Are you concerned about the side effects of GLP-1 weight management treatments? At Bolt Pharmacy, we understand your worries. Our latest article discusses the potential connection between the GLP-1 drug, Wegovy, and panic attacks. Engage with us as we unpack this potent issue, offering trustworthy insights to support you on your weight loss journey.

Understanding Wegovy and Its Effects on Mental Health

Wegovy (semaglutide 2.4mg) is a glucagon-like peptide-1 (GLP-1) receptor agonist licensed by the MHRA for chronic weight management in adults with obesity or overweight with weight-related comorbidities. Administered as a once-weekly subcutaneous injection, Wegovy works by mimicking the naturally occurring hormone GLP-1, which regulates appetite and food intake through actions on the brain's satiety centres.

According to the Wegovy Summary of Product Characteristics (SmPC), the mechanism of action involves binding to GLP-1 receptors, slowing gastric emptying, reducing hunger signals, and promoting feelings of fullness. Whilst Wegovy primarily targets metabolic pathways, GLP-1 receptors are also present in various brain regions, including some associated with mood regulation, though a direct link to emotional processing remains hypothetical rather than proven.

It's worth noting that increased heart rate is a recognised class effect of GLP-1 receptor agonists, which some individuals may perceive as anxiety or palpitations.

Clinical trials for Wegovy, including the STEP programme (Semaglutide Treatment Effect in People with obesity), have primarily focused on weight loss efficacy and cardiometabolic outcomes. Mental health effects were not a primary endpoint in these studies, though adverse event reporting captured some psychiatric symptoms. The SmPC for Wegovy lists gastrointestinal side effects as most common (nausea, diarrhoea, vomiting, constipation), but does not specifically highlight panic attacks as a recognised adverse reaction.

However, the relationship between weight loss medications and mental health is complex. Rapid weight loss itself can affect mood and anxiety levels through various mechanisms. Additionally, individuals seeking weight management treatment may have pre-existing mental health conditions that could be affected by metabolic changes. Understanding this context is essential when considering any potential link between Wegovy and panic symptoms.

Can Wegovy Cause Panic Attacks or Anxiety Symptoms?

There is currently no established causal link between Wegovy and panic attacks in the official prescribing information or major clinical trials. The pivotal STEP (Semaglutide Treatment Effect in People with obesity) trials, which involved over 4,500 participants, did not identify panic attacks as a significant adverse event. Published analyses of the STEP trials (Wilding et al., NEJM 2021; Davies et al., JAMA 2021) reported psychiatric adverse events at similar rates between semaglutide and placebo groups, suggesting no clear direct causation.

Recently, the European Medicines Agency's Pharmacovigilance Risk Assessment Committee (PRAC) reviewed GLP-1 receptor agonists and found no evidence of increased risk of suicidal thoughts or self-harm, though monitoring continues.

However, post-marketing surveillance and patient reports have documented some individuals experiencing anxiety symptoms or panic-like episodes whilst taking GLP-1 receptor agonists. It remains unclear whether these represent true drug-induced effects, coincidental occurrences, or indirect consequences of the weight loss process. Several potential mechanisms have been proposed, though evidence specifically linking them to panic symptoms with Wegovy is limited:

• Increased heart rate: GLP-1 receptor agonists can increase heart rate, which may be perceived as anxiety or palpitations • Hypoglycaemia: Though uncommon with Wegovy alone in people without diabetes, low blood sugar can trigger anxiety-like symptoms (risk increases if taking insulin or sulfonylureas) • Gastrointestinal distress: Severe nausea or abdominal discomfort may provoke anxiety or panic responses in susceptible individuals

Individual susceptibility varies considerably. People with a history of anxiety disorders, panic disorder, or other mental health conditions may be more vulnerable to experiencing panic symptoms during treatment. The MHRA's Yellow Card scheme (yellowcard.mhra.gov.uk) has received some reports of anxiety-related symptoms with semaglutide products, though causality has not been definitively established. Healthcare professionals should maintain awareness of this possibility whilst recognising that current evidence does not support a direct pharmacological mechanism linking Wegovy to panic attacks.

Recognising Panic Attack Symptoms While Taking Wegovy

Panic attacks are sudden episodes of intense fear or discomfort that reach peak intensity within minutes. Recognising these symptoms is crucial for appropriate management, particularly when taking any new medication. According to NICE Clinical Guideline 113 and NHS guidance, a panic attack involves four or more of the following symptoms:

• Cardiovascular: Palpitations, pounding heart, or accelerated heart rate; chest pain or discomfort • Respiratory: Shortness of breath or smothering sensations; feeling of choking • Neurological: Dizziness, light-headedness, or feeling faint; trembling or shaking; paraesthesia (numbness or tingling) • Psychological: Fear of losing control or "going crazy"; fear of dying; feelings of unreality (derealisation) or detachment from oneself (depersonalisation) • Other physical symptoms: Sweating; nausea or abdominal distress; chills or hot flushes

Distinguishing panic attacks from Wegovy side effects can be challenging, as some overlap exists. Nausea, dizziness, and gastrointestinal symptoms are common with Wegovy, particularly during dose escalation. Additionally, the increased heart rate associated with GLP-1 receptor agonists can feel like anxiety. However, panic attacks typically involve a constellation of symptoms with prominent psychological features (intense fear, sense of impending doom) that are not characteristic of medication side effects alone.

Hypoglycaemia symptoms may also mimic panic attacks and should be considered, especially if you're taking Wegovy alongside diabetes medications like insulin or sulfonylureas. If you have diabetes or have been advised to monitor your glucose, check your levels if you experience these symptoms. True panic attacks occur independently of blood sugar levels and are accompanied by significant psychological distress.

If you experience these symptoms whilst taking Wegovy, keep a symptom diary noting the timing, duration, severity, and any potential triggers. This information will be valuable for your healthcare provider in determining whether symptoms represent panic attacks, medication side effects, or another medical condition requiring investigation.

What to Do If You Experience Panic Attacks on Wegovy

If you experience panic attack symptoms whilst taking Wegovy, consult your healthcare provider before making medication changes. However, if symptoms are severe or concerning, it is reasonable to pause doses pending medical review. Take the following steps:

Immediate management during an episode: • Move to a quiet, safe space if possible • Practice controlled breathing: breathe in slowly through your nose for 4 counts, hold for 4, exhale through your mouth for 6 counts • Use grounding techniques: focus on physical sensations (feet on floor, objects you can see, sounds you can hear) • Remind yourself that panic attacks, whilst distressing, are not dangerous and will pass • If symptoms include chest pain, severe breathlessness, or you're unsure whether it's a panic attack, seek immediate medical attention by calling 999 or NHS 111 for urgent but non-emergency advice • If experiencing thoughts of self-harm or suicide, seek urgent help via your local crisis team, A&E, or call 999

Follow-up actions:

Contact your GP or prescribing clinician within 1-2 days to discuss your symptoms. They should: • Review your complete medication list for potential interactions or contributing factors • Assess for underlying anxiety disorders or other mental health conditions • Check for physical causes (thyroid function, electrolyte imbalances, cardiovascular issues) • Evaluate whether Wegovy dose adjustment or temporary discontinuation is appropriate • Consider referral to mental health services if panic symptoms are severe or recurrent

NICE guidance (CG113) on panic disorder recommends cognitive behavioural therapy (CBT) as first-line treatment for panic attacks. Your GP may refer you to NHS Talking Therapies for psychological support. If medication is needed, selective serotonin reuptake inhibitors (SSRIs) are the first-line pharmacological treatment. Benzodiazepines are generally not recommended except for short-term use in crisis situations.

Report your experience to the MHRA Yellow Card scheme (yellowcard.mhra.gov.uk), as post-marketing surveillance helps identify potential safety signals. Your prescriber can also submit a report on your behalf.

Lifestyle measures that may help include maintaining regular eating patterns despite reduced appetite, ensuring adequate hydration, limiting caffeine intake, prioritising sleep, and incorporating stress-reduction techniques. The Wegovy SmPC notes that slowing the dose escalation schedule (delaying increases until side effects improve) may reduce overall side effects and improve tolerability.

Ultimately, the decision to continue or discontinue Wegovy should be made collaboratively with your healthcare provider, weighing the benefits of weight management against any adverse effects on mental wellbeing. Your safety and overall health remain the priority in any treatment decision.

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