Do drugs commonly used to treat diabetes and obesity increase suicide risk?
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are a type of drug used to treat diabetes and obesity. They are effective and commonly used, but there have been reports linking these drugs to an increase in suicidal thoughts.
People living with severe mental illness like bipolar disorder and depression are at an increased risk of obesity and diabetes. Additionally, research from the lab of Dr. Roger McIntyre conducted during the past two decades suggests that obesity and diabetes may be a risk factor for mental illness and may be a contributing cause.
In this context it is extremely important to determine if GLP-1 RAs increase the risk of suicide.
Dr. McIntyre and his team evaluated GLP-1 RAs to determine if they are associated with an increase in suicide risk.
What are GLP-1 RAs and why is it so important to study them?
RM: GLP-1 RAs are a category of drugs that reduce blood sugar and energy intake by activating the GLP-1 receptor. They mimic the actions of the hormone GLP-1, which the body releases after eating. They are an effective way to treat obesity and diabetes.
What motivated this research?
RM: Since GLP-1 RAs are approved treatments for common health problems, it was extremely important to conduct research responding to reports of suicidal behavior associated with these drugs. Moreover, obesity and diabetes are more common among those with mental illness who may already be at a higher risk of self-harm and suicide than the wider population. There is also evidence that GLP-1 RAs may also be effective in preventing and treating mental illness, specifically depression, anxiety, and cognitive impairment in person with serious mental illnesses like dementia.
To ensure that GLP-1 RAs can be safely used to treat those with mental illness, we needed to be sure they did not increase suicide risk.
What was the most important finding of this study, in your opinion?
RM: Our group evaluated a large database compiled by the United States Food and Drug Administration and found that GLP-1 RAs may have been associated with more reporting of thoughts of suicide. However, there is no evidence that these drugs were associated with an increase in suicide completion . In fact, our lab discovered that there is no causal relationship between GLP-1 RAs and suicide completion, and there may be a decrease in suicide risk when people take these medications.
How does this change treatment in the future?
RM: People with mental illness such as biopolar disorder and depression are more susceptible to being overweight. Knowing that GLP-1 RAs do not cause an increase in suicide risk mean these drugs can be safely used to treat patients with bipolar disorder and depression.
Any next steps?
RM: The next steps that have taken place are that the European Medicines Agency (EMA) and the US Food and Drug Administration (FDA) confirmed there is no evidence to suggest a causal relationship between GLP-1 RAs and suicide completion. Moreover, now there is additional scientific work taking place that suggests GLP-1 agents may protect the brain from mental illness.
What is the major take home message for the public?
RM: People who have mental illnesses can consider GLP-1 RAs as potential treatment to help their concurrent obesity and diabetes, without concerns regarding increased suicide risk.
Read this month's ImPACT paper.
Roger S. McIntyre, Rodrigo B. Mansur, Joshua D. Rosenblat & Angela T.H. Kwan (2024) The association between glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and suicidality: reports to the Food and Drug Administration Adverse Event Reporting System (FAERS), Expert Opinion on Drug Safety, 23:1, 47-55, DOI: 10.1080/14740338.2023.2295397
