Liraglutide-Associated Depression in Type 2 Diabetes Patient: Case Report Raises Concerns

Liraglutide is a glucagon-like peptide-1 receptor agonist (GLP-1 RA) widely used to improve glycemic control and aid weight loss in patients with type 2 diabetes (T2D). While it has demonstrated efficacy in lowering blood sugar levels and promoting weight loss, concerns have emerged regarding its potential psychiatric side effects, particularly depression.

The case report documents the experience of a patient with type 2 diabetes who developed symptoms of depression shortly after initiating treatment with Liraglutide for glycemic control and weight reduction. Symptoms included irritability, poor mood, progressing to sadness, decreased interest and energy, physical discomfort, and low self-esteem. A clinical diagnosis of a depressive episode was made, coinciding with the initiation of liraglutide.

The patient, a 39-year-old male with a graduate degree and employed as a company staff member, was admitted to the hospital on December 4, 2023, due to “poor mood for over two months.” Two months before admission, the patient was diagnosed with T2D at another hospital and was prescribed Liraglutide 0.6 mg subcutaneous injection once daily (qd) and Dapagliflozin 10 mg qd for blood sugar control and weight loss

Subsequently, he began to experience symptoms of mood deterioration, primarily characterized by irritability, inexplicable sadness, decreased energy, and loss of interest. After two weeks, the liraglutide dose was increased to 1.8 mg qd during a follow-up visit at the same hospital due to insignificant weight loss.

Under the treatment with Dapagliflozin and Liraglutide, the patient lost approximately 20 kg over 2 months.

Regarding treatment, the patient continued his previous regimen for diabetes and hypertension. In terms of psychiatric treatment, he was initially prescribed Escitalopram Oxalate 10 mg qd and Alprazolam 0.4 mg every night to improve sleep and mood. After one week of medication, the patient reported an improvement in mood. To further improve symptoms, the doctors increase the dose of Escitalopram Oxalate to 20 mg qd.

On the day of discharge, the patient reported significant improvement in mood, regaining control over his life, feeling calm and relaxed, good appetite, resuming outdoor activities, and better sleep quality. At discharge, the patient's Hamilton Depression Scale score was 6, suggesting no depressive symptoms, and Hamilton Anxiety Scale score was 5, suggesting no anxiety symptoms. A 2-week follow-up showed that the patient's mood remained stable.

The report by Yiming Wang, Department of Psychiatry, Affiliated Hospital of Guizhou Medical University, Guiyang, China, and colleagues explores potential mechanisms, such as GLP-1RA effects on glucose fluctuations and dopamine modulation, which might lead to depressive symptoms. The impact on the brain reward system and the reduction in cravings for addictive substances after GLP-1RA use is also discussed as a factor in mood regulation.

In conclusion, the case report contributes to the growing body of literature on the psychological side effects of GLP-1RAs, calling for a balanced approach to patient care that encompasses both mental and physical health considerations. As the use of these agents expands, clinicians should be aware of the potential psychological impacts and ensure comprehensive monitoring and management strategies for their patients.

"Future research should focus on elucidating the neuropsychological mechanisms of GLP-1RAs and exploring the potential risks and benefits in patients with preexisting mood disorders," the researchers wrote.

Reference:

He, Yangliuqing MDa; Liang, Fenrong MDa; Wang, Yiming PhDa,b,*; Wei, Yuhan MDa; Ma, Tianpei MDa. Liraglutide-associated depression in a patient with type 2 diabetes: A case report and discussion. Medicine 103(18):p e37928, May 03, 2024. | DOI: 10.1097/MD.0000000000037928