TW: Rapid weight loss drugs (Ozempic) and suicide ideation
Today, the Therapeutic Goods Administration (TGA) released a new safety alert regarding glucagon-like peptide-1 receptor agonist (GLP-1 RA) medications — the class of drugs that includes Ozempic (semaglutide), Wegovy, and Mounjaro (tirzepatide).
These medications have become increasingly common not only for diabetes and obesity treatment, but also among women seeking to improve fertility outcomes, particularly those with PCOS or weight-related infertility. Because so many of my patients fall within this group, this alert is highly relevant — and important to understand.
Why the TGA has updated the warnings
The TGA has updated the product information and consumer medicine information for all GLP-1 drugs to include warnings about the potential risk of suicidal thoughts and behaviours.
This update aims to “ensure consistent information regarding the potential risk of suicidal thoughts or behaviours” across all medications in this class.
These concerns were first raised by a study published here in August 2024, which was an analysis using the World Health Organisation’s global adverse-event database which showed a broader pattern of psychiatric effects, finding that these medications found:
People with pre-existing anxiety or depressive disorders were more likely to report suicidal ideation when taking Ozempic.
There were 107 reported cases of suicidal thoughts associated with semaglutide use — a small number overall, but statistically meaningful when compared with other medications.
The study highlighted:
45% higher risk of suicidal ideation compared to people taking other medications on the database - so just less than double the risk
98% increased risk of any psychiatric disorder - almost double the risk
195% higher risk of major depression - nearly triple the risk
108% higher risk of anxiety - double the risk
106% higher risk of suicidal behaviour - double the risk
And a further study published in October 2024 (found here) also found a significant association between GLP-1 medications and increased risks of depression, anxiety, and suicidality.
While these findings do not prove causation, they are strong enough signals for regulators worldwide to issue precautionary warnings.
Why might these medications affect mood?
Researchers have suggested two main mechanisms:
1. Dopamine disruption
Dopamine pathways influence:
motivation
reward
mood
impulse control
Changes in dopamine signalling could potentially influence depression or suicidality in vulnerable individuals.
2. Loss of the emotional reward of eating
One theory — especially relevant to binge or emotional eaters, is that these medications reduce pleasure from food. If food has been a person’s primary coping mechanism, then removing the reward response suddenly can feel like removing the only source of emotional comfort.
For someone dealing with stress, loneliness, anxiety, or depression, this could significantly impact mental wellbeing.
It makes sense: when you take away the one reliable source of joy (food) during moments of emotional distress, mood can decline sharply.
Why this matters in fertility and PCOS care
In my practice, many women taking GLP-1 medications are doing so to support:
ovulation
hormonal regulation
weight-related fertility challenges
insulin resistance associated with PCOS
Obesity is a major factor in infertility, and GLP-1 medications can be useful tools, but not without risks.
Women with PCOS already have higher baseline rates of:
anxiety
depression
eating disorders
insulin-related mood fluctuations
So any medication that has the potential to impact mood or dopamine pathways deserves careful monitoring in this population.
Naturopathic support if you’re taking Ozempic (etc.)
Whether you’re taking these medications for metabolic health or fertility support, it is essential to protect your nutrient status, mental health, and metabolic resilience during treatment.
Here’s what I recommend in clinic:
1. Learn to cook — don’t just eat less, eat better
These medications reduce appetite, but they don’t teach you how to nourish yourself.
To maintain weight loss long-term, you must learn to choose nutrient-dense foods.
2. Prioritise easily digestible protein
Rapid weight loss increases the risk of muscle loss and sarcopenia, which can slow metabolism and worsen hormone balance.
Helpful options include:
collagen
eggs
Greek yoghurt
slow-cooked meats
bone broth
protein smoothies
3. Choose gut-friendly meals
Aim for foods that your digestive system doesn’t have to work hard to break down:
smoothies
soups
stews
home-prepared juices
soft-cooked vegetables
These ensure you are still absorbing nutrients even when your appetite is low.
4. Protect your mental health through nutrition
Mood stability is heavily dependent on:
B-vitamins (in particular, folate, B12 and B6)
omega-3 fatty acids
amino acids
minerals such as zinc and magnesium
Avoiding malnutrition is key to reducing psychiatric side-effects.
Important: a separate new warning about Mounjaro and Oral Contraceptives
The TGA has also issued a second safety notice regarding tirzepatide (Mounjaro) and reduced effectiveness of oral contraceptives.
Their statement notes:
“Our investigation into the potential for reduced effectiveness of oral contraception when first taking or increasing the dose of Mounjaro has found that this association could not be ruled out.”
And:
“Patients taking tirzepatide are advised to switch to a non-oral contraceptive or add a barrier method of contraception for four weeks after first taking the medicine and for four weeks after each dose increase.”
This has major implications for pregnancy planning and cycle awareness.
Why charting your cycle is now more important than ever
Medication-induced contraceptive failure is real — so if you’re on GLP-1 medications, using a fertility awareness-based method like Billings Ovulation Method® offers an extra layer of reliability and body-literacy.
You should always know if your cervical mucus patterns shift, fertility changes, or ovulation becomes irregular.
A final word
If you or someone you know is taking GLP-1 medication and experiencing:
mood changes
increased anxiety
depression
loss of motivation
intrusive or suicidal thoughts
please seek help immediately.
Lifeline Australia: 13 11 14
https://www.lifeline.org.au/
Love,
Liz
