Why coming off Ozempic can leave you feeling hungrier than you did before, doctors reveal

When the US comedian and influencer Claudia Oshry, now 30, came off the weight-loss drug Ozempic after a year, she experienced something she certainly wasn’t expecting — extreme hunger. Explaining this on TikTok, she said she was hungry all the time and struggling to feel full.

“I’m always looking for snacks and things to fill me up,’ she said in a viral video earlier this year, after losing an impressive 70lb. “I cannot stay full, it’s impossible. I just had a 12oz steak and I’m starving, so I’m eating popcorn.”

After posting the video, which has since been viewed more than 1.5 million times, many of her followers shared similar struggles of extreme hunger. While it takes about five weeks for Ozempic to completely leave your system, in some cases, these problems appeared three weeks after patients stopped taking it.

“It’s wild how much brain space food takes up. I can eat so much protein and will still be starving,” said one; “I’ve been saying this for a while. My dad takes Ozempic and had to go off for a little bit and I’ve never seen him eat more than he did then. Bottomless pit,” said another; “I just stopped three weeks ago and the hunger is definitely back,” commented another follower.

Since then, similar anecdotal experiences have been reported by Jamy Ard, a clinical scientist at Wake Forest University School of Medicine in Winston-Salem, North Carolina, who oversees the weight management programme there.

His patients are on GLP-1 agonists, a group of drugs that includes Ozempic. Developed originally as a treatment for type 2 diabetes to manage blood sugar levels, their ability to reduce appetite and slow down digestion has led to them also being used as weight-loss drugs.

In the journal Nature, Jamy Ard says that some of his patients quitting GLP-1 agonists report feeling more hungry than they did before they started the treatment.

While this perceived ‘after effect’ of the drug may have come as something of a surprise to these patients, to Laura Wilson, director of The Royal Pharmaceutical Society in Scotland, it’s hardly unexpected. She says: “This phenomenon, known as a rebound effect or rebound symptom, is when symptoms that have been alleviated while on a medication return when you stop taking it.

“Very broadly speaking, this is generally the result of one of three things: withdrawal effects from the medicine itself which has caused physical or psychological dependence; returning symptoms which have nothing to do with the medicine; or worsening symptoms.

“The latter again is nothing to do with the medicine but simply as a result of the body either getting used to working with the drug then having to adapt to being without it, or the underlying condition worsening or progressing while taking the medication to manage it.”

The first of these — withdrawal effects from a medicine as a result of drug dependency — is probably the most well-publicised and concerning, with 7.1 million patients prescribed dependency-forming medicines in England in 2022/23, according to NHS figures. Common culprits here include painkilling opioids, sleeping pills and antidepressants.

But in the case of weight-loss drugs such as Ozempic, it is to do with returning symptoms.

“While constant hunger is not a symptom in the conventional sense, a desire to curb it is one of the factors for people turning to these treatments in the first place,” says Laura Wilson.

To understand why hunger comes back with these drugs, you have to look at why we feel it in the first place, explains Dr Ralph Abraham, a consultant in endocrinology and diabetes at the London Diabetes Centre.

“Hunger is a complex physiological response and there are many hormones in the gut and the brain that interact to help maintain body weight.

“Gut hormones and the drugs that are now used in obesity have powerful and complex direct actions on amino acids known as peptides. These are connected with appetite in the hypothalamus, the area of the brain which produces hormones that control things like hunger and mood.”

He adds: ‘GLP-1 agonists such as Ozempic work by recreating the effects of GLP-1, a hormone naturally produced in the gut after eating, which sends signals to block these brain hunger receptors. This, in turn, reduces hunger and cravings.

“This means that while you take the medication all those desires are put on hold.

“The drugs also make you feel fuller more quickly and slow down digestion in the stomach. But like any medication — when you stop taking it, this stops too,” says Dr Abraham.

He adds: “With regards to people saying they feel hungrier than they did before, it’s difficult to measure people’s perception of hunger.

“However, it isn’t surprising that if your hunger is suppressed by medication and you stop taking it — then you’d certainly be struck by the contrast and therefore more likely to notice and remark on it.”

Because of this, Dr Anita Raja, a Birmingham-based GP, who also runs a weight-loss clinic, says you have to change other behaviours during that time to give yourself a fighting chance of keeping weight off when you stop taking the medication.

“These drugs aren’t miracle cures,” she says.

“If you don’t recognise that you were overeating, or fail to address why that was happening in the first place — your relationship with food, your behaviours towards it or your overall lifestyle, for instance — then when you come off the medication you’ll revert back to where you were in the first place, namely feeling overly hungry and putting that weight back on.”

But in Dr Abraham’s experience that’s not always easy or possible. “That’s why some of my patients are going to be on GLP-1 agonists drugs long term. I’m talking up to ten years here,” he adds.

When it comes to rebound effects as a result of medicine dependency, antidepressants, which more than eight million people in the UK are on, can cause rebound “depression” — or rather, symptoms that seem to be the depression returning but are actually withdrawal symptoms from the drug.

A recent review in The Lancet Psychiatry noted one out of every six people in the UK who take the drugs experienced withdrawal symptoms.

Dr Mark Horowitz, a training psychiatrist and clinical research fellow in psychiatry at North East London NHS Foundation Trust, says: “Antidepressants affect not just your brain, but your entire nervous system and even your hormonal system — and the body can adapt and become physically dependent on these in as little as a few weeks of taking the drug.

“Because of this, when you come off them, you can experience both psychological withdrawal symptoms: low mood, anxiety, panic attacks, crying and suicidality — plus physical symptoms such as dizziness, headaches and brain zaps, essentially the feeling of an electric shock in your head.

“Unfortunately, some doctors mistake these withdrawal effects as simply the depression returning and, hence, re-enforcing the need for medication. But in many cases it’s nothing to do with that at all, it’s all about the body’s dependency on the drug.

“That’s why it’s vital to taper off the medication, reducing it by a small percentage every few weeks. Quitting antidepressants can take months or even years.”

A similar rebound effect can be seen with anti-anxiety pills such as bromazepam, part of a class of medicines called benzodiazepines.

Also widely prescribed — 6.4 million items (a single unit of medication listed separately on a prescription form) were prescribed between December 2022 and November 2023, according to the NHS — studies have shown that 50 per cent of those using benzodiazepines for just four weeks suffer withdrawal symptoms such as anxiety, dizziness, nightmares and weakness.

And anywhere between 58 and 100 per cent of patients experience a withdrawal reactions after taking them for more than one year.

Once again, Dr Horowitz stresses the importance of tapering off and not stopping the drugs abruptly or too quickly.

Headache medication can also cause rebound symptoms — these rebound headaches or medication-overuse headaches occur in those who stop taking medication for chronic headaches or migraines.

“This can be caused by painkilling opioids such as codeine, tramadol and oxycodone which may be prescribed to treat migraines along with other moderate to severe pain,” says Dr Raja.

“They work by attaching to opioid receptors in the brain to block pain messages, and overuse — taking more than the recommended daily dose for more than a few times a week — can lead to the body having a withdrawal reaction as the pain reliever wears off. This means it’s not the original headaches, it’s a drug-withdrawal induced one. It’s a vicious circle.”

She adds: “Rebound headaches can also be caused by an overuse of NSAIDs such as aspirin or ibuprofen.

“Gabapentinoids, a group of anticonvulsant drugs that include gabapentin and pregabalin, can cause this too.”

These drugs are used to treat epilepsy and conditions that cause nerve pain such as diabetes and shingles — “they change the way nerves send messages to your brain”, says Dr Raja.

Rebound insomnia can occur from coming off sleeping tablets such as Z-drugs (e.g. zolpidem and zopiclone), explains Dr Dipesh Mistry, a psychiatrist and sleep expert based at the private Ankha clinic in London.

You don’t need to be taking some medication for long to suffer from rebound symptoms when you come off them.

Decongestant nasal sprays containing oxymetazoline or phenylephrine can cause rebound congestion if used for more than a few days, explains Laura Wilson.

“These sprays work by basically shrinking inflamed blood vessels to relieve congestion and swelling. But take these for more than three days and the blood vessels in your nose become sensitised and basically swell back up as the medication wears off,” she says, “and then you use more spray”.

The last category, namely the worsening of symptoms after stopping medication is, perhaps, less well-known than the other two types of rebound.

Rebound diabetes — when patients experience an increase in blood sugar levels after coming off their medication — can fall into this camp.

“Type 2 diabetes medications such as GLP-1 agonists work mainly by making the pancreas produce more insulin, the hormone our body makes to keep blood glucose levels within the normal range,” explains Dimitris Papamargaritis, an associate professor in diabetes and endocrinology at Leicester Diabetes Centre.

“They also reduce levels of the hormone glucagon, which helps improve blood glucose levels. Additionally, as we know, they suppress the appetite, helping you lose weight.”

“If you have type 2 diabetes and stop taking them, they stop having that direct effect on the pancreas which is independent to weight loss. As a result, even if you manage to keep the weight off and maintain healthy eating habits, your blood glucose levels will likely rise.”

Similarly, patients can experience rebound hypertension —high blood pressure — when coming off or lowering the dose of certain antihypertensive drugs such as betablockers, says Laura Wilson. It can occur days — even hours — after stopping.

“While these drugs aren’t addictive, the body can get used to working with the medicine when taken regularly, so stopping suddenly can cause a rise in blood pressure.”

So is there anything you can do to prevent these rebound effects?

“Always take your medicine for the prescribed length of time — no longer,” says Dr Raja.

“Ensure you don’t stop any medication you’ve taken for a while for a chronic condition without seeking medical advice — often you’ll be put on a clear plan to taper off over weeks or months. Finally, ask about alternative ways to complement the management of the condition.”