---
type: source
title: "Q1 2026 in Review: GLP-1 RAs for Psychiatric Practice — Psychopharmacology Institute"
author: "Psychopharmacology Institute"
url: https://psychopharmacologyinstitute.com/publication/q1-2026-in-review-milsaperidone-glp-1-ras-and-zuranolone/
date: 2026-04-01
domain: health
secondary_domains: []
format: article
status: processed
processed_by: vida
processed_date: 2026-05-07
priority: high
tags: [glp-1, psychiatry, clinical-guidance, CME, schizophrenia, monitoring, suicidality]
intake_tier: research-task
extraction_model: "anthropic/claude-sonnet-4.5"
---

## Content

The Psychopharmacology Institute is a widely used CME (continuing medical education) platform for psychiatrists and mental health prescribers. This Q1 2026 review covers three major psychopharmacology developments: milsaperidone approval, GLP-1 RAs in psychiatric practice, and zuranolone.

**On GLP-1 RAs in Psychiatric Practice — Key Clinical Guidance:**

**1. FDA suicidality warning removal (January 2026):**
- FDA requested manufacturers remove suicidal ideation and behavior (SI/B) warning from GLP-1 RA labeling
- Warning was carried over from postmarketing reports of older weight-loss medications — NOT based on GLP-1-specific data
- FDA's comprehensive review found no increased risk of suicidal ideation, anxiety, depression, or psychosis
- Clinical implication: "Patients can be reassured the FDA found no increased risk of suicidal ideation and behavior after a comprehensive review"

**2. Psychiatric benefit evidence cited:**
- Lancet Psychiatry Swedish cohort: semaglutide → 42% lower risk of worsening mental illness (vs. same patients' non-use periods); liraglutide → 18% lower risk
- Data source: within-individual design (n=95,490 with pre-existing depression/anxiety)

**3. Schizophrenia-specific guidance (separate companion article):**
- Priority population: patients on clozapine or olanzapine who cannot easily switch treatment
- Metabolic screening: hemoglobin A1c cutoff 5.4% for early-stage metabolic risk targeting (preventative threshold, below the 5.7% prediabetes cutoff)
- Rationale: antipsychotic-induced weight gain and metabolic syndrome are common; GLP-1 addresses metabolic risk while patients remain on necessary antipsychotics

**4. Monitoring protocol:**
- Monthly check-ins using validated depression/suicidality tools
- Psychoeducation for patients and caregivers: mood lability, appetite changes, suicidal ideation

**Significance of source:** Psychopharmacology Institute represents de facto clinical guidance infrastructure for psychiatrists in the US. No formal APA clinical practice guideline on GLP-1 exists as of Q1 2026. This review is the primary channel through which psychiatrists are learning prescribing guidance. ~60 hours ABOM certification is the formal path; this CME is the informal path.

## Agent Notes
**Why this matters:** This is the closest thing to a formal psychiatric professional society position on GLP-1 as of May 2026 — not an APA guideline, but a widely used CME platform's structured clinical review. The Psychopharmacology Institute's guidance is what many US psychiatrists will use in practice. The 5.4% HbA1c screening threshold for schizophrenia patients is a specific, actionable claim.

**What surprised me:** The focus on schizophrenia/clozapine/olanzapine patients as the priority population is narrower than I expected. The guidance isn't "prescribe GLP-1 for psychiatric indications" — it's "manage metabolic side effects of antipsychotics using GLP-1." This is a much more conservative framing than Osmind's "GLP-1 is a psychiatric drug" argument.

**What I expected but didn't find:** Any guidance on GLP-1 for SUD (despite the JAMA Psychiatry AUD RCT evidence being available by Q1 2026). The Institute's guidance doesn't include addiction medicine applications — suggesting professional society guidance lags clinical evidence by ~1 year.

**KB connections:**
- [[value-based care transitions stall at the payment boundary]] — reimbursement for GLP-1 in psychiatric indications is not addressed in this guidance because CMS/payers have not yet created psychiatric GLP-1 reimbursement codes
- [[the mental health supply gap is widening not closing]] — this guidance serves the already-served: psychiatrists who use CME platforms; the competency gap in primary care prescribers goes unaddressed

**Extraction hints:**
1. Claim: "Psychiatry is addressing GLP-1 prescribing competency through CME infrastructure rather than formal APA guidelines, creating uneven competency distribution across the prescriber population" — Belief 3 instance
2. The 5.4% HbA1c threshold for schizophrenia/antipsychotic patients is a specific monitoring claim
3. The FDA suicidality warning removal is already captured in Session 37 sources — check for duplicates before extracting

## Curator Notes (structured handoff for extractor)
PRIMARY CONNECTION: [[value-based care transitions stall at the payment boundary because 60 percent of payments touch value metrics but only 14 percent bear full risk]]
WHY ARCHIVED: Represents the state of formal clinical guidance on GLP-1 in psychiatry as of Q1 2026 — de facto guidance through CME, not formal society guidelines. Documents the structural gap in competency infrastructure.
EXTRACTION HINT: The gap between "SUD evidence available in JAMA Psychiatry" and "SUD not mentioned in Psychopharmacology Institute Q1 guidance" is itself a claim about evidence-to-practice lag time — approximately 1 year based on this data point.
