Disproportionality Analysis From World Health Organization Data on Semaglutide, Liraglutide, and Suicidality
Open accessAbstract
Importance: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have gained use primarily due to their weight-reduction effects, although a regulatory review was undertaken for potential suicidality concern. Objectives: To evaluate potential signals for suicidal and self-injurious adverse drug reactions (ADRs) associated with the GLP-1 RAs semaglutide and liraglutide. Design, Setting, and Participants: Disproportionality analysis through the case-control design using the World Health Organization (WHO) global database of suspected ADRs. Participants were clinical patients worldwide experiencing an ADR suspectedly attributable to semaglutide or liraglutide in the database from inception to August 30, 2023. Data were analyzed from September to December 2023. Exposure: Treatment with semaglutide or liraglutide regardless of indication or treatment duration. Main Outcomes and Measures: Reporting odds ratio (ROR) and the bayesian information component (IC) with 95% CIs were calculated as measures of disproportionate reporting of suicidal and self-injurious ADRs associated with semaglutide and liraglutide compared with all other medications. Sensitivity analyses were conducted including patients with coreported use of antidepressants and benzodiazepines and using dapagliflozin, metformin, and orlistat as comparators. A disproportionality signal was considered when the lower limits of the ROR and IC were above 1 and 0, respectively. Results: A total of 107 (median [IQR] age 48 [40-56] years; 59 female patients [55%]) and 162 (median [IQR] age 47 [38-60] years; 100 female patients [61%]) cases of suicidal and/or self-injurious ADRs were reported between November 2000 and August 2023 with semaglutide and liraglutide, respectively. Significant disproportionality was detected only for semaglutide-associated suicidal ideation (ROR, 1.45; 95% CI, 1.18-1.77; IC, 0.53; 95% CI, 0.19-0.78), which remained significant in patients with coreported use of antidepressants (ROR, 4.45; 95% CI, 2.52-7.86; IC, 1.96; 95% CI, 0.98-2.63) and benzodiazepines (ROR, 4.07; 95% CI, 1.69-9.82; IC, 1.67; 95% CI, 0.11-2.65), when compared with dapagliflozin (ROR, 5.56; 95% CI, 3.23-9.60; IC, 0.70; 95% CI, 0.36-0.95), metformin (ROR, 3.86; 95% CI, 2.91-5.12; IC, 1.20; 95% CI, 0.94-1.53) and orlistat (ROR, 4.24; 95% CI, 2.69-6.69; IC, 0.70; 95% CI, 0.36-0.95). Conclusions and Relevance: This study using the WHO database found a signal of semaglutide-associated suicidal ideation, which warrants urgent clarification.
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There were no concerns regarding suicide risk or major depressive events across the included trials.
“Notably, there were no concerns regarding suicide risk or major depressive events across the included trials55,56.”
From A systematic review and meta-analysis of the efficacy and safety of pharmacological treatments for obesity in adults (2025) · cites this paper as [56]
The Discussion (page not available) says pooled liraglutide trials identified a potential risk of suicidal ideation, with reports in 0.27% of liraglutide participants versus 0.10% of placebo participants. That contradicts the claim that there were no suicide-risk concerns across the trials. The paper does not establish the claim about major depressive events. (LLM, conf=0.88)
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Experimental — accuracy not yet measuredThe WHO's VigiBase identified a notable disproportionality signal for suicidal ideation linked to semaglutide (ROR 1.45; 95% CI 1.18 to 1.77).
“The WHO’s VigiBase identified a notable disproportionality signal for suicidal ideation linked to semaglutide (reported odds ratio [ROR], 1.45; 95% CI, 1.18 to 1.77), absent for liraglutide, especially in patients concurrently using antidepressants (ROR, 4.45; 95% CI, 2.52 to 7.86) [73].”
From Exploring the Side Effects of GLP-1 Receptor Agonist: To Ensure Its Optimal Positioning (2025) · cites this paper as [73]
The VigiBase disproportionality signal for suicidal ideation was absent for liraglutide.
“The WHO’s VigiBase identified a notable disproportionality signal for suicidal ideation linked to semaglutide (reported odds ratio [ROR], 1.45; 95% CI, 1.18 to 1.77), absent for liraglutide, especially in patients concurrently using antidepressants (ROR, 4.45; 95% CI, 2.52 to 7.86) [73].”
From Exploring the Side Effects of GLP-1 Receptor Agonist: To Ensure Its Optimal Positioning (2025) · cites this paper as [73]
In patients concurrently using antidepressants, the VigiBase signal for suicidal ideation linked to semaglutide had an ROR of 4.45 (95% CI 2.52 to 7.86).
“especially in patients concurrently using antidepressants (ROR, 4.45; 95% CI, 2.52 to 7.86) [73].”
From Exploring the Side Effects of GLP-1 Receptor Agonist: To Ensure Its Optimal Positioning (2025) · cites this paper as [73]
The benefits of tirzepatide for OSAS and semaglutide for KOA are largely driven by weight reduction rather than by unique pharmacodynamic properties of each molecule.
“it is plausible that these effects are largely driven by weight reduction rather than by unique pharmacodynamic properties of each molecule55,56.”
From A systematic review and meta-analysis of the efficacy and safety of pharmacological treatments for obesity in adults (2025) · cites this paper as [56]
The Introduction (page not provided) describes weight loss with semaglutide, but does not address benefits for obstructive sleep apnea or knee osteoarthritis. The Discussion concerns suicidality; searches for those conditions, tirzepatide, and weight-loss mediation found no passage assessing whether the claimed benefits arise from weight reduction rather than molecule-specific effects. (LLM, conf=0.76)
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- Authors
- Schoretsanitis, G., Weiler, S., Barbui, C., Raschi, E., & Gastaldon, C.
- Affiliations
- Northwell Health (US)
- University of Zurich (CH)
- University of Verona (IT)
- University of Bologna (IT)
- University of Bern (CH)
- Corresponding author
- Schoretsanitis, Georgios
- Venue
- JAMA Network Open
- Publisher
- American Medical Association (AMA)
- Published
- 2024-08-20
- Volume
- 7
- Issue
- 8
- Pages
- e2423385
- ISSN
- 2574-3805 (ISSN-L)
- PMC
- PMC11337067
- OpenAlex
- W4401715897
- Cited by
- 107
- References
- 35
- Citations by year
- 2026: 45 · 2025: 53 · 2024: 9
- FWCI
- 25.46
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JAMA Network Open (publishedVersion, cc-by)
- PubMed (publishedVersion)
- PubMed Central (publishedVersion, cc-by)
- Bern Open Repository and Information System (University of Bern) (submittedVersion, cc-by)
- Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion, cc-by)
- Repository for Publications and Research Data (ETH Zurich) (submittedVersion, cc-by)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion, cc-by)
- ETH Zürich Research Collection (cc-by)
- Topics
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Pharmacovigilance and Adverse Drug Reactions
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Health Sciences › Medicine › Pharmacology › Pharmacology and Obesity Treatment
- Keywords
- semaglutide, liraglutide, GLP-1 receptor agonists, suicidality, self-harm, suicidal ideation, adverse drug reactions, disproportionality analysis, drug safety, anti-obesity drugs, reporting odds ratio, dapagliflozin
- MeSH terms
- Liraglutide, Semaglutide, Adult, Glucagon-Like Peptides, Female, Humans, Hypoglycemic Agents, Male, Middle Aged, Suicide, World Health Organization, Case-Control Studies, Self-Injurious Behavior
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