When the U.S. comic and influencer Claudia Oshry, now 30, got here off the weight-loss drug Ozempic after a 12 months, she skilled one thing she no doubt wasn’t anticipating — excessive starvation. Explaining this on TikTok, she mentioned she used to be hungry at all times and suffering to really feel complete.‘I’m all the time on the lookout for snacks and issues to fill me up,’ she mentioned in a viral video previous this 12 months, after dropping an excellent 70lb. ‘I can’t keep complete, it’s inconceivable. I simply had a 12oz steak and I’m ravenous, so I’m consuming popcorn.’After posting the video, which has since been considered greater than 1.5 million instances, lots of her fans shared identical struggles of utmost starvation. Whilst it takes about 5 weeks for Ozempic to totally depart your gadget, in some instances, those issues seemed 3 weeks after sufferers stopped taking it. 
Whilst it takes about 5 weeks for Ozempic to totally depart your gadget, in some instances, those issues seemed 3 weeks after sufferers stopped taking it‘It’s wild how a lot mind area meals takes up. I will consume such a lot protein and can nonetheless be ravenous,’ mentioned one; ‘I’ve been pronouncing this for some time. My dad takes Ozempic and needed to cross off for a bit bit and I’ve by no means observed him consume greater than he did then. Bottomless pit,’ mentioned every other; ‘I simply stopped 3 weeks in the past and the starvation is indubitably again,’ commented every other follower.Since then, identical anecdotal studies were reported by way of Jamy Ard, a medical scientist at Wake Wooded area College College of Drugs in Winston-Salem, North Carolina, who oversees the burden control programme there.His sufferers are on GLP-1 agonists, a bunch of gear that comes with Ozempic. Evolved at the start as a remedy for kind 2 diabetes to control blood sugar ranges, their skill to cut back urge for food and decelerate digestion has resulted in them additionally getting used as weight-loss pills.Within the magazine Nature, Jamy Ard says that a few of his sufferers quitting GLP-1 agonists document feeling extra hungry than they did ahead of they began the remedy.Whilst this perceived ‘after impact’ of the drug can have come as one thing of a marvel to those sufferers, to Laura Wilson, director of The Royal Pharmaceutical Society in Scotland, it’s rarely surprising. She says: ‘This phenomenon, referred to as a rebound impact or rebound symptom, is when signs which were alleviated whilst on a drugs go back while you forestall taking it.‘Very extensively talking, that is usually the results of certainly one of 3 issues: withdrawal results from the medication itself which has led to bodily or mental dependence; returning signs which don’t have anything to do with the medication; or worsening signs.‘The latter once more is not anything to do with the medication however merely on account of the frame both being used to running with the drug then having to evolve to being with out it, or the underlying situation worsening or progressing whilst taking the drugs to control it.’The primary of those — withdrawal results from a medication on account of drug dependency — is one of the crucial well-publicised and relating to, with 7.1 million sufferers prescribed dependency-forming drugs in England in 2022/23, in keeping with NHS figures. Not unusual culprits right here come with painkilling opioids, slumbering tablets and antidepressants.However when it comes to weight-loss pills similar to Ozempic, it’s to do with returning signs. Right here are some not unusual medicines that may motive ‘rebound’ signs while you forestall taking them Ozempic and identical pills (see major article): Could make you’re feeling much more hungry and, when taken for diabetes, lift blood glucose ranges.Painkillers: Opioids similar to codeine, tramadol and oxycodone; gabapentinoids (gabapentin and pregabalin); non-steroidal anti inflammatory pills (NSAIDs) similar to aspirin and ibuprofen, if used longer term, can all make complications worse.Dozing tablets: Z-drugs similar to zolpidem and zopiclone can irritate insomnia.Decongestant nasal sprays containing oxymetazoline or phenylephrine: Those can building up emotions of congestion.Anti-anxiety medicine: Benzodiazepines similar to diazepam and bromazepam can irritate emotions of hysteria and fear.Blood power pills: Betablockers may end up in an building up in blood power. ‘Whilst consistent starvation isn’t a symptom within the standard sense, a want to curb it is among the components for other people turning to those therapies within the first position,’ says Laura Wilson.To grasp why starvation comes again with those pills, you must have a look at why we really feel it within the first position, explains Dr Ralph Abraham, a expert in endocrinology and diabetes on the London Diabetes Centre.‘Starvation is a posh physiological reaction and there are lots of hormones within the intestine and the mind that engage to lend a hand care for frame weight.‘Intestine hormones and the medicine that at the moment are utilized in weight problems have tough and sophisticated direct movements on amino acids referred to as peptides. Those are hooked up with urge for food within the hypothalamus, the realm of the mind which produces hormones that keep an eye on such things as starvation and temper.’He provides: ‘GLP-1 agonists similar to Ozempic paintings by way of recreating the results of GLP-1, a hormone naturally produced within the intestine after consuming, which sends alerts to dam those mind starvation receptors. This, in flip, reduces starvation and cravings.‘Which means that whilst you’re taking the drugs all the ones wants are placed on grasp.‘The medicine additionally make you’re feeling fuller extra temporarily and decelerate digestion within the abdomen. However like several medicine — while you forestall taking it, this stops too,’ says Dr Abraham.He provides: ‘Relating to other people pronouncing they really feel hungrier than they did ahead of, it’s tough to measure other people’s belief of starvation.‘Alternatively, it isn’t unexpected that in case your starvation is suppressed by way of medicine and also you forestall taking it — you then’d no doubt be struck by way of the distinction and due to this fact much more likely to note and statement on it.’As a result of this, Dr Anita Raja, a Birmingham-based GP, who additionally runs a weight-loss hospital, says you must exchange different behaviours all through that point to present your self a preventing likelihood of maintaining weight off while you forestall taking the drugs.‘Those pills aren’t miracle remedies,’ she says. ‘In the event you don’t recognise that you just had been overeating, or fail to handle why that used to be going down within the first position — your courting with meals, your behaviours against it or your total way of life, for example — then while you come off the drugs you’ll revert again to the place you had been within the first position, particularly feeling overly hungry and striking that weight again on.’However in Dr Abraham’s revel in that’s now not all the time simple or conceivable. ‘That’s why a few of my sufferers are going to be on GLP-1 agonists pills longer term. I’m speaking as much as ten years right here,’ he provides.Relating to rebound results on account of medication dependency, antidepressants, which greater than 8 million other people in the United Kingdom are on, could cause rebound ‘despair’ — or somewhat, signs that appear to be the despair returning however are in reality withdrawal signs from the drug.A up to date overview in The Lancet Psychiatry famous one out of each six other people in the United Kingdom who take the medicine skilled withdrawal signs.Dr Mark Horowitz, a coaching psychiatrist and medical analysis fellow in psychiatry at North East London NHS Basis Agree with, says: ‘Antidepressants impact now not simply your mind, however your whole frightened gadget or even your hormonal gadget — and the frame can adapt and develop into bodily depending on those in as low as a couple of weeks of taking the drug.‘As a result of this, while you come off them, you’ll revel in each mental withdrawal signs: low temper, nervousness, panic assaults, crying and suicidality — plus bodily signs similar to dizziness, complications and mind zaps, necessarily the sensation of an electrical surprise for your head.‘Sadly, some docs mistake those withdrawal results as merely the despair returning and, therefore, re-enforcing the desire for medicine. However in lots of instances it’s not anything to do with that in any respect, it’s all concerning the frame’s dependency at the drug. 
To grasp why starvation comes again with those pills, you must have a look at why we really feel it within the first position, explains Dr Ralph Abraham‘That’s why it’s important to taper off the drugs, lowering it by way of a small proportion each few weeks. Quitting antidepressants can take months and even years.’A identical rebound impact may also be observed with anti-anxiety tablets similar to bromazepam, a part of a category of medications referred to as benzodiazepines.Additionally broadly prescribed — 6.4 million pieces (a unmarried unit of medicine indexed one at a time on a prescription shape) had been prescribed between December 2022 and November 2023, in keeping with the NHS — research have proven that fifty in step with cent of the ones the usage of benzodiazepines for simply 4 weeks undergo withdrawal signs similar to nervousness, dizziness, nightmares and weak point. And any place between 58 and 100 in step with cent of sufferers revel in a withdrawal reactions after taking them for multiple 12 months.As soon as once more, Dr Horowitz stresses the significance of really fizzling out and now not preventing the medicine all of a sudden or too temporarily.Headache medicine too can motive rebound signs — those rebound complications or medication-overuse complications happen in those that forestall taking medicine for power complications or migraines.‘This may also be led to by way of painkilling opioids similar to codeine, tramadol and oxycodone that may be prescribed to regard migraines together with different average to serious ache,’ says Dr Raja.‘They paintings by way of attaching to opioid receptors within the mind to dam ache messages, and overuse — taking greater than the beneficial day-to-day dose for various instances every week — may end up in the frame having a withdrawal response because the ache reliever wears off. This implies it’s now not the unique complications, it’s a drug-withdrawal brought on one. It’s a vicious circle.’She provides: ‘Rebound complications can be led to by way of an overuse of NSAIDs similar to aspirin or ibuprofen.‘Gabapentinoids, a bunch of anticonvulsant pills that come with gabapentin and pregabalin, could cause this too.’ Those pills are used to regard epilepsy and stipulations that motive nerve ache similar to diabetes and shingles — ‘they modify the best way nerves ship messages in your mind’, says Dr Raja.Rebound insomnia can happen from coming off slumbering capsules similar to Z-drugs (e.g. zolpidem and zopiclone), explains Dr Dipesh Mistry, a psychiatrist and sleep skilled founded on the non-public Ankha hospital in London.You don’t want to be taking some medicine for lengthy to be afflicted by rebound signs while you come off them.Decongestant nasal sprays containing oxymetazoline or phenylephrine could cause rebound congestion if used for various days, explains Laura Wilson.‘Those sprays paintings by way of mainly shrinking infected blood vessels to alleviate congestion and swelling. However take those for greater than 3 days and the blood vessels for your nostril develop into sensitised and mainly swell again up as the drugs wears off,’ she says, ‘and you then use extra spray’.The remaining class, particularly the worsening of signs after preventing medicine is, in all probability, much less well known than the opposite two kinds of rebound.Rebound diabetes — when sufferers revel in an building up in blood sugar ranges after coming off their medicine — can fall into this camp.‘Kind 2 diabetes medicines similar to GLP-1 agonists paintings principally by way of making the pancreas produce extra insulin, the hormone our frame makes to stay blood glucose ranges inside the customary vary,’ explains Dimitris Papamargaritis, an affiliate professor in diabetes and endocrinology at Leicester Diabetes Centre.‘Additionally they cut back ranges of the hormone glucagon, which is helping enhance blood glucose ranges. Moreover, as we all know, they suppress the urge for food, serving to you shed weight.’‘If in case you have kind 2 diabetes and forestall taking them, they forestall having that direct impact at the pancreas which is unbiased to weight reduction. Because of this, even though you arrange to stay the burden off and care for wholesome consuming behavior, your blood glucose ranges will most probably upward push.’In a similar way, sufferers can revel in rebound high blood pressure —hypertension — when coming off or reducing the dose of positive antihypertensive pills similar to betablockers, says Laura Wilson. It may well happen days — even hours — after preventing.‘Whilst those pills aren’t addictive, the frame can get used to running with the medication when taken ceaselessly, so preventing unexpectedly could cause a upward push in blood power.’So is there the rest you’ll do to stop those rebound results? ‘At all times take your medication for the prescribed period of time — now not,’ says Dr Raja.‘Be sure you don’t forestall any medicine you’ve taken for some time for a protracted situation with out searching for clinical recommendation — continuously you’ll be placed on a transparent plan to taper off over weeks or months. After all, ask about different ways to counterpoint the control of the situation.’
