ArticleFrontiers in psychiatry2026
Case Report: Oral semaglutide-associated depression in a patient with type 2 diabetes mellitus: a dose-dependent recurrence confirmed on rechallenge and managed with vortioxetine-bupropion combination therapy.
Article in Frontiers in psychiatry, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Oral semaglutide carries a neuropsychiatric safety profile that continues to evolve. Large clinical trials have not, at the group level, demonstrated excess psychiatric adverse events-but pharmacovigilance databases and case reports have documented a signal for depression and suicidal ideation in individual patients. A dose-dependent onset with rechallenge has not, to our knowledge, been previously described for the oral formulation, though such an association cannot be established from a single observation. Case presentation: We describe a 54-year-old man with type 2 diabetes and no psychiatric history who developed moderately severe major depression (Patient Health Questionnaire-9 [PHQ-9]: 18; Hamilton Depression Rating Scale 17 items [HDRS-17]: 22) within 2 weeks of escalating oral semaglutide from 3 to 7 mg daily. Vortioxetine 10 mg combined with bupropion XL 150 mg produced remission within 4 weeks (PHQ-9: 6). On structured rechallenge, depression returned when the dose was re-escalated to 7 mg (PHQ-9: 17; HDRS-17: 20). Permanent discontinuation was followed by sustained remission. Conclusion: As far as we are aware, this is the first reported case of a dose-related, rechallenge-associated depressive episode tied in time to oral semaglutide and treated with a vortioxetine-bupropion combination. A Naranjo score of 7 puts the relationship in the probable range, though that reading is held back by the usual limits of a single case and by an incomplete washout before rechallenge. The step from 3 to 7 mg may be a point of raised psychiatric risk in vulnerable patients, and watching mood during titration looks like a sensible precaution.
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