# Adolescent Suicidality on GLP-1 Drugs vs Lifestyle Intervention and Metformin A cohort of 9,222 matched adolescent pairs found no increased psychiatric risk with incretin drugs, a protective signal against lifestyle intervention, and none against metformin. Publisher: This GLP Editorial Team Canonical: https://thisglp.com/research/glp1-adolescent-suicidality-comparators Updated: 2026-09-18 Published: 2026-09-16 [← Research](https://thisglp.com/research) Evidence # Adolescent Suicidality on GLP-1 Drugs vs Lifestyle Intervention and Metformin In 9,222 matched pairs of adolescents, incretin drugs looked protective against lifestyle intervention and made no difference against metformin. Neither comparison found harm. [This GLP Editorial Team](https://thisglp.com/about)September 20266 min readUpdated September 2026 Suicide-related events, same drugs, two comparisons · vs lifestyle intervention · HR 0.74 — 95% CI 0.57 to 0.95 · vs metformin, an active drug · no significant difference · Neither comparison found increased risk. Only one found a benefit. **Research, not medical advice.** This GLP is independent and educational. Nothing here is a substitute for individualized care from a licensed clinician, and reading it creates no doctor–patient relationship. Talk to your own provider before starting, stopping, or changing any medication, peptide, or therapy. See our [methodology](https://thisglp.com/methodology) and [terms](https://thisglp.com/terms). ## Key takeaways - A matched cohort of 9,222 adolescents per group compared incretin drugs against lifestyle intervention. - Neither comparison found increased psychiatric risk — which is the answer to the question people actually ask about this class in teenagers. - Against lifestyle intervention: suicide-related events HR 0.74, suicidal ideation HR 0.73, anxiety HR 0.92. - No differences for suicide attempt, insomnia, depression or eating disorders. - Against metformin, an active drug comparator, there was no significant difference — and the authors say to read the headline cautiously because of it. The most publicized worry about these drugs in young people is suicidality. This study addresses it directly in 9,222 matched pairs of adolescents, and the reassuring finding holds however you cut it: no increase. The more interesting part is what happened when the authors changed who they compared against. ## The reassuring answer first Adolescents with overweight or obesity starting semaglutide, liraglutide or tirzepatide were matched against adolescents receiving lifestyle interventions, using global electronic health records, and followed from 30 days to about three years after starting. [\[1\]](https://thisglp.com/research/glp1-adolescent-suicidality-comparators#ref-1) Incretin therapy was not associated with increased risk of any psychiatric outcome measured. Suicide attempt, insomnia, depression and eating disorders all showed no significant difference. That is the finding most families are looking for, and it is consistent with what [the pooled randomized evidence in children](https://thisglp.com/research/glp1-in-children-all-eighteen-trials) found over its much shorter follow-up. ## Then it looked protective Against lifestyle intervention, the drugs were associated with lower risks: suicide-related events HR 0.74, 95% CI 0.57 to 0.95; suicidal ideation HR 0.73, 95% CI 0.56 to 0.96; and anxiety HR 0.92, 95% CI 0.84 to 0.99. The reductions were significant among girls, HR 0.61, 95% CI 0.46 to 0.82, and among adolescents without type 2 diabetes, HR 0.63, 95% CI 0.47 to 0.85. They were not significant among boys or among those with type 2 diabetes. The study reports those splits without explaining them, and so does this page. And then it changed the comparator The authors also ran the analysis against metformin — another drug, prescribed to a more similar kind of adolescent through a more similar route. In that comparison there was no significant difference. They flag this themselves, along with potential selection bias, as the reason to interpret the protective finding cautiously. A benefit that appears against lifestyle advice and vanishes against a pill is a benefit that may belong to the patients rather than the molecule. ## Why the comparator decides so much An adolescent prescribed a GLP-1 and an adolescent enrolled in a lifestyle program differ before either starts. One has a prescriber willing to medicate, usually insurance, and a family navigating specialty care. The other may have been offered the cheaper option, or the only one available. Those differences predict mental health outcomes on their own. Metformin narrows that gap. It is also a prescription, also given for metabolic reasons, also requiring a clinician. When the difference disappears under that comparison, the most economical explanation is that some of what looked like a drug effect was a difference in who receives drugs — the point [comparator choice](https://thisglp.com/research/do-glp1-drugs-cause-gout) makes in almost every observational study this desk reads. ## What to carry away The safety question has a clear answer and the efficacy-adjacent claim does not. Nothing here suggests these drugs raise psychiatric risk in adolescents, across two comparators and seven outcomes. Nothing here establishes that they lower it either. For adults the picture is separate and has [its own longer history](https://thisglp.com/research/glp1-and-suicidal-ideation). And nobody on this roster ships to anyone under eighteen or offers a pediatric service, so this is a conversation for a family and a clinician — one in which the questions worth asking are the ones [no intake form covers](https://thisglp.com/tools/questions-they-leave-open). ## Frequently asked Do these drugs increase suicidality in teenagers? Not in this study. Across 9,222 matched pairs and seven psychiatric outcomes, incretin therapy was not associated with increased risk in either comparison the authors ran. Do they reduce it? Against lifestyle intervention the hazard ratio for suicide-related events was 0.74. Against metformin there was no significant difference, and the authors cite that as a reason to read the protective finding cautiously. Why did the answer change with the comparator? Adolescents who get prescribed a drug differ from those offered a lifestyle program in access, insurance and family circumstances. Metformin is also a prescription, which narrows that gap — and the difference vanished. Why were girls' results different from boys'? The reductions reached significance in girls and in adolescents without type 2 diabetes, and not in boys or those with it. The study reports the split without explaining it. ## Sources 1. \[1\] Liu TH, et al. (2026). Psychiatric Safety of GLP-1 and Dual GIP/GLP-1 Receptor Agonists in Adolescents With Obesity Diabetes, Obesity and Metabolism. [PMID 42736027](https://pubmed.ncbi.nlm.nih.gov/42736027/) ## Where to get it ### Best GLP-1 injections Every injectable seller we can verify, with the price each one publishes and an honest read of what the trials measured. 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