drug from Eli Lilly, is expected to be authorized this year. New rivals are also in development.

The global market for weight-loss drugs is forecast to reach as much as $100 billion within the decade. Yet the best use of such drugs among patients with psychiatric diagnoses is just beginning to be understood.

Beyond severe mental health disorders, other patients struggling with obesity tend to suffer from mental health issues like depression and anxiety at higher levels than the general population, studies show. Clinical trials for Wegovy, which belongs to a class of drugs known as GLP-1 agonists that began as diabetes medicines, excluded psychiatric patients, a common practice in drug development.

The U.S. Food and Drug Administration has cautioned doctors to monitor patients taking the drug for development of depression or suicidal thoughts. Regulators in Europe are now investigating several reports of patients who experienced suicidal thoughts after starting Wegovy. Novo did not comment on Wegovy use among psychiatric patients, but its safety data has not shown a link between the drug and suicidal thoughts.

The Danish drugmaker is "continuously performing surveillance of the data from ongoing clinical trials and real-world use of its products," said spokesperson Natalia Salomao in an email.

LOST WEIGHT, GAINED SELF-CONFIDENCE

Psychiatrists interviewed by Reuters said they are already vigilant about suicide risk in their patients, and have experience in closely monitoring for signs of distress whenever they add a new medication. Dr. Dost Ongur, chief of the psychotic disorders division of Mass General Brigham McLean Hospital near Boston said use of GLP-1 medications for psychiatry patients has grown so much that he is considering drafting a standard approach paper for his staff on prescribing them.

A selection of injector pens for the Wegovy weight loss drug are shown in this photo illustration in Chicago, Illinois, U.S., March 31, 2023. REUTERS/Jim Vondruska/Illustration/File Photo

However, psychiatrists specializing in eating disorders are wary that drugs like Wegovy could exacerbate their patients’ focus on weight loss because they are so effective. A good candidate for Wegovy would be a patient who is capable of self-administering the medicine, or be supervised in doing so, and is eager to adopt a healthy lifestyle, said Dr. K. N. Roy Chengappa, a psychiatrist at University of Pittsburgh Medical Center. New Yorker Alexander Roger, 23, was diagnosed with bipolar disorder at age 10. In February, the Fordham University student began taking Wegovy, prescribed through a collaboration between his endocrinologist and psychiatrist, to combat the persistent weight gain from lithium and other mood stabilizers. "When you're on the psychiatric meds, you're so hungry, you just eat whatever is available," Roger said. In the last six months, Roger said he lost 30 pounds (13.6 kg) and gained self-confidence and energy. But he is finding it difficult getting Wegovy from his pharmacy, an experience common to patients across the country as Novo Nordisk struggles to meet soaring demand. Some psychiatrists said their prescriptions had been rejected by patients' health insurance. In such cases, these doctors said they will refer patients to an endocrinologist, a specialty recognized for managing diabetes and obesity.

More broadly, health plans are adding restrictions to the use of Wegovy, which is priced at $1,350 per month, and other weight-loss drugs due to a spike in their related costs. Dr. Michael Weintraub, an endocrinologist at NYU Langone Health, said ideally psychiatrists will work with endocrinologists because weight-loss drugs require careful monitoring not related to mental health issues.

Others say the next step might be to offer these medications well before a patient gains significant weight from their antipsychotic drugs. "Waiting until somebody has gained 50 pounds and has developed diabetes is just not serving the patient," McLean's Ongur said.

(Reporting by Elissa Welle in New York; Editing by Michele Gershberg and Bill Berkrot)

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