Zepbound for Depression Patients: Evidence, Eligibility

Zepbound is not FDA approved for depression. It is approved for weight loss and sleep apnea. Some doctors prescribe it when one of those uses also applies. In SURMOUNT-1, people on Zepbound lost 20.9% of body weight on average, vs 3.1% on placebo.

Active ingredient: tirzepatide
How it is taken: weekly injection
Approved for: Weight loss and sleep apnea
Best result (SURMOUNT-1): 20.9% weight loss

Zepbound in brief

Time in the body

The half-life is 5 to 6 days. After 5.5 d, half is gone, and after 27.5 d, five half-lives have passed, leaving about 3%.

Weight loss in the main trial

In SURMOUNT-1 over 72 weeks, weight loss was 20.9% of body weight, compared with 3.1% on placebo.

Costs as time goes on

Monthly prices in US dollars include the list price and self-pay offers. Each comes from the maker's price page.

Sources: FDA label (DailyMed), Eli Lilly 1 2, cnbc.com.

Who qualifies?

Zepbound: who qualifies
Who sets the rule	Who qualifies
FDA label	Adults with obesity can use it to lose weight and to keep the weight off over the long term, with diet and activity. It also applies to adults who are overweight and have a weight-related condition.
FDA label	Moderate to severe obstructive sleep apnea is treated by it in adults with obesity.
Medicare GLP-1 Bridge	BMI 35 or higher, no condition needed
Medicare GLP-1 Bridge	You need a BMI of 30 or higher, plus heart failure, uncontrolled blood pressure or CKD 3a+
Medicare GLP-1 Bridge	Your BMI must be 27 or higher, and you must have Prediabetes, a heart attack or stroke in the past, or PAD
Typical commercial plan (Aetna policy)	BMI 30 or higher
Typical commercial plan (Aetna policy)	BMI 27 or higher with a weight-related condition
Typical commercial plan (Aetna policy)	a diet and activity program of 6 months is the first condition

Sources: FDA label (DailyMed), medicare.gov 1 2, aetna.com.

Trial findings on depression

Adults in the studies had obesity or were overweight without diabetes. Other adults had obesity but no type 2 diabetes.

Zepbound depression studies
Trial	Medicine	Who took part	Length	People	Main result	Comparison
SURMOUNT-1	Zepbound	Adults with obesity or overweight, without diabetes	72 weeks	2,539	20.9% weight loss	3.1% on placebo
SURMOUNT-5	Zepbound	Adults with obesity, without type 2 diabetes	72 weeks	751	20.2% weight loss	Not listed

Check SURMOUNT-1 (FDA label (DailyMed)) and SURMOUNT-5 (PubMed) for trial evidence.

What is different for depression?

Depression points from the Zepbound label
What changes	What the label says
Severe Gastrointestinal Adverse Reactions	Side effects in the stomach and gut often occur and may be severe in some cases. Not recommended for people with severe gastroparesis.

Based on the FDA labels: DailyMed FDA label.

These warnings come from the label: FDA DailyMed label.

Coverage for depression

Medicare Part D does not pay for a GLP-1 used only for weight loss.

The Medicare GLP-1 Bridge puts Zepbound at $50 each month for people who meet its rules.

Medicaid programs that cover weight-loss GLP-1s usually require prior authorization.

Sources: humana.com, CMS, KFF.

Alternatives for depression

GLP-1 medicines and depression
Medicine	For people with depression	How it is taken	Trial result
Zepbound	Not a listed use	weekly injection	20.9% weight loss
Ozempic	Not a listed use	weekly injection	Not listed
Wegovy	Not a listed use	weekly injection or daily tablet	14.9% weight loss
Rybelsus	Not a listed use	daily tablet	Not listed
Mounjaro	Not a listed use	weekly injection	Not listed
Foundayo	Not a listed use	daily tablet	11.1% weight loss
Trulicity	Not a listed use	weekly injection	Not listed
Saxenda	Not a listed use	daily injection	7.4% weight loss
Victoza	Not a listed use	daily injection	Not listed
Byetta	Not a listed use	twice-daily injection	Not listed