Welcome to Back from the Abyss. I'm Dr. Craig Hecock. Before we get into today's story,

I wanted to read a listener letter that I got a few weeks ago

because I think it's very interesting and relevant to something I talked about a few episodes

ago. So here we go. Dear Dr. H, I'm a long-time listener of your podcast and really appreciate

the profound and moving information you provide there. I wanted to share a recent psychiatric experience I had

with you, since I suspect it will soon be an issue faced by many people, but I haven't heard

all that much said or written about it yet. My story is that I started using semaglutide,

I think that's how you pronounce it, or Wagovi, which is a GLP1 agonist. I started using that for weight loss

last summer, and it triggered some intense bouts of suicidality in me in such a cyclical way

that I began to realize that I'm probably on the bipolar spectrum. I'm 54 now and have had

episodes of depression and long periods of dysthymia since adolescence. This summer, I started taking Wagovi because my BMI was around 28, and I had high cholesterol.

While I started losing weight immediately, I also had intense intermittent fatigue.

And after a couple weeks, I started noticing very depressed mood, although it would only

last for a portion of each day.

I started taking the second lowest dose, and then I began having suicidal ideation.

I would feel intensely depressed and strongly suicidal many days of the week, but bizarrely,

these feelings would usually last for about four hours, and something would happen,

and I'd switch back to feeling pretty normal.

Because the mood effects were so disturbing, I decided to stop taking Wagovi, although I was sad

because it's so effective for weight loss. It's now been about three weeks since my last shot,

and the suicidal thoughts have completely gone away. However, I still feel very odd. My baseline

mood is pretty normal, but I find myself bursting into tears at the slightest stressor or sad discussion. And worse than that, my brain is definitely not functioning normally. My thoughts seem slower. I really can't do my work. I'm an economist for the federal government, and I can't really do anything that requires executive functioning,

...