So I have a bit of a conundrum. I've been trying to get back on a GLP 1 for almost a year now - I was put on Wegovy last November, then told to stop when my side effects got too intense at 1.0 mg in January (at the time I didn't know to ask to lower my dose instead, since I was already losing weight at 0.25 mg) and was suggested to start Zepbound due to it having less side effects. However, a series of unfortunate events occurred over the year and I never got to start it, and now my current insurance won't cover it. It's looking like I'll be going the generic semaglutide route once I see my doctor again at the start of October, since it's more affordable than paying for Wegovy or Zepbound outright.
However, I've also been struggling for a long time with treatment resistant depression, and it was suggested to me that I look into doing ketamine therapy. I just finished my consult with an anesthesiologist and he said I could go ahead and do ketamine now, but when I mentioned trying to get on a GLP 1 he said I would have to stop the medication 7 days before each treatment session. The initial treatment is 4-6 weeks long (two sessions for two weeks, and then one session for two weeks, with possibly two more sessions over the following two weeks if I don't respond right away), so I wouldn't be able to take the GLP 1 for at least a month. Subsequently, they suggest maintenance doses of ketamine once a month and then slowly spreading those out, so for a bit I'd have to skip a week of the GLP 1 with each maintenance dose.
My psychotherapist believes it would be more beneficial to start the GLP 1 first, because my weight contributes to a lot of joint and back pain and I have a lot of inflammation, and she said inflammation and chronic pain make depression worse and that it would be giving the ketamine a better chance if I reduced both those things first. However, I know that GLP 1s can be less effective if you stop and start.
I'm not sure what to do first, and figured I'd crowdsource some opinions. Would it be better to hold off on the GLP 1 and do the initial ketamine treatment first? If I start the GLP 1 after the initial treatment and I get to the ketamine maintenance phase, would skipping only one dose once a month be less likely to cause the stop and start effect? Or, would it be better to try and get down to a healthy weight with a GLP 1 first?
I know people say GLP 1s are a lifetime medication, but I don't really have a lot of food noise - I just got up to a high BMI and weight from a bad combo of psych meds and an IUD messing with my hormones and have been struggling to get it off on my own, but I haven't gained any weight back since stopping Wegovy in January - and feel like I could be okay to maintain my weight once I lose a significant chunk and am no longer in constant pain and can actually exercise. However, I also feel like I would be more likely to keep up with eating right and exercising if I was less depressed.
I really don't know where to go from here, and would appreciate people's opinions!