Due to the high cost and significant side effects of these medications, many studies show that more than half of patients have stopped them by the 12th month
First principles: when stacking makes sense vs when its just noise Heres the simplest clinical lens I know: A stack can be reasonable when it meets all 4 criteria Different primary mechanisms (true complement, not redundancy) A clear problem statement (e.g., Im losing weight but also losing lean mass vs I want to feel optimized) Human evidence exists for at least one component and the combined physiology isnt contradictory You can monitor outcomes and safety objectively (labs, body composition, symptoms, performance, vitals) A stack is usually unjustified when it has any of these patterns Redundant signaling (two compounds tugging the same rope) Unmonitorable goals (recovery, vitality, anti-aging without measurable endpoints) Axis overstimulation (especially GH/IGF-1 signaling) Quality/sterility uncertainty (common with online research vials) No exit plan (no defined stop criteria or reassessment window) The 4 major peptide lanes youll see in stacking culture Most stacks are built from some combination of these buckets: Incretin/metabolic lane (GLP-1/GIP-based pharmacologytypically FDA-approved drugs rather than peptides in the wellness sense) GH/IGF-1 lane (GHRH analogs and ghrelin receptor agonists/secretagogues) Lipolytic fragments/modulators (often marketed for fat loss
Similarly, Trx2 has been shown to negatively regulate apoptosis across multiple studies (173,174)
Finding support Speak to your GP or epilepsy specialist if youre experiencing persistent low mood, anxiety, or difficulty coping Regular physical activity has evidence for improving both mood and quality of life in people with epilepsy 10 Cognitive behavioural therapy (CBT) has evidence for managing anxiety and depression in chronic health conditions Epilepsy support organisations like the Epilepsy Society and Epilepsy Action offer peer support and helplines If youre starting Wegovy, be aware that the early weeks of dose escalation can be physically uncomfortable, which may temporarily affect your mood If you think your AED is affecting your mood, discuss this with your neurologist rather than stopping the medication When to speak to your GP Contact your GP, prescriber, or epilepsy specialist if you experience any of the following after starting Wegovy: Any change in seizure frequency or severity New or worsening side effects from your anti-epileptic medication (dizziness, double vision, unsteadiness, skin rash) Persistent nausea or vomiting that could affect AED absorption Significant weight loss (more than 1 kg per week over several weeks), as this may require AED dose adjustment If you take lamotrigine, report any unusual symptoms promptly as blood levels may need checking Significant mood changes or worsening mental health symptoms Signs of dehydration from persistent vomiting or diarrhoea (dizziness, dark urine, extreme thirst) Frequently asked questions Is Wegovy safe for people with epilepsy
