We are living through a massive, rapid shift in how we approach human health, and as I watch the excitement surrounding the new generation of glucagon-like peptide-1 (GLP-1) agonists, I can’t help but see a familiar ghost in the room. It feels exactly like the early days of the selective serotonin reuptake inhibitor (SSRI) revolution, a time when we were all so eager for a solution that we sometimes overlooked the long, winding road ahead.
Both of these drug classes arrived on the scene with immense promise, each designed to solve a very specific problem (depression for one, diabetes for the other). But their success was so loud that they quickly became the default answer for almost everything. For the pharmaceutical companies, that popularity was an incredible financial windfall. For those of us in the office, it meant learning an entirely new language of care. These aren’t “take it and forget it” medications; they require a patient, careful dance of titrating doses up to find that subtle sweet spot, and then agonizing over how to taper them back down when the time is right.
It doesn’t take long for the real world to fill in the blanks that clinical trials couldn’t predict. We learned that the hard way with SSRIs, where we eventually had to face the reality of sexual dysfunction, emotional blunting, and the often grueling rebound of depression, anxiety, and hypersensitivity upon stopping. Now, we are starting to see a similar pattern emerge with GLP-1s. The stories are beginning to trickle out, revealing that weight rebound, the biological “snap-back” once these medications are discontinued, is a very real hurdle.
One of the most important lessons I’ve taken from the past is that the urge to rush to a maximum dose for rapid results almost always backfires. With both classes, moving too fast ignores the body’s need to adjust. There is a deep, quiet wisdom in slow titration and deliberate tapering; it is the most reliable way to hold onto the benefits while respecting the physiology of the person sitting across from you.
Then, of course, there is the noise. With SSRIs, we spent years filtering out the fear-mongering from politicians and pundits who were far removed from the actual, daily work of healing. We are seeing that same pressure build now around GLP-1s, with everyone weighing in on the “risks” and the morality of the treatment. But vilifying these tools in the media isn’t the answer. There is a substantial, deserving population out there who are immensely benefiting from these medications and enhancing their lives because of them.
If I could sit down with anyone starting this journey today, I’d tell them to lean into that history. There is so much to be gained by honestly looking at the good, the bad, and the ugly of the antidepressant era. We should be deeply grateful for the help these new medications provide, but we owe it to ourselves to stay watchful, to keep our conversations honest, and to remember that no pill is a magic wand. We have walked this path before, and if we are careful and humble, we can make sure this time the journey is a little smoother for everyone.
Farid Sabet-Sharghi is a psychiatrist.
