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GLP-1 and NMDA receptors are expressed throughout the mammalian brain and, although reports indicate that GLP-1 analogues engage central appetite circuits through distinct subpopulations of neurons (most notably in the brainstem and the hypothalamus) 36 , feedforward neural pathways modulated by inhibition of NMDA receptors specifically in GLP-1-receptor-positive neurons may differ from those engaged by exclusive activation of GLP-1 receptors

Medical history : Disclose any history of: Pancreatitis or gallbladder disease Thyroid disorders Kidney or liver impairment Eating disorders (particularly relevant given fluoxetine's use in bulimia nervosa) Bipolar disorder (SSRIs can trigger manic episodes in susceptible individuals) Bleeding disorders (fluoxetine can affect platelet function) Cardiovascular disease (relevant due to potential heart rate increases with Saxenda) Treatment goals and expectations : Discuss realistic weight loss targets with Saxenda

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