Neuropsychiatric association of tirzepatide and semaglutide in obesity with and without type 2 diabetes
- 1Department of Life Science, National Chung Hsing University
- 2Department of Pediatrics, Chung Shan Medical University Hospital
- 3School of Health and Society, University of Wollongong
Abstract
Background: Neuropsychiatric outcomes after starting newer anti-obesity medicines remain uncertain in routine care. We evaluate associations between initiation of tirzepatide or semaglutide and incident neuropsychiatric diagnoses in people with obesity, stratified by type 2 diabetes (T2D). Methods: Using a United States electronic health record network (2020–2025), we identified adults with obesity who newly started tirzepatide or semaglutide and matched them one-to-one to new users of naltrexone–bupropion, phentermine, or phentermine–topiramate. We modeled the time to first recorded diagnosis over 24 months; bariatric surgery recipients were examined as a contextual comparator. Confidence intervals are 95%. Results: Here we show that, versus naltrexone–bupropion, semaglutide is associated with lower hazards of anxiety disorder in adults with T2D (hazard ratio 0.67, 0.51–0.87) and without T2D (0.73, 0.64–0.83), and lower hazards of depression in both strata (with T2D: 0.69, 0.50–0.95; without T2D: 0.53, 0.45–0.61). Tirzepatide versus naltrexone–bupropion is associated with lower hazard ratios for anxiety disorder (with T2D: 0.55, 0.40–0.76; without T2D: 0.78, 0.68–0.89) and depression (with T2D: 0.49, 0.33–0.72; without T2D: 0.57, 0.49–0.66). In adults without T2D, tirzepatide versus semaglutide is associated with higher hazards of anxiety disorder (1.12, 1.06–1.18) and insomnia (1.13, 1.05–1.21). Conclusions: Initiation of tirzepatide and semaglutide is associated with differing hazard patterns across prescription comparators, with bariatric surgery providing additional context. These findings inform monitoring and shared decisions, while remaining subject to residual confounding and diagnosis misclassification.
Related
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- Neuropsychiatric Safety of GLP-1 Receptor Agonists and Tirzepatide in Adults with Type 2 Diabetes Mellitus or Obesity.
- Semaglutide and Tirzepatide Suppress Hepatic Fatty Acid Uptake and Fatty Acid β-Oxidation in High-Fat Diet-Induced Obesity Mice.
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BibTeX
@article{huang2026neuropsychiatric,
title = {{Neuropsychiatric association of tirzepatide and semaglutide in obesity with and without type 2 diabetes}},
author = {Yu-Nan Huang and Kai-Wen Liu and Pin-Hung Li and Jo-Ching Chen and Gideon Meyerowitz-Katz and Pen-Hua Su and Chieh-Chen Huang},
journal = {Communications Medicine},
year = {2026},
month = jun,
doi = {10.1038/s43856-026-01750-z},
url = {https://doi.org/10.1038/s43856-026-01750-z},
note = {CC BY},
}
RIS
TY - JOUR
TI - Neuropsychiatric association of tirzepatide and semaglutide in obesity with and without type 2 diabetes
AU - Yu-Nan Huang
AU - Kai-Wen Liu
AU - Pin-Hung Li
AU - Jo-Ching Chen
AU - Gideon Meyerowitz-Katz
AU - Pen-Hua Su
AU - Chieh-Chen Huang
PY - 2026
DA - 2026/06/01
JO - Communications Medicine
DO - 10.1038/s43856-026-01750-z
UR - https://doi.org/10.1038/s43856-026-01750-z
AB - Background: Neuropsychiatric outcomes after starting newer anti-obesity medicines remain uncertain in routine care. We evaluate associations between initiation of tirzepatide or semaglutide and incident neuropsychiatric diagnoses in people with obesity, stratified by type 2 diabetes (T2D). Methods: Using a United States electronic health record network (2020–2025), we identified adults with obesity who newly started tirzepatide or semaglutide and matched them one-to-one to new users of naltrexone–bupropion, phentermine, or phentermine–topiramate. We modeled the time to first recorded diagnosis over 24 months; bariatric surgery recipients were examined as a contextual comparator. Confidence intervals are 95%. Results: Here we show that, versus naltrexone–bupropion, semaglutide is associated with lower hazards of anxiety disorder in adults with T2D (hazard ratio 0.67, 0.51–0.87) and without T2D (0.73, 0.64–0.83), and lower hazards of depression in both strata (with T2D: 0.69, 0.50–0.95; without T2D: 0.53, 0.45–0.61). Tirzepatide versus naltrexone–bupropion is associated with lower hazard ratios for anxiety disorder (with T2D: 0.55, 0.40–0.76; without T2D: 0.78, 0.68–0.89) and depression (with T2D: 0.49, 0.33–0.72; without T2D: 0.57, 0.49–0.66). In adults without T2D, tirzepatide versus semaglutide is associated with higher hazards of anxiety disorder (1.12, 1.06–1.18) and insomnia (1.13, 1.05–1.21). Conclusions: Initiation of tirzepatide and semaglutide is associated with differing hazard patterns across prescription comparators, with bariatric surgery providing additional context. These findings inform monitoring and shared decisions, while remaining subject to residual confounding and diagnosis misclassification.
SN - 2730-664X
ER -