GLP-1 Prescribing Rose Among Adults With Serious Mental Illness

Adults with serious mental illness (SMI)—schizophrenia, bipolar disorder, or major depressive disorder (MDD)—received glucagon-like peptide-1 (GLP-1) receptor agonist prescriptions at rates similar to or higher than adults without SMI between 2018 and 2024, according to a research letter published online in JAMA Psychiatry.¹

The analysis, based on national insurance claims covering more than 104 million US adults, found that unadjusted GLP-1 prescribing was higher among people with SMI overall, but the gap largely closed once the researchers accounted for underlying clinical need. One notable exception included adults with schizophrenia who continued to receive GLP-1 prescriptions at a lower rate than their peers without SMI, even after adjustment.¹

People with SMI experience 10 to 20 years of premature mortality driven by a high prevalence of cardiovascular risk factors, according to the study authors. GLP-1 receptor agonists are transforming cardiovascular risk prevention and could have high impact in this population, the authors wrote, but prescribing patterns among people with SMI had not previously been examined.¹

How the Study Was Designed

The researchers used Inovalon Insights Real-World Data, which includes deidentified medical and pharmaceutical claims for commercial, Medicare Advantage (MA), and Medicaid Managed Care beneficiaries across all 50 states. The sample included adults 18 years and older who were continuously enrolled in a single insurance type in a given calendar year from 2018 to 2024. SMI was defined hierarchically as schizophrenia, bipolar disorder, or MDD.¹

The researchers measured any GLP-1 prescription using National Drug Codes, along with GLP-1-indicating conditions (diabetes, obesity, sleep apnea, or overweight plus a co-occurring chronic condition), a modified Elixhauser comorbidity index, and demographic and insurance variables. Multivariable logistic regression with predictive margins was used to calculate adjusted predicted proportions of adults with and without SMI receiving a GLP-1 prescription, overall and stratified by SMI diagnosis, GLP-1-indicating condition, and insurance type.¹

The sample included 104,315,456 adults, of whom 14,187,676 had SMI. Among those with SMI, 14.0% had schizophrenia, 20.8% had bipolar disorder, and 65.2% had MDD. Mean (SD) age was similar between adults with SMI (44.9 [18.4] years) and without SMI (43.0 [17.9] years), though more adults with SMI were female (66.2% vs 51.3%). Among people with SMI, 48.8% had commercial insurance and 11.7% had MA, with the remainder covered through Medicaid Managed Care; among those without SMI, 67.3% had commercial insurance, 6.5% had MA, and 28.3% had Medicaid Managed Care.¹

Prescribing Trends, Burden, and Persistent Gap

Adults with SMI had a substantially higher prevalence of every condition the researchers used to indicate GLP-1 treatment. Diabetes prevalence was 22.4% among adults with SMI compared with 11.5% among those without. Obesity prevalence was 42.9% vs 21.8%, sleep apnea prevalence was 17.0% vs 6.3%, and prevalence of overweight plus a co-occurring chronic condition was 16.9% vs 8.7%, respectively. All differences were statistically significant.¹

Across the full study period, 5.4% of adults with SMI and 2.1% of adults without SMI received any GLP-1 prescription. Among the subset of adults with a GLP-1-indicating condition, more adults with SMI received a GLP-1 prescription than their counterparts without SMI in every year studied, rising from 2.3% in 2018 to 13.7% in 2024 among those with SMI, compared with 1.8% in 2018 to 11.1% in 2024 among those without SMI—with one exception. Among adults with diabetes specifically, a lower proportion of those with schizophrenia received any GLP-1 prescription (3.4% in 2018, 19.4% in 2024) relative to adults without SMI (4.5% in 2018, 23.1% in 2024).¹

After adjustment, differences between adults with and without SMI in the estimated proportion receiving a GLP-1 prescription were statistically significant but small in magnitude—less than 1 percentage point. A higher adjusted proportion of adults with SMI received a GLP-1 prescription than adults without SMI, with the exception of the schizophrenia subgroup, in which 1.2% of adults received a GLP-1 prescription compared with 1.5% of adults without SMI.¹

What the Findings Suggest

The researchers wrote that the narrowing of unadjusted differences after adjustment suggests higher GLP-1 prescription rates among people with SMI overall may be driven by clinical need rather than diagnosis-based disparities. The persistently lower adjusted rate among adults with schizophrenia, however, could point to a need for targeted approaches to support equitable prescribing for this subgroup, the authors wrote.¹

The authors noted that existing evidence suggests GLP-1s effectively treat indicated conditions among people with SMI, including those using antipsychotic medications, without adverse psychiatric effects. They also wrote that this study's findings of higher unadjusted and similar adjusted proportions of GLP-1 receipt among adults with vs without SMI differ from prior literature describing lower guideline-concordant cardiovascular care for people with SMI, particularly those in Medicaid.¹

The authors suggested this difference may reflect the simpler nature of prescribing relative to multicomponent care processes captured in previous research, such as diabetic glucose monitoring or eye exams, or prescribers' perceived efficacy of GLP-1s for reducing cardiovascular risk in this high-need population. GLP-1s, the authors wrote, should be considered part of comprehensive care that also incorporates behavioral lifestyle changes and, potentially, other medications such as metformin for antipsychotic-induced weight gain.¹

The authors noted that although the Inovalon data captured a large, geographically comprehensive sample of insured US adults, the data were not nationally representative and did not capture medication use or prescriptions paid out of pocket. They called for further research to assess GLP-1 continuity among people with SMI.¹

Pharmacy Implications

The findings arrive as GLP-1 receptor agonists continue to account for a growing share of prescription volume nationally, reaching nearly 8% of all US prescriptions filled as of March 2026, with first-time antiobesity medication prescriptions rising 21.7% between December 2025 and March 2026. That growth has come with persistent operational challenges for pharmacies, including supply shortages, administrative burdens tied to high medication costs, and prescription abandonment linked to coverage restrictions.²

For pharmacists working with patients who have SMI or other psychiatric comorbidities, monitoring remains a key role as GLP-1 use expands into populations managing complex medication regimens. In a related discussion of GLP-1 use among patients with substance use disorder, Sylvie Stacy, MD, MPH, chief medical officer at Rehab.com, said pharmacists can help distinguish GLP-1 adverse effects, such as nausea, vomiting, or diarrhea, from other symptoms in patients managing co-occurring conditions.³

"Pharmacists can play a major role in monitoring and patient safety," Stacy said in an interview. Stacy also noted that although no clear link has been established between GLP-1s and suicidal ideation, patients with a history of psychiatric or substance use conditions warrant close mood monitoring while taking these medications.³

REFERENCES

1. McGinty EE, Wagle P, Daumit GL. GLP-1 Receptor Agonist Prescriptions Among People With and Without Serious Mental Illness. JAMA Psychiatry. Published online September 2, 2026. doi:10.1001/jamapsychiatry.2026.2667

2. Gallagher A. New data show semaglutide's effects on depression and migraine. Drug Topics. May 12, 2026. Accessed September 4, 2026. https://www.drugtopics.com/view/new-data-show-semaglutide-s-effects-on-depression-and-migraine

3. Nowosielski B. Q&A: pharmacists could play key role in managing GLP-1 use for SUD. Drug Topics. April 1, 2026. Accessed September 4, 2026. https://www.drugtopics.com/view/pharmacists-could-play-key-role-in-managing-glp-1-use-for-sud