Daily Body (Dis-)Satisfaction and Dietary Restriction in Women Across the Eating Disorder Spectrum.

The Glucagon-like peptide-1 receptor agonist (GLP-1 RA) has been approved by the U.S. Food and Drug Administration (FDA) and the European Medicines Agency (EMA) to treat diabetes for more than a decade and has recently been authorized to treat overweight and obesity (FDA 2021, EMA 2022) []. GLP-1 RAs improve glycemic control, promote cardiovascular and renal protection, and reduce all-cause mortality [, ]. Despite this, recent safety concerns have emerged about a potential link to suicidal behavior []. Due to 150 spontaneous reports to EMA regarding suicidal ideation [] EMA and FDA have launched independent investigations into the potential risk of suicide and suicide attempts among users of GLP-1 RAs. However, these investigations remain inconclusive []. The mechanism by which GLP-1 RAs potentially increase suicide or suicide attempts is unclear but may involve an overactivation of the hypothalamic-pituitary-adrenal (HPA) axis [], rapid weight loss [], and reduced expression of brain-derived neurotrophic factor which may link weight changes to heightened anxiety and suicidal risk []. Along this line, a recent large case-control study from 2024 including 162,253 obese patients treated with GLP-1 RAs and a matched group of untreated patients found an association between GLP-1 RAs and increased risk of depression, anxiety and suicidal behavior []. In contrast, other large observational cohort studies have not shown any significant associations between treatment with GLP-1 RAs and risk of suicide or suicide attempts, respectively [, ]. Similarly, a recent systematic review and meta-analysis including 27 randomized controlled trials (RCT’s) found no association between GLP-1 RAs and increased incidence of suicidal ideation or suicide []. It is well established that individuals with mental illness have a higher risk of suicide [, ]. A Danish nationwide registry study, including 116,699 individuals with type 2 diabetes and 116,008 matched controls without diabetes, revealed that treatment with GLP-1 RAs was associated with a lower risk of depression []. Also, a meta-analysis on antidepressant effects of GLP-1 RA including 2071 participants showed reduced depression scores with GLP-1 treatment compared with controls []. This could suggest that GLP-1 may have a protective effect on suicide risk []. A systematic review of 26 studies including 3020 participants showed mixed and inconclusive effects of GLP-1 RAs on psychiatric symptoms. Some studies indicated potential benefits, and others found no significant effects. Given that GLP-1 RAs may offer therapeutic options for addressing psychiatric symptoms, it is crucial to evaluate the potential risk of increased suicide rates associated with their use. Thus, we aimed to examine the association, if any, between the use of GLP-1 RAs and the risk of suicide or suicide attempts.