Use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) has expanded rapidly across type 2 diabetes and obesity care, prompting continued evaluation of potential psychiatric adverse effects. A systematic review published in Diabetes, Obesity and Metabolism found mixed evidence regarding suicidal ideation and behaviors among adults treated with GLP-1 RAs.

The review searched MEDLINE, PubMed, EMBASE, CINAHL, and PsycINFO from database inception through December 11, 2025. Forty-three observational studies evaluating suicidal ideation, suicide attempts, or completed suicide among adults receiving GLP-1 RAs were included. Eligibility screening, data extraction, and risk-of-bias assessments were performed independently and in duplicate.

Findings

• Some case reports described a temporal relationship between GLP-1 RA use and onset of suicidal ideation.
• Cross-sectional and case-control studies identified negative associations between GLP-1 RA use and suicide attempts.
• Pharmacovigilance and cohort studies showed mixed findings, with some studies reporting positive associations between semaglutide or liraglutide and suicidal ideation.
• Other cohort studies reported lower rates of suicidal behaviors, including suicide attempts, intentional self-harm, and completed suicide, among GLP-1 RA users.

Current evidence does not support a causative role for GLP-1 RAs in suicidality. The findings support routine mental health assessment before and during GLP-1 RA treatment, while indicating that pre-existing psychiatric conditions should not automatically preclude GLP-1 RA use.