6 ms·
Clinical psychologist here in Norway, and just my subjective experience: People stop GLP1 agonists for the following reasons, in descending order: - They want t
by jtrn 1y ago
Clinical psychologist here in Norway, and just my subjective experience: People stop GLP1 agonists for the following reasons, in descending order:
- They want to enjoy eating again.
- Medications are a hassle.
- Worry about long-term effects, even if there is no alarming evidence for now.
- Price (we are a spoiled/rich country).
- Other (like hating needles, feeling bad for taking medications that others need more, being aggressively lazy).
Often, I think that it’s a bad move, as the clinical effect of losing around 20 kg would have to be matched by some extremely high frequency and severe side effects. Overweight is still not sufficiently appreciated for how dangerous it is, especially after they ramped up production so much that there isn't a real shortage anymore.
Ironically, most of the people who respond well to Ozempic and stay on it have few psychiatric problems. But those who almost desperately want to get off it after a while might be those who have a psychological component to their overeating. The obvious suspect then is eating as emotional regulation. So one could extrapolate, at least as a hypothesis, that the ones who have worse life expectancy due to regained weight after a year of usage are the ones who have a double set of problems stacked against them: overweight and emotional problems. That would have a huge effect on longevity.
This is PURE free association though, no deep analysis behind it.
- k__ 1y agoHow much does it cost right now? Are there any alternatives coming out soon or generics?
- jtrn 1y agoFor semaglutide, the newest and most potent GLP1. United States: The main patent is expected to expire around 2032. Monthly Price: $950 - $1,350+ (cash price without insurance) Norway: The main patent is expected to expire around 2031. Monthly Price: $109 - $301 (cash price equivalent in USD)
- thatnerdyguy 1y agoI'll note that in the US that 1000+ is the "list price". For those paying out of pocket, both zepbound and wegovy offer coupons available to anyone taking it down to $500 (and I'll note that discounted price keeps coming down, slowly, as well)
- glp1guide 1y ago> For semaglutide, the newest and most potent GLP1. Tirzepatide is the most potent GLP1 https://glp1.guide/content/semaglutide-vs-tirzepatide-clinical-trial/ https://glp1.guide/content/semaglutide-vs-tirzepatide-clinic...
- hippich 1y agoCan't find the post on Reddit right now, but someone broke all three down and it is more nuanced. They act slightly differently in different areas. Before I started experiments on "my lab rat" with retatrutide, I found that combination of the about half max dose of semaglutide and 1/3 of Max dose of tirzepatide had the best combination of losing weight and lowering side effects. But another "lab rat" did not respond that well to this combo and we keep adjusting it. Retatrutide so far looks the most compatible, but it is sample of 1.
- stewarts 1y agoI've had pretty good results on Tirz, definitely interested in how Reta will compare.
- glp1guide 1y agoRetatrutide looks to be very effective, but it's not possible to get legally/safely at this point. TONS of experience/knowledge in the r/retatrutide subreddit though, a lot of pretty conscientious consumers in there that have done their research, but obviously impossible to recommend outside of finding a sanctioned study to join. That said, Reta is a triple agonist[0] and it seems to be quite amazing with good muscle retention as well -- it's unclear if this is just the people who are taking it being more likely to be gym goers. Up until now the only formulation I've seen that specifically targets preserving muscle is GLP1s in combination with bimagrumab[1]. [0]: https://glp1.guide/content/a-new-glp1-retatrutide/ https://glp1.guide/content/a-new-glp1-retatrutide/ [1]: https://glp1.guide/content/preserving-muscle-glp1s-with-bimagrumab/ https://glp1.guide/content/preserving-muscle-glp1s-with-bima...
- jtrn 1y agoThis is where I failed as a psychologist because I don't have extensive training in pharmacodynamics, so I forgot that "potent" is a specific term in that world. What I meant was: I subjectively believe that Semaglutide is the best choice for weight loss, given the overall profile and response in my subjective clinical experience. A fancy way of saying: I *think* Semaglutide is best.
- loeg 1y agoThat US price is way too high. No consumer pays that much. You can buy it straight from Novo for $500/mo.
- noboostforyou 1y agoLilly also offers it direct to consumer for $500/mo
- int_19h 1y agoIf these things really boost life expectancy that much, this sounds like a textbook case for eminent domain.
- eru 1y agoI'm no fan of the patent system, but "patent system promises spoils for coming up with great new drug, companies comes up with great new drug, companies gets spoils" is exactly how it's supposed to work. Yes, it's sucks that you have to pay, but that's how you incentives getting the wonder drugs invented in the first place. (I have my own take on this, but if anything this is a 'textbook case' in favour of the patent system.) Eminent domain would still require fair compensation to the company, so you'd have to pay them more or less what they'd lose from not having the patent anymore. (Though I think the term you might be looking for is 'compulsory licensing' or so? Not sure.)
- LadyCailin 1y agoIf this research was done fully via the public system in the first place, it would be an easier nut to crack. I mean, some of it is already, and that’s the absolute worst scenario: the public paid for it via taxes, and now has to pay for it privately after the fact.
- coredog64 1y agoThe public isn't paying for the phase 2 and phase 3 trials.
- pmyteh 1y agoDepending on how transformative the effects are (and the price drop possible upon genericisation) then there could be a compulsory licensing trade to do here. The drug companies are presumably pricing optimally for profit (but not for maximum public benefit, for which the optimum price is ~0). You could calculate the net present value of the drug companies' total profits attributable to the patent, add on 10% as a bonus, and pay them off. If the welfare gains of having cheap drugs are genuinely greater than the value of the patent to the holder, this would be win/win.
- deleted 1y ago[deleted]
- AbstractH24 1y ago> United States: The main patent is expected to expire around 2032. Monthly Price: $950 - $1,350+ (cash price without insurance) While 2032 seems very far away now, its actually remarkably soon in the grand scheme of society. My understanding is one of their defendable moats is the patent not on the compound itself, but on the injectors. Which is far longer.
- dmoy 1y ago> one of their defendable moats is the patent not on the compound itself, but on the injectors. Which is far longer. That is very typical in the drug/medical industry. To the point where it is sometimes (often? usually?) an intentional strategy. https://sites.uclawsf.edu/evergreensearch/ https://sites.uclawsf.edu/evergreensearch/
- thephyber 1y agoYeah, the drug + the injector together are the patentable thing. When the first patent nears expiration, they work on an iteration of the injector or a time release change for the drug, then they get another few decades of product monopoly. They have also made a business of either stifling or “catch and kill”ing of the generics for their products. It’s cheaper to pay off a generic manufacturer to not compete with the new thing than it is to lose price elasticity of the n non-generic.
- s1artibartfast 1y agoThis is not correct. New patents cover the new combination, but don't prevent practice of the old combination
- AbstractH24 1y agoScroll down to the area referencing footnote 9 in this article https://pmc.ncbi.nlm.nih.gov/articles/PMC11457043/ https://pmc.ncbi.nlm.nih.gov/articles/PMC11457043/ That articulates it better than I will
- shadowtree 1y agoCanada: January 2026(!) Novo lawyers messed up, didn't renew the patent filing over a payment dispute. Hilarity is ensuing. https://www.cnbc.com/2025/07/09/hims-hers-generic-semaglutide-novo-nordisk-ozempic-wegovy-canada.html https://www.cnbc.com/2025/07/09/hims-hers-generic-semaglutid... And once generics for GLP-1s are going in Canada, Section 804 of the FD&C act becomes VERY interesting: https://www.fda.gov/about-fda/reports/importation-program-under-section-804-fdc-act https://www.fda.gov/about-fda/reports/importation-program-un... Reimports of generics from Canada into the US here. we. go.
- barumrho 1y agoLOL, that must be one of the biggest fuck ups in pharmaceutical industry.
- htrp 1y agoAll over 250 CAD >Novo Nordisk’s lawyers requested a refund for the paid 2017 maintenance fee of $250 Canadian dollars ($185) because the company wanted more time to see if it wanted to pay it, according to letters included in the documents. >Two years later, the office sent a letter saying the fee, which now included a late charge bringing the total to CA$450, was not received by the prescribed due date. >Novo Nordisk had a one-year grace period to pay, but never did, and so its patent lapsed in Canada. It lapsed in 2020 when the fee was not received, but it doesn’t expire until January.
- chhxdjsj 1y agoGrey market from China is around $250/year for tirzepatide There are group chats with tens of thousands of people and I havent seen any issues with the drug
- glp1guide 1y agoThat's an insane cost reduction -- $250/month is a common gray market price in the US.
- AbstractH24 1y agoHow do you ensure the safety and consistency of anything? Asking for a friend.
- chhxdjsj 1y agoUse stairwaytogray, find a supplier with a history of many many 99+% purity reports from 3rd party testing sent to janoshik, then order 20 vials from that supplier, then either send a vial to janoshik yourself or participate in a group buy test (or just wait for someone else to test the same batch. At that point, it is very likely your ampoules have the same purity and amount. The best supplier seems to currently be sigma audley.
- jajko 1y agoThat's the darknet level of drug addicts safety. For poor & desperate much better than nothing, but certainly not without its own risks
- glp1guide 1y agoLiraglutide is now available as a generic, but it is the least effective of the big 3 (Semaglutide, Tirzepatide, Liraglutide): Basically, Tirz > Sema > Lira https://glp1.guide/content/semaglutide-vs-tirzepatide-clinical-trial/ https://glp1.guide/content/semaglutide-vs-tirzepatide-clinic... https://glp1.guide/content/semaglutide-liraglutide-continue-to-be-effective/ https://glp1.guide/content/semaglutide-liraglutide-continue-... https://glp1.guide/content/another-generic-liraglutide-launch-hikma-phamaceuticals/ https://glp1.guide/content/another-generic-liraglutide-launc...
- Tangurena2 1y agoI used to be prescribed Victoza (for diabetes). When liraglutide (the generic) went off-patent, every pharmacy reported that both Victoza and liraglutide were "no longer available".
- ceejayoz 1y agoThe generic manufacturers get paid not to make it. https://www.theatlantic.com/ideas/archive/2023/06/pharmaceutical-generic-drugs-pay-for-delay/674410/ https://www.theatlantic.com/ideas/archive/2023/06/pharmaceut...
- SkyPuncher 1y agoLiraglutide isn't fully comparable. On aspect that's a lot touch for many is it's a daily injection. More needles is a turn off for some that can manage 1x/week.
- abirch 1y agoDaily needles vs 12K a year is a tradeoff many people may consider. Especially if insurance companies mandate Liraglutide as a first line treatment.
- SkyPuncher 1y agoIt’s one people need to consider, but it’s one that the people needing it the most won’t do. It’s a massive problem for several of my friends who are doctors. Patients start on something that works incredibly well for them then their insurance pushes them to Litaglutide and they loose all of their progress. Some of it comes down to a fear of needles, some of it comes down to non-compliance, some of it comes down to access. Daily injections are fatiguing on people. Its a big challenge with diabetes management.
- Lawliepop 1y agoIt’s unlikely new meds will be approved this year (unless the FDA really does speed up approval processes) I made a tool to compare prices: https://www.glpwinner.com/ https://www.glpwinner.com/ If you’re on name brand without insurance coverage you’re sitting around $499 a month. On compounded you can get between $150-300 a month. If you live somewhere expensive like the bay and eat out a lot you are likely saving money by being on the medication.
- OptionOfT 1y agoDid you see a decrease in people gambling / drinking when on the medication? N=1, I'm on ZepBound and in general my brain is less likely to give in to things that give instant satisfaction.
- jtrn 1y agoActually yes. Not as much as with ADHD medication, but obvious subset of addictive personalities that have relief from addictive behaviors (beyond eating addiction) with semiglutide.
- eru 1y agoAppropriately enough, (most) ADHD medications also tend to suppress appetites. So much so that weight loss is perhaps the most serious side effect for ADHD meds in children.
- theshrike79 1y agoYea, it's specifically warned against. Kids will just plain forget to eat on ADHD meds, which is kinda bad.
- wil421 1y agoI could never eat lunch or sometimes dinner if I took it. I gained like 30 healthy pounds after stopping it at the end of my teens.
- jawilson2 1y agoI can't drink whatsoever now. I've been on Wegovy for ~4 months. I used to be a VERY light drinker, i.e. like 10 drinks per YEAR (rum and diet coke, glass of wine, or 2-3 beers in a night). I would usually get a drink when my band played. A month or so ago, I got a bourbon, which I'll happily sip for an hour while talking, and I had to force it down, and left over half of it. Same with a beer; I went to a baseball game with some friends, someone bought the group some drinks, and it was disgusting. It was like whatever enjoyment lightbulb that is usually activated was completely unscrewed, or like trying it for the first time as a kid when an adult lets you try a sip on a holiday. Just sitting here typing and thinking about it has me slightly nauseated. I've been telling people recently I CAN'T drink because of some new medicine I've started.
- gibagger 1y agoHaving ADHD myself, and a bunch of friends who also have it, I have noticed that the people with this condition rarely have a healthy relationship with food. There is either a tendency to overeat indulgent foods, or a tendency to not think about food that much. I have also heard about people with ADHD being on GLP1 agonists that it does a lot for their reward seeking behavior and impulse control. This makes me wonder two things: - Whether at some point these molecules will also start being used for ADHD and addiction treatment in general. I think they hold a lot of promise for issues rooted in the reward system. - Whether a sizable portion of people who struggle with their weight have co-morbid ADHD which creates or worsens their overeating issues. Have you noticed anything along these lines in your practice?
- cik 1y agoAs someone with diagnosed ADHD. I fully agree. There's some background thread that says "you, now, eat". It's almost impossible to shut off. That being the case, the same behaviours have led me to a compulsive need to plan meals. Doing so has helped me lessen (not eliminate) food noise. Anecdotally, I've noticed with others as well, that this is the way. Prep - be fine. Don't prep - eat a small village.
- thewebguyd 1y agoAlso ADHD here, and same thing for me. Hyperfixating on meal planning and strength training has pretty much saved me. It's hard, and I still have to fight food noise daily, but having everything pre-prepped means I have easy, friction free healthy choices instead of reaching for a bag of chips and downing the entire thing while sitting at my desk, or not having the executive function necessary to cook an un-prepped, unplanned dinner and just eating a whole pizza instead. I also used to binge, and meal planning and pre has also helped with that, as I tend to have periods of either really high food drive, or almost no food drive at all leading to not eating for an entire day, then downing 3000+ calories in one meal. ADHD sucks. It's often trivialized in pop culture, but it makes life so difficult, and those real difficulties are almost never talked about.
- 1y ago
- joncrane 1y agoI believe you 100%. I have a history of substance abuse with bad consequences. I quit alcohol and now my drug is food. People tell me I'm a "supertaster." I can taste many of the ingredients in my food that others can't. I also have BPD and am in therapy for it, but man. Food is the drug that always works. When I get into a certain mode, it's like I don't care that I'm overweight and have high blood pressure. I just crave the deliciousness and the "full feeling." And it never fails to work! I always feel more calm and happy after I eat.
- jtrn 1y agoReminds me of a client I had once. He said that the only thing that made him reset was to "pig out" with a carb-overdose, then just sit in front of the TV with a sugar high. Incidentally, I had been nagging him about trying ANYTHING (in addition to the therapy we were doing to find a life goal he believes in) that might help him get SOME help. Be it Adderall or Ozempic. But people are complex, and at best, a person is a Venn diagram with massive overlapping "biological susceptibility," "life situation," "negative thinking style," and inertia. The best one can do is to pull at as many threads as possible to hope the suffering unravels. So one of the threads one can pull at are medication. Not to give advice, but just for shits and giggles, look into "vulnerable narcissism." Many describe stuff like you do and fit those traits. And don't give a shit about the negative associations and stereotypes regarding this personality. I love narcissists! It's one of the coolest personalities there is! But when you are not allowed to be proud of yourself, and all the desire for status and power gets refocused onto self-hate and learned helplessness, then it's a monster of a situation. Had so many people become awesome versions of themselves when they stop being so afraid of being arrogant :) . Just to remember when you read about it, that the descriptions are only in the context of things having gone wrong. Every trait can manifest as something good or negative. Even psychopaths can have good and prosocial lives. For instance, some of the best ambulance workers often have high loading on psychopathy, and that makes them better at their job. Because they don't get scared. I’d rather be picked up by an ambulance worker that is curious and thinks the situation is interesting than one that is panicking and losing due to anxiety and empathy overload. This is just a long-shot association/pattern I noticed, though. It's not worth a dime more than the sentences you put into the machine. :P
- xattt 1y agoCan you talk about people who discontinue for GI side-effects? I understand they are present for a short duration, but have heard anectdata that they persist for months for some people. Have you observed persistent GI side-effects in your own practice, and if so, do you believe these are legitimate? Or… are they a social cover for individuals to get back to eating for psychological coping?
- jtrn 1y agoIt's not just GI side effects. Semaglutide is genuinely GI TOXICITY. That's why it's EXTREMELY important to ramp slowly. So yeah, it's a thing. But for basically everybody, it's manageable with slow and controlled ramping of dosage. There has been hard to find any lasting danger if you ramp slowly. There has been almost a hysteria, it seems, regarding "Pancreatitis." And when I see multiple diagnoses, medications, and reports associated with Pancreatitis, I recognize a pattern I have seen many times before. Both the mental health and medical fields have periodic fixations on certain symptoms or diffuse diagnosis, and when it has the "wave-like" pattern like this, I am willing to bet it's just the latest version of "Fatigue," "Whiplash," "Repetitive Strain Injury", "lactose intolerance" or the dental amalgam controversy. Don't get me wrong. These are real things. But sometimes they just balloon beyond anything reasonable, and an unreasonable amount of people suddenly get diagnosed with it or suspect they have it. Pancreatitis is giving me that vibe over the last year or so. Copy paste this for "Stomach Paralysis". But let's say the social benefit of alcohol has a value of 100 and a health risk score of 100. I would say that GLP-1 agonists have a health value of 500 and a risk score of 20. Nothing is without risk, but mathematically speaking, if you are overweight, I would be 25x more positive about injecting myself with Ozempic than alcohol... mathematically at least. And to answer your question, I personally haven't seen many people stop early due to GI symptoms. And if they did stop early, I would think it was because they genuinely had a physical negative response that was horrible for them. Anecdotally, I feel the people that stop so they can get back to eating usually last at least 6 months, and probably more. I am 100% in agreement with the studies that many stop at around 1 year. So if someone stopped at 2 months, I would belive them when they said it was due to GI symptoms. But if they stopped at 1 year and CLAIMED it was due to GI symptoms, I would doubt; and guess that it was driven by missing food. Please note that I am speculating wildly, and this is just PURELY anecdotal and stream of consciousness.
- nopcode 1y agoI'm in the exact situation you describe: Overweight due to emotion-eating and stress-eating, taking GLP1. Now I can binge-eat until I'm full or sick (mostly sick) and maintain weight. If I'd go off GLP1 now my weight would skyrocket.