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We sit down with Jennifer Jonsson, a patient advocate, to explore the complex world of medication interactions and their impact on mental health. Jennifer shares her personal journey of managing ADHD, bipolar disorder, and Type 2 diabetes while navigating the unexpected side effects of medications like Rybelsus. We discuss the importance of self-advocacy, effective communication with health care providers, and practical strategies for handling multiple chronic conditions.

Jennifer Jonsson is a patient advocate.

She discusses the KevinMD article, “Can weight loss medication interfere with ADHD meds?”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast, and get CME for this episode by clicking on the CME link in the show notes. Today we welcome Jennifer Jonsson. She’s a patient advocate. Today’s KevinMD article is “Can weight loss medication interfere with ADHD meds?” Jennifer, welcome to the show.

Jennifer Jonsson: Thank you.

Kevin Pho: So you wrote this KevinMD article potentially associating your story of weight loss medications interfering with ADHD medications. Tell us what your story is about.

Jennifer Jonsson: OK. Well, in my case it was actually prescribed for diabetes, but it was Rybelsus, the pill form of the semaglutide. I was prescribed that and was taking it, and after about two weeks I began noticing that I couldn’t get my thoughts together, I couldn’t stay organized. I also have bipolar disorder, and I was getting manic, and I just felt like I had completely lost my mind and had no idea why this was happening.

Kevin Pho: When you were at your physician’s office and they offered you Rybelsus for your diabetes, as far as you know, was there any behavioral health side effects from that medicine?

Jennifer Jonsson: I know that it’s in the prescriber’s instructions. I don’t actually recall if she specifically said that could be an issue.

So what happened next was, after about two weeks of this, a friend of mine told me that there’s some anecdotal evidence that ADHD meds are interfered with by the semaglutide medicines. And I said, oh, that’s exactly what’s going on, and was so glad to hear that. And I called my psychiatrist. I hate calling my psychiatrist, although he’s a great guy. I just feel like I’ve been dealing with this for 20 odd years now, I should be able to handle it. And he said, of course, why didn’t you call me two weeks ago?

But he said, yeah, that can definitely be a problem, and we definitely need to address that. He had some workarounds. He thought I might take the ADHD meds very early in the morning before I took Rybelsus, so that I could get it into my system before it kicked in. And that worked a little bit, but not very. And he finally said, you know, if I were you I would take something else.

Kevin Pho: Now, what were you taking for your ADHD?

Jennifer Jonsson: I was taking, at the time, I was taking Vyvanse, which is a stimulant, amphetamine stimulant. And I was also taking, for bipolar disorder, I was taking vilazodone, which is an antidepressant, and something for anxiety, propranolol it was called. And all of those seemed to not be working.

So I did go back to my physician and tell her, I’m sorry, we’re going to have to try something else. So she took me off it. Unfortunately, it takes five to six weeks to get out of your system, so things got gradually better over time, but it was very rough.

I ended up having to take about a week off work. I was mainly afraid I was going to screw something up, which would not be good. And they were very nice about it. I didn’t tell them exactly what was going on, just that I was having a medication issue and that I should probably take some time. So they were very nice about that. And it was just very disruptive to pretty much every area of my life.

Kevin Pho: So your physician started your Rybelsus, and you mentioned that a lot of your behavioral health medications, including the Vyvanse and your medicine for anxiety, stopped working. So just give us a sense of exactly what you were feeling during that time, while you were on Rybelsus and some of your behavioral health medicines stopped working.

Jennifer Jonsson: In general it was just a total loss of control. I didn’t have control over my thoughts, I didn’t have control over what I was doing. When I get manic, I get grandiose ideas that sound great but they’re really not, and I want to run off and do those instead of whatever it is I’m supposed to be doing. And just to not have control of any of that, after 20 years of being well medicated and pretty much stable, was just very upsetting and scary. Mainly scary.

Kevin Pho: And there was a clear delineation that all these symptoms started after the Rybelsus?

Jennifer Jonsson: Yes, after I’d been on it for about two weeks.

Kevin Pho: Even changing your behavioral health medication, taking it at different times, for instance, like your psychiatrist suggested, didn’t make a difference in terms of what you were feeling?

Jennifer Jonsson: It made it slightly better, but I was also having the issue of waking up at like 5:00 in the morning to take a high-test amphetamine and then trying to go back to sleep, which obviously doesn’t work very well. So there were problems with all of that. And we did try, though, we tried a couple of things, and then the psychiatrist said, if I were you I would take something else.

Kevin Pho: So you stopped the Rybelsus, and you mentioned that it does stay in your system for weeks afterwards. So how did you start feeling after stopping the Rybelsus?

Jennifer Jonsson: After about a week I started to notice that there were gradual improvements, that I was able to concentrate better, I was getting more work done, and my grandiose plans had kind of dialed down a little bit, which was good.

One time I wanted to quit my job, drive to another town, and open a Chinese restaurant, for example, because this seemed like a great idea, but it really isn’t. So I’m glad I never acted on any of that, and I’m glad they started to go away.

Kevin Pho: Now, is this the first time where you had a diabetes medicine, or a non-behavioral health medicine, interact and interfere with some of the other behavioral health medicines that you were taking?

Jennifer Jonsson: With behavioral health medicines, yes. I’ve had drugs interfering with other drugs for various reasons, but it hadn’t been behavioral health medicines at that point.

Kevin Pho: So you shared your story on KevinMD. What kind of lessons did you want readers to come away with after reading your story?

Jennifer Jonsson: Mainly I just want readers to know that this is possible, that a lot of Americans take prescription drugs, and if this can interfere with my meds, it could interfere with your meds. And just, if you’re taking something else, your physician needs to be following you to make sure it’s still working. And I don’t think a lot of people know that. These drugs have become very popular, of course, because of the weight loss element, and I just want people to be aware that this can be an issue.

Kevin Pho: And talking among your colleagues and friends, or even reading on the internet, how common are these interactions specifically with behavioral health medications?

Jennifer Jonsson: Well, I did not see anything as far as specific studies or actual research that’s been done on that, but there were lots of anecdotal, there were people talking about it on Reddit, there were posts on Threads and places like that saying, I’m having this problem. So I mean, it’s evidently out there, but it hasn’t made its way into the general knowledge yet. So I’m hoping that I can help that to happen faster.

Kevin Pho: And then when you see some of these stories online, on Reddit for instance, what exactly are you seeing? What are other people experiencing?

Jennifer Jonsson: Pretty much the same thing, that suddenly they can’t concentrate on anything, they’re having trouble working, they’re having issues with mental health in one way or another that they didn’t have before. And their experiences have been similar to mine. So that’s happening.

Kevin Pho: And do you feel at baseline now after stopping the Rybelsus?

Jennifer Jonsson: Yes, yes, I feel much better now. I just had knee surgery, so I am taking a whole bunch of other medications, so that’s causing various issues, but it’s not interfering with my mental health issues right now, which is great.

Kevin Pho: And did your physician try you on another diabetes medicine eventually?

Jennifer Jonsson: I’m taking Januvia, and it’s been great. No problems.

Kevin Pho: Great. And in terms of amongst your physicians, if you were to experience this over again, and hopefully you don’t, what would you like to have seen differently in terms of the discussion in the exam room?

Jennifer Jonsson: I just would like to have had somebody tell me, by the way, this can cause this problem, you need to look out for this and this, and if you start seeing that, come back to me right away. That would have been helpful.

I mean, again, it is in the prescribing instructions, so it’s not like it’s not known. But it wasn’t really discussed. So maybe it’s very rare and it doesn’t happen often enough. I mean, I think my doctor was much more worried about my family history, if I had ever had anyone with thyroid cancer or anything like that, because that can be an issue too.

Kevin Pho: We’re talking to Jennifer Jonsson. She’s a patient advocate. Today’s KevinMD article is “Can weight loss medication interfere with ADHD meds?” Jennifer, we’ll end with some of your take-home messages that you want to leave with the KevinMD audience.

Jennifer Jonsson: Just be aware that when you’re prescribed a new medication, there can be side effects and interference with other things that you’re taking. I think a lot of people feel like they’re in the position of not being able to question their physician and say, what can happen if I take this? And it’s not disrespectful to say, hey, is there something that could happen that I might want to be aware of? Because prescription drugs are pretty powerful things, and they can cause lots of different effects for different people.

Kevin Pho: How about your advice to other patients who find themselves in similar positions to what you experienced, in terms of speaking up? You alluded to the fact that sometimes patients are afraid to speak up. What kind of advice do you have for these patients in terms of how to do so effectively?

Jennifer Jonsson: Well, hopefully at the time the medicine is prescribed, that would be the best time to ask, what should I look for as far as side effects, interference with other medications, that kind of thing. But if you start seeing something like that, I would say immediately call your doctor and say, I need to come back in and be seen, because this is happening.

And just making the appointment will probably clear up a lot of that concern of coming across as disrespectful, or otherwise making the doctor angry. Which I don’t think doctors really get angry in situations like that, but I certainly felt like she could.

Kevin Pho: And was your physician surprised that there was such a marked effect on you and your behavioral health medications with the Rybelsus?

Jennifer Jonsson: She was surprised, and I think also disappointed, because unfortunately it had been working great for my diabetes, my sugars were great, and I don’t think she wanted to disrupt that. But it had to happen, so, yeah.

Kevin Pho: Jennifer, thank you so much for sharing your story, time, and insight. Thanks again for coming on the show.

Jennifer Jonsson: Thank you.