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While there has been no clear association with certain psychiatric side effects, such as depression or suicidal ideation in research-based 31 or real-world 32 samples, the potential modulation of reward pathways by these drugs necessitates vigilant monitoring in patients with psychiatric histories, particularly in the setting of treatment with a medication that can substantially modulate the response of appetitive neurocircuitry to natural rewards such as food and water

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Physicians should establish baseline levels of IGF-1, fasting insulin, HbA1c, and a comprehensive metabolic panel prior to initiation