What treatment options are available for a 31-year-old postpartum (postpartum) woman with obesity, who is not breastfeeding, and is experiencing hunger while taking semaglutide (semaglutide), a glucagon-like peptide-1 (GLP-1) receptor agonist, and also reports increased symptoms of depression and anxiety, and acne potentially related to her current medication, such as marina (likely referring to a hormonal contraceptive, e.g., Nuvaring), and is seeking alternative medications or therapies?

From the Guidelines

The patient's history of present illness (HPI) is significant for obesity, previous use of semaglutide with some success, and current symptoms of depression and anxiety, which are affecting her quality of life and relationships. The patient is a 31-year-old woman who presented to clinic requesting information about medication pricing, specifically regarding semaglutide, which she previously used with some success but still experienced hunger 1. She now wants to try it again through a compounding pharmacy. She reports worsening depression and anxiety symptoms, with anger outbursts during periods of high anxiety, and is requesting medication for these symptoms. She denies suicidal or homicidal ideation and substance use. The patient mentions relationship difficulties with her husband, particularly around communication. She also reports increased acne from her current contraceptive (likely Mirena IUD) and questions if it might be affecting her mood. When offered Depo-Provera as an alternative contraceptive, she declined. The patient has a 7-month-old baby but is not breastfeeding.

Key points in the patient's HPI include:

• Obesity and previous use of semaglutide
• Current symptoms of depression and anxiety
• Relationship difficulties with her husband
• Increased acne from her current contraceptive
• Request for medication to manage depression and anxiety symptoms
• Denial of suicidal or homicidal ideation and substance use

According to the American Gastroenterological Association (AGA) clinical practice guideline on pharmacological interventions for adults with obesity, semaglutide is a recommended medication for weight loss in adults with obesity or overweight with weight-related complications 1. The guideline suggests using semaglutide 2.4 mg with lifestyle modifications, compared with lifestyle modifications alone, due to its glucoregulatory benefits and approval for the treatment of type 2 diabetes. However, the patient's current symptoms of depression and anxiety should also be addressed, and medication options for these conditions should be considered. The patient's request for medication to manage her depression and anxiety symptoms should be prioritized, and a treatment plan should be developed to address these symptoms in conjunction with her obesity management.

From the FDA Drug Label

The patient is a 31-year-old on service for obesity. The History of Present Illness (HPI) for this patient is as follows:

• The patient is a 31-year-old female presenting with obesity.
• She has a 7-month-old baby but is not breastfeeding.
• She is requesting medication for weight loss, specifically semaglutide, which she has tried before and found to be effective but caused some hunger.
• She reports increased depression and anxiety, with symptoms including anger outbursts and yelling, but denies suicidal ideation or homicidal ideation.
• She also reports increased acne, possibly related to her current medication, and is unsure if it is causing mood changes.
• Her relationship with her husband is strained, which may be contributing to her anxiety.
• She is seeking an alternative medication for weight loss and possibly for her mental health symptoms. 2, 2, 2

From the Research

History of Present Illness

The patient is a 31-year-old female presenting with obesity, with a 7-month-old baby and not breastfeeding. She is requesting information about the availability of semaglutide on the $4 medication list at the pharmacy.

• She has previously tried semaglutide, which was effective for weight loss, but she still experienced hunger and would like to try it again 3, 4, 5.
• The patient reports increased symptoms of depression and anxiety, denying any suicidal or homicidal ideation, alcohol, or drug use 6.
• She mentions marital issues, including poor communication with her husband, leading to anxiety and anger outbursts.
• The patient is also concerned about the potential side effects of her current medication, including increased acne, and is unsure if it contributes to her mood changes.
• She was offered an alternative medication, including a depo injection, which she declined at this time.
• Semaglutide has been shown to be effective in weight management, with significant weight loss and improvements in cardiometabolic risk factors, although it may have gastrointestinal side effects 3, 4, 5.