GLP-1 Scripts Rising Faster Among Adults With Serious Mental Illness

Adults with serious mental illness (SMI) received GLP-1 drug prescriptions at higher rates than those without SMI from 2018 to 2024, an analysis of U.S. insurance claims data showed.

Among people with an underlying GLP-1-indicating condition, prescription rates rose significantly in both groups, but remained higher for those with SMI, reported Emma McGinty, PhD, MS, of Weill Cornell Medicine in New York City, and colleagues:

• Adults with SMI: 2.3% in 2018 to 13.7% in 2024
• Adults without SMI: 1.8% in 2018 to 11.1% in 2024

However, the researchers noted one exception: Among adults with diabetes, those with schizophrenia had lower GLP-1 prescription rates (rising from 3.4% in 2018 to 19.4% in 2024) than those without SMI (4.5% in 2018 to 23.1% in 2024). This “could suggest a need for targeted approaches to support equitable prescribing for this subgroup,” they pointed out in a JAMA Psychiatry research letter.

“People with SMIs … experience 10 to 20 years of premature mortality driven by a high prevalence of cardiovascular risk factors,” they highlighted. “GLP-1 receptor agonists are transforming cardiovascular risk prevention and could have high impact in this population.”

McGinty said she was somewhat surprised by the findings, given that people with SMI — including schizophrenia, bipolar disorder, and major depressive disorder — are often less likely than others to receive clinical guideline-concordant cardiovascular care, especially those covered by Medicaid.

“Our findings support the idea that clinicians view these medications as safe and effective for people with SMI, with the possible exception of people with schizophrenia,” she told MedPage Today.

The findings follow years of regulatory scrutiny over the class’s psychiatric safety profile. While early adverse reports led to a preliminary FDA review into suicidal ideation risks in early 2024, extensive safety evaluations ultimately prompted the agency by January 2026 to request that manufacturers remove suicidal behavior and ideation warning language from GLP-1 drug labels entirely.

“Extant evidence suggests GLP-1s effectively treat indicated conditions among people with SMI, including those using antipsychotic medications, without adverse psychiatric effects,” McGinty and colleagues noted. This popular drug class “should be considered as part of comprehensive care incorporating behavioral lifestyle changes and possibly other medication (e.g., metformin for antipsychotic-induced weight gain).”

For the study, the researchers analyzed Inovalon Insights Real-World Data, which includes deidentified medical and pharmaceutical claims for commercial, Medicare Advantage, and Medicaid Managed Care beneficiaries across all 50 states. The sample included 104,315,456 adults continuously enrolled in a single insurance type during a given calendar year from 2018 to 2024.

Among the 14,187,676 adults with SMI, 14% had schizophrenia, 20.8% had bipolar disorder, and 65.2% had major depressive disorder. The average age of adults with SMI was 44.9 years, and 66.2% were female.

Prevalence of underlying GLP-1-indicating conditions was significantly higher in adults with SMI, including diabetes (22.4% vs 11.5%), obesity (42.9% vs 21.8%), sleep apnea (17% vs 6.3%), and overweight plus another chronic condition (16.9% vs 8.7%).

The authors acknowledged that the data were not nationally representative and failed to capture medication use or prescriptions paid out of pocket. “Further research should assess GLP-1 continuity among people with SMI,” they concluded.