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While human evidence is still limited, the warning remains due to: persistent concern about thyroid proliferation lack of long-term human safety data increased calcitonin levels in some patients Related: Black Box Warnings Potential Long-Term Neurological Effects Because GLP-1 receptors exist in the brain, long-term use may influence: mood regulation cognition reward systems appetite pathways Emerging reports suggest possible risks: depression anxiety emotional blunting reduced hunger signaling long-term Research is ongoing

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Biased agonism: one receptor, different signals Where is the GLP-1 receptor actually found

American Journal of Respiratory and Critical Care Medicine Foer D, Strasser ZH, Cui J, Cahill KN, Boyce JA, Murphy SN et al (2023) Association of GLP-1 receptor agonists with chronic obstructive pulmonary disease exacerbations among patients with type 2 diabetes

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