South African Society of Psychiatrists: GLP1s may fuel the fire for mental illness

The South African Society of Psychiatrists warned that rising use of GLP1 agonists — prescription drugs licensed for type 2 diabetes and chronic weight management — has uncertain effects on brain function and could 'fuel the fire of mental illness'. In the interview (Dr. Honpah Masi / Dr. Ampamosia), clinicians made three linked points: appropriate use in target groups can be beneficial, inappropriate use or illicit access can worsen mental disorders, and long-term neurological effects remain unknown.

• Clinical scope and eligibility: GLP1s are licensed for people living with obesity — specifically those with a BMI above 30 or a BMI above 27 with a weight related comorbidity. Trials in those target groups have shown safety and in some cases "life-changing effects".
• Contraindications and risks: GLP1s are contraindicated in eating disorders such as anorexia and bulimia; when prescribed by clinicians who are unaware of an existing eating disorder or when obtained illicitly, patients (notably women, where eating disorders are more prevalent) risk relapse or worsening symptoms.
• Emotional and functional signals to monitor: reported effects include 'numbing of emotions, lower mood and less interest in other previously pleasurable activities'. Dramatic weight loss itself can improve or worsen self-image, mood, emotions, and relationships.
• Treatment recommendations from the Society: continue the "traditional root of diet, exercise and healthy lifestyle" for general weight loss; ensure mental-health support and to "treat the weights together with the mental health issues" rather than isolating one from the other.

The interview closes with a call for more long-term studies on GLP1 impact on healthy individuals and people with preexisting mental illness, and a caution about drug interactions and prescribing outside comprehensive care teams.