Patient Perspectives: Experiences of Using Ozempic for ADHD Management

By Dr. Jerry D. Smith Jr.

I have spent decades as a clinical and forensic psychologist specializing in ADHD assessment and treatment. Through my work in private practice and government settings, I have encountered a kaleidoscope of patient experiences, sometimes unexpected in their source and outcome. One of the more recent off-label approaches patients have explored involves Ozempic — an agent classically approved for type 2 diabetes and, more recently, obesity management. In today’s article, I share both my direct observations and aggregated patient perspectives regarding the off-label use of Ozempic in the context of ADHD management.

Disclaimer:
 Ozempic (semaglutide) is not approved by the U.S. Food and Drug Administration (FDA) for ADHD management. The experiences and anecdotes described below represent patient-reported outcomes rather than evidence from controlled clinical trials. Clinicians and patients are urged to follow current treatment guidelines and the advice of licensed professionals.

The Rationale Behind an Unconventional Approach

At the outset, you may wonder why a medication primarily known for glycemic control and weight loss would even be considered in the realm of attention-deficit/hyperactivity disorder. The answer is multifaceted. For many individuals with ADHD, coexisting challenges — such as obesity and metabolic dysregulation — can exacerbate executive functioning difficulties. In my clinical work, I have observed that for some, addressing metabolic concerns indirectly yields benefits in everyday functioning. In both private sessions and high-volume government clinics, patients sometimes voluntarily experiment with treatments outside conventional guidelines, driven by anecdotes shared in self-help forums or from other patients’ experiences.

I have observed firsthand that the appeal of using Ozempic in an off-label manner is typically twofold:

  • Weight Management and Improved Self-Esteem: For several patients, rapid weight loss translated into enhanced self-esteem and decreased anxiety — two factors that may indirectly translate into improved concentration and reduced impulsivity.
  • Unexpected Cognitive and Mood Changes: A subset of patients shared that as their appetite regulated and their metabolic profile improved, they experienced a “clearing of the fog” that often accompanies ADHD, leading to a subjective experience of better focus.

Clinical colleagues and I remain cautious, though. While these effects are intriguing, they are anecdotal. In times past, cross-specialty collaborations have yielded surprising insights, but rigorous research is necessary before any clinical recommendations can be made.

A Personal Journey in Two Worlds

First-Person Reflections from Private Practice

In my private practice, I once treated a young man — “James” for confidentiality — who struggled with the dual diagnosis of ADHD and obesity. Having undergone multiple stimulant trials without significant improvement in energy levels or concentration, James began researching alternative approaches. After reading reports about Ozempic’s weight loss benefits, he discussed the possibility of off-label use with his primary care physician. Although I was initially skeptical, I decided to incorporate regular psychological evaluations during his trial period to monitor any changes in his ADHD symptoms.

Over several months, James experienced steady weight loss, improved self-image, and — anecdotally — a reduction in daytime sluggishness. He reported that his mind felt “less cluttered,” although he acknowledged that the cognitive shifts were subtle. I noted these changes alongside improvements in his mood and self-confidence, factors known to influence ADHD management indirectly. Yet, I always underscored that the medication was not a direct treatment for ADHD. The improvement in executive function might be equally linked to enhanced overall health rather than a neuropharmacological action on ADHD-specific pathways.

Third-Person Perspectives from Government Settings

In government-operated settings — where patients often present with complex, multifactorial challenges — the narrative unfolds slightly differently. Consider the case of “Marina,” a middle-aged woman with longstanding ADHD and comorbid obesity. Her forensic evaluations for competency and adaptive functioning had, over time, revealed that psychosocial stressors exacerbated her ADHD symptoms. While her comprehensive treatment regimen featured behavioral modifications, she was later seen in a pilot metabolic health program where Ozempic was introduced off-label as part of a weight management initiative.

In Marina’s case, clinicians observed improvements in her metabolic profile and a degree of stabilization in her mood fluctuations. Her legal records reflected fewer instances of impulsive decision-making in stressful situations. While the treatment team (comprising endocrinologists, psychiatrists, and psychologists) maintained a healthy skepticism about attributing these improvements solely to Ozempic, they acknowledged that the metabolic changes may have played a role in enhancing her overall cognitive resilience.

The Science (and Its Gaps)

What We Know About Ozempic

Ozempic is primarily known as a glucagon-like peptide-1 (GLP-1) receptor agonist. It has already made its mark as an effective agent for improving glycemic control in type 2 diabetes. More recently, clinical trials have validated its efficacy in inducing weight loss among adults with obesity (Wilding et al., 2021). The pharmacological mechanisms — delayed gastric emptying, increased satiety, and central effects on hypothalamic circuits — are well understood in these contexts.

  • Wilding, J. P. H., et al. (2021). In their groundbreaking randomized controlled trial published in The New England Journal of Medicine, Wilding and colleagues demonstrated that once-weekly semaglutide produced significant weight loss in adults with overweight or obesity. This study — which remains a beacon in obesity research — underscores the robust metabolic effects of the medication.
  • Davies, M. J., et al. (2017). A comprehensive review in Diabetes, Obesity and Metabolism analyzed the efficacy and safety of semaglutide, bolstering its credibility as a transformative agent in metabolic medicine.

While these studies reinforce the benefits of Ozempic in metabolic domains, none were designed to evaluate its impact on ADHD symptomatology. This gap in knowledge leaves open many pressing questions regarding the underlying mechanisms, if any, that might connect metabolic regulation with attention and executive function.

What We Do Not Yet Know

The allure of applying Ozempic in the context of ADHD arises, in part, from the increasingly recognized link between metabolic health and cognitive function. For instance, obesity and inflammation have been hypothesized as contributing factors to neurocognitive decline across various conditions, and ADHD is no exception. However, substantial clinical research that specifically addresses the impact of GLP-1 receptor agonists on ADHD symptoms is nonexistent. Until rigorous trials are conducted, any conclusions remain speculative.

It is worth noting that ADHD, as outlined by the American Psychiatric Association (2013) in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), is fundamentally a neurodevelopmental disorder with a complex interaction of genetic, environmental, and neurobiological factors. The management of ADHD typically revolves around stimulant and nonstimulant pharmacotherapies that directly target neurotransmitter systems. The hypothesized benefits of metabolic improvement, although plausible, cannot replace evidence-based ADHD interventions without further validation.

Anecdotal Insights and the Necessity of Caution

A Balancing Act

In my dual roles — both as a caregiver and an evaluator in forensic settings — I have learned that narratives are as important as numbers. Patients tell me stories of transformation that are rich in detail. For example, one patient described the experience as akin to “pressing a reset button” on her life. Initially, she had chronic difficulties with impulsivity that affected her interpersonal and professional relationships. Once she began her course of Ozempic as part of a broader metabolic intervention, she remarked that the weight loss offered her a fresh vantage point from which to approach daily challenges. In her words, “It’s like the burden I felt on my body was finally lifting, and with it, some of the mental fog.”

However, I have also witnessed cautionary tales. A forensic case involved a young man who, confronting severe side effects such as gastrointestinal discomfort and occasional mood lability, became increasingly disillusioned with a self-directed approach to managing his ADHD symptoms. His story serves as a reminder that until we have controlled data and long-term follow-up, off-label use must be approached with great care, robust monitoring, and clear conversations about risks versus benefits.

Navigating Ethical and Forensic Complexities

From a forensic standpoint, the introduction of any off-label treatment introduces additional layers of complexity. In government-assisted treatment settings, where decisions may carry legal implications, it is critical that clinicians document the process fully, both for patient welfare and for possible future scrutiny. I have often had to explain during forensic evaluations that while a patient’s improved functioning after an off-label intervention might appear favorable, it does not necessarily indicate that the treatment itself is addressing the neurobiological substrates of ADHD.

In several cases, my colleagues and I have encountered judicial questions related to an individual’s competence or risk assessments that tangentially referenced the effects of nontraditional treatments. At these junctures, detailed records and multidisciplinary consultation become indispensable. Our experiences underscore that anecdotal improvements on therapies like Ozempic do not supplant the need for established treatments — medications with proven efficacy for ADHD (e.g., stimulants and approved nonstimulants) remain the mainstay of management.

Integrating the Novel with the Established

Bridging Metabolic Health and ADHD

One hypothesis is that improvements in metabolic health might have a real — but indirect — effect on ADHD symptoms. Obesity is known to be associated with chronic low-grade inflammation, which in turn has been linked with cognitive impairments. By facilitating weight loss and modulating inflammatory processes, Ozempic might contribute to a more favorable milieu for cognitive processes. What we are witnessing in these early, anecdotal accounts could very well be a stepping stone toward understanding the physiological intersections between metabolism and brain function.

However, it is crucial to stress that the mechanisms involved remain hypothetical at best. In large-scale clinical studies, the primary endpoints for semaglutide revolve around weight loss, cardiovascular risk, and glycemic control — not attention regulation. In this context, any cognitive or behavioral benefits remain secondary and unproven. Rigorous clinical trials are urgently needed to evaluate such off-target effects, and until those results are in, clinicians must rely on evidence-based ADHD treatments.

My Role as a Clinician and Advocate

Throughout my career, I have championed the importance of individualized care. When patients come to me armed with innovative ideas — even those as unconventional as using a diabetes drug to address ADHD symptoms — I listen empathetically. I have witnessed firsthand the transformative power of treatments that address the whole person, not just isolated symptoms. In many cases, what my patients have experienced with Ozempic has been an adjunct to broader lifestyle modifications, cognitive-behavioral therapy, and, when applicable, standard pharmacotherapy for ADHD.

I recall one particular session in a private practice setting when a patient, after much trial and error, almost whispered in relief, “For the first time, my thoughts aren’t racing in circles.” Such moments are precious and underscore both the resilience of the human mind and the sometimes serendipitous benefits of targeting physical health to improve mental well-being.

At the same time, in my role serving in government settings where forensic evaluations are routine, I must emphasize accuracy, adherence to clinical guidelines, and awareness of the legal implications of off-label prescriptions. Here, multidisciplinary discussions, continuous patient monitoring, and clear documentation are not just best practices — they are requirements.

Looking Ahead: A Call for Research and Collaboration

The experiences shared herein reflect a nascent area of inquiry. As a clinician, I am driven by both professional curiosity and a desire to see my patients thrive. I advocate for a more systematic exploration of the intersection between metabolic health and neurocognitive functioning in ADHD. Collaborative studies bringing together endocrinologists, neuroscientists, and psychologists could illuminate whether interventions focused on weight loss and metabolic regulation might have a broader role in managing ADHD symptoms.

Until such studies are undertaken — and until their findings can be replicated in randomized controlled trials — clinicians must remain guided by ethics and caution. In my view, the reported benefits must be balanced against known risks, with full transparency to patients regarding the off-label nature of the approach.

Practical Takeaways for Patients and Providers

Drawing on my years of practice, here are several points for both patients and clinicians considering off-label interventions like Ozempic for ADHD-associated challenges:

  1. Holistic Health Is Key:
     Addressing metabolic dysfunction and ADHD symptoms simultaneously can yield overall improved quality of life. This does not mean one should substitute evidence-based ADHD treatments for a metabolic intervention but rather consider them as potential complementary approaches.
  2. Informed Consent Is Non-Negotiable:
     When considering off-label use, patients must be fully informed about the deviations from standard guidelines, the unknowns, and the potential risks. Documentation and close monitoring are essential.
  3. A Multi-Disciplinary Approach Matters:
     Integrating care between endocrinologists, psychiatrists, psychologists, and primary care physicians enhances both patient safety and the potential for identifying unexpected benefits or adverse effects.
  4. Personal Narratives Provide Valuable Clues:
     Patient anecdotes should inspire further research rather than serve as definitive clinical evidence. As clinicians, we must remain open-minded yet scientifically rigorous.
  5. Prioritize Well-Established Treatments:
     While the metabolic benefits seen with Ozempic are promising, the frontline treatments for ADHD — be they stimulants or nonstimulants — remain the mainstay of therapy until more evidence is available.

Conclusion

The off-label exploration of Ozempic for ADHD management is a telling example of how patients — especially those who have weathered the disappointment of suboptimal responses to conventional treatments — will seek out novel ways to reclaim control over their lives. In recounting these patient perspectives from both private and government settings, I have strived to convey a balanced message: while early anecdotal reports can be intriguing, they do not constitute an endorsement of a treatment practice that lacks robust evidence.

As we move forward, I hope that collaborative, multidisciplinary research will shed light on the interface between metabolic health and cognitive function. Until then, clinicians must advocate for treatments grounded in rigorous evidence while remaining empathetic to the lived realities of their patients.

In my dual roles as a hands-on clinician and an evaluator within forensic contexts, I remain committed to ensuring that every intervention, off-label or not, is pursued with caution, scientific rigor, and an unwavering commitment to patient well-being.

References

  • American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). American Psychiatric Publishing.
  • Davies, M. J., et al. (2017). Semaglutide: a review of its efficacy and safety for type 2 diabetes. Diabetes, Obesity and Metabolism, 19(7), 887–894.
  • Food and Drug Administration. (2019). Ozempic (semaglutide) prescribing information. Retrieved from https://www.fda.gov
  • Wilding, J. P. H., Batterham, R. L., Calanna, S., Davies, M., van Gaal, L. F., Lingvay, I., … & Group, S. (2021). Once-Weekly Semaglutide in Adults with Overweight or Obesity. The New England Journal of Medicine, 384(11), 989–1002.

Dr. Jerry D. Smith Jr. is a clinical and forensic psychologist with decades of experience in ADHD assessment and treatment in both private and government settings. His work emphasizes a holistic, multi-disciplinary approach to addressing complex patient challenges.

Note to readers:
Always consult with healthcare professionals before considering any off-label treatments. This article is intended for informational purposes and reflects personal experience and aggregated patient perspectives rather than definitive clinical guidelines. Enjoy exploring this evolving landscape as we all work toward better, evidence-based strategies to improve mental and physical health.