This Is Your Brain On Drugs Psychiatry Podcast

This is the final episode in the obesity series. I will discuss weight loss procedures such as bariatric surgery and endoscopic procedures. I will then talk about lipedema and how it can cause obesity but should be treated differently. Lastly I will talk a little about fatty liver and a new medication approved for it.

In today's episode I'm going to cover the GLP1 medications on the horizon. These include CagriSema, retatrutide, survodutide, and amycretin. Then I'll compare and contrast the currently approved GLP1s. I'll go over which weight loss medications are approved at which ages for pediatrics. Lastly, I'll go over the hurdles of insurance coverage and give you an example of how the requirements for payment change and what those requirements are.

Today I will be covering the GLP1 medications. Starting with exenatide and dulaglutide and then covering liraglutide (Saxenda), semaglutide (Wegovy), tirzepatide (Zepbound), and orforglipron (Foundayo). I'll go over how they are different, which work better, which are better tolerated, how to customize them, how they compare, and when I would pick each one.

Ok, so last time I discussed some of the downsides of GLP1 medications, and this will be part 2 of those downsides. First, I'll discuss eating disorders. How prescribing GLP1 medications in a world with eating disorders is complicated, and how GLP1 medications can actually induce eating disorders; something call "agonorexia." Then, I'll talk about drug interactions. Most of those listed on the package insert are not terribly important, however there are actually several that no one talks about and many of them apply to use with psychiatric medications! Lastly, I'll talk about cost, frequent shortages, and the world of compound pharmacies. I'll discuss how these pharmacies have really taken off with these medications, when they are legit, when they aren't, and how to know the difference.

Ok, so I've exalted the benefits of GLP1s and last time I went over how to customize to your patient. Today I will be going over some of the downsides. I'll cover the really serious stuff first that actually never happens in some cases or rarely happens in others. Then in the second half I'll go over the stuff that actually happens pretty frequently and bothers patients and how to combat it to customize these medications to get the best out of them for those that need and respond to them!