Category: Self Care

When Food Is No Longer Your Friend: The Emotional Side of GLP-1 Medications

By Madeline Goodman, D.O., Diplomate, American Board of Psychiatry and Neurology

GLP-1 medications have been a game changer for many—especially individuals with conditions like cardiac disease, where weight loss is not just helpful but medically urgent. Patients taking certain psychotropic medications who have experienced significant weight gain have also benefited from these medications, offering a much-needed option for weight management that doesn’t require stopping effective psychiatric treatment. The ability to reduce appetite and promote steady weight loss can significantly improve cardiovascular outcomes and reduce long-term health risks. This makes these medications a potentially life-saving option for some patients, and their medical impact should not be underestimated.

GLP-1 receptor agonists like semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound) have been truly transformative for many people—helping with weight loss, blood sugar control, and overall metabolic health.

As a psychiatrist, I’m not against these medications—in fact, I’m very much in favor of them for the right patients. But they’re not for everyone, and like any powerful tool, they come with layers that extend beyond the physical.

This post explores some of the mental health implications I’ve seen in patients using GLP-1s—not to deter, but to add depth to the conversation. Because while appetite may go away, the emotional reasons we eat often don’t—and those deserve just as much attention.

1. When Food Was a Friend—and Suddenly Isn’t

Many of us develop a long-standing emotional relationship with food. It’s comfort, company, celebration, or stress relief. So when GLP-1 medications reduce appetite so drastically that meals feel like a chore, it can stir up feelings of loss, disorientation, or even grief.

I’ve had patients describe it as “losing their best friend,” or “feeling like they don’t know themselves anymore.” This is a valid emotional response—and one that deserves support, not shame.

For some, the grief can be profound. If a tough day used to end with a comforting meal or favorite snack, and that ritual suddenly disappears, it can feel as though a reliable coping mechanism is gone. That loss can feel overwhelming at times—not unmanageable, but difficult at best. Acknowledging this grief is the first step toward replacing it with healthier, more sustainable sources of comfort.

2. Nutrition Still Matters—Even If You’re Not Hungry

One of the most common issues I’ve seen is inadequate nutrition, especially protein. When appetite drops, it’s easy to eat very little—but without enough protein and hydration, people can feel weak, irritable, or even depressed.

In fact, when nutrition suffers, depression can re-emerge, often presenting with psychomotor slowing, low energy, and even brain fogginess. These symptoms may not always be immediately linked to food intake, but they are critical to address.

These medications are tools—not magic—and the body still needs fuel to function well. I often encourage patients to work with a registered dietitian or nutritionist, even if weight loss isn’t their only goal.

3. Emotional Eating Doesn’t Magically Go Away

Even when hunger signals disappear, emotional eating patterns remain. You might not feel hungry, but you may still feel lonely, bored, or anxious. That drive to soothe through food can come back suddenly, especially if the medication is paused or stopped.

This is why therapy, self-awareness, and building alternative coping strategies are still crucial. GLP-1s can remove the cue (hunger), but they don’t erase the conditioning or emotional patterns. The groundwork still needs to be done.

4. It’s a Personal Choice—Not a Shortcut

I never tell someone whether GLP-1s are “right” or “wrong” for them. It’s a deeply personal decision—influenced by medical needs, emotional history, lifestyle, and goals.

What I do encourage is informed use: knowing what you’re signing up for, not just physically but emotionally. Support from your medical provider, therapist, or support group can make the difference between feeling isolated versus empowered.

Closing Thoughts:

GLP-1 medications can be incredibly helpful, and I’ve seen many patients benefit greatly. But for long-term success—emotionally and physically—it’s important to do the inner work, too. Understanding why we overeat, how we soothe ourselves, and what role food plays in our lives is essential, whether or not we’re on medication.

You deserve more than weight loss—you deserve peace with your body, your mind, and your relationship with food.

About Dr. Goodman: Dr. Madeline Goodman, is a board-certified psychiatrist offering compassionate, personalized Telepsychiatry to adults across Maine. She specializes in treating anxiety, depression, trauma, and emotional eating. Learn more at www.drmadelinegoodman.com

Therapy isn’t just for bad weather

Therapy Isn’t Just for Bad Weather

When spring arrives and the long Maine winters give way to sunshine and warmth, it’s tempting to step back from routines that feel “heavy” — like therapy. Life feels lighter, moods lift, and we find ourselves outdoors more. It’s understandable. But therapy isn’t just for stormy seasons.

In fact, some of the most meaningful work in therapy happens when we’re not in crisis.

Why Summer Can Be an Ideal Time for Growth

When we’re not in survival mode, we can reflect more deeply. We can ask:

Who am I becoming?
What habits do I want to reinforce?
How do I build on the progress I’ve made?

Without the emotional urgency that comes with winter blues or life stressors, summer gives us space to explore.

Skipping Sessions Can Disrupt Momentum

Taking a break may feel harmless, but therapy often builds on itself. Each session adds to the last, and gaps in treatment can slow or even reverse progress. If you’ve worked hard to get where you are, summer might be the time to solidify that progress — not pause it.

Therapy Isn’t Seasonal — It’s Foundational

Think of therapy like tending a garden. You don’t just water it when it’s wilting — you care for it consistently to see it bloom. Our mental health is similar. Sunny days don’t always mean we’re done healing. Sometimes they offer the best light to see things clearly.

Final Thought

Enjoy the sunshine, take the beach days — but don’t lose sight of the steady work you’ve been doing in therapy. Emotional health isn’t a seasonal project. It’s a lifelong investment in yourself.

What Am I Really Hungry for?

A midlife reflection on food, freedom, and letting go

A Dream About Coffee

Last night, I had a dream that I was drinking a sweet, creamy coffee — more like a dessert than a drink. It came in a plastic cup with a straw, and I knew it was full of caffeine. I also knew it was late, and it would likely keep me up. But I drank it anyway. And in the dream, just as in real life sometimes, I found myself lying awake — overstimulated, restless, and regretting the choice I’d made for comfort. The dream stayed with me.

When Food Isn’t About Hunger

That dream mirrored something I’ve been grappling with for a while: my relationship with food. I eat when I’m not hungry. I know I do it. I love food, but the kind of eating I’m doing isn’t always about nourishment — it’s about soothing. It’s about giving myself something sweet in the midst of a life that often demands too much. I know this pattern is keeping me from feeling the way I want to feel — lighter, freer, more in sync with my body. And yet, I reach for food the way someone might reach for a comforting blanket, or a distraction from the weight of care.

Caretaking Has Been My Rhythm

So much of my life has been shaped by responsibility. I’m a psychiatrist — I spend my days tending to others’ minds and emotions. I’m also a mother. And for the last 12 years, I’ve raised chickens. These creatures, small and unassuming, became part of my daily rhythm. Feed, water, collect, protect. But chickens — like children, like aging parents, like patients — need you. They need you consistently, daily, without fail. And lately, I’ve been asking myself: Do I want to start that cycle over again? I’m down to a smaller flock now. My son, now in college but still living at home, helps. But he may leave in a few years. And when he does, I’ll be alone again in the daily task of tending to these small lives. Just like I was when he was younger and too little to help.

Motherhood in All Its Forms

Recently, I saw my neighbor with her new baby. She looked tired. She had longed for this child, but I could see in her face what I’ve seen in my own life: the moment when the fantasy of caretaking meets the reality. She said to me, “I just want to eat a meal without nursing.” I told her that yes, it would get better — but even older children still want you all the time. And I realized: I don’t want to be wanted that much anymore. Not by chickens. Not by my mother, who still adds to her list after I’ve agreed to one or two errands. Not by anyone.

What Freedom Looks Like Now

I want to travel without stress. I want to eat when I’m hungry — not when I feel I should. I want to make choices that don’t stimulate me past the point of rest. I want sweetness, yes — but I want it on my terms. And that includes stepping away from things I used to love, or things I thought I had to keep doing because they made me who I was.

I Am Enough Without Being Needed

This is what midlife is teaching me: that I don’t have to be constantly useful to be worthy. That I can stop. That I can say no. That I can rest. My job is about caring for others — but my life doesn’t always have to be. I’m learning to feed myself with compassion, not just food. I’m learning to ask, “What am I really hungry for?” The answer is becoming clearer: Stillness. Space. Sovereignty. Peace.

To Others Standing at the Same Threshold

If you’re there too — standing at the edge of old patterns, wondering whether to keep mothering something that drains you — know this: it’s okay to want a different life now. It’s okay to step back. It’s okay to feed yourself first. We can honor what we’ve built, and still choose freedom.

Why Personalized Psychiatry Still Matters in a Telehealth World

🧠 Why Personalized Psychiatry Still Matters in a Telehealth World

Telehealth has transformed the way people access mental health care. With a few clicks, it’s now possible to schedule an appointment, consult with a provider, and even receive prescriptions — all without leaving home.

But not all telehealth is the same. And while large platforms have helped expand access, many people are finding that what they truly need is personalized, consistent, and thoughtful care — the kind that can sometimes be hard to find in fast-paced, high-volume systems.

🏥 When Convenience Comes at a Cost

Many online platforms offer quick access to care, including features like brief check-ins, medication consults, or even therapy through text. While this convenience works well for some, others find that something gets lost in translation — especially when sessions feel rushed or when they rarely see the same provider twice.

I’ve worked with many people who started with these services and later realized they were craving more depth, more consistency, and a stronger therapeutic relationship.

“It felt like no one really knew me,” is something I often hear.

For a deeper look at best practices in telepsychiatry, you can visit the American Psychiatric Association’s Telepsychiatry Toolkit.

🤝 The Power of Personalized Psychiatry

In my practice, whether we meet in person or through telehealth, you are not just a time slot or a diagnosis. You’re a full human being — and your care should reflect that.

Because I work independently, I’m not part of a larger corporate structure. That means your care is guided by your needs — not quotas or time limits.

What to expect:

Consistent care with the same provider
Integrated therapy and medication insight
Sessions that allow time to reflect and explore
A relationship built on trust, not turnover

🌿 Telehealth With a Human Touch

Yes, I offer telehealth. But it’s grounded in relationship, respect, and care. Whether you’re navigating anxiety, life transitions, depression, or trauma — you deserve a space where you feel truly seen and heard, not just evaluated.

💬 If You’ve Tried Other Options and Still Feel Unseen…

You’re not alone — and there are alternatives.

If you’re looking for a more personal and consistent experience with a psychiatrist who takes the time to understand your whole story, I’d be honored to talk with you.

Post Election Anxiety

I have been treating a lot of patient anxiety in my practice since the outcome of the November election. We live in a “blue state.” My patient’s wonder how one administration could have won the electoral college when the popular vote was so close? They felt so sure everything would be “OK.” What happened? It is no surprise that my patients who reside here, with a governor who has vowed to protect them, worry about what a new administration will do. They worry about reproductive rights. They worry about their education or their children’s education and how they will pay for it if and when the Department of Education is eliminated? I wish I could say nothing was going to change, but I can’t. I do not believe things will be as grim as they think, but it is understandable why they feel afraid.

Don’t Panic

As much as I believe the cabinet picks very much resemble a new season of the Apprentice, I know the plans of the new administration are designed to make people very afraid. I have to support my patients and work through the anxiety. The anxiety feels real but likely not based in reality. Something has been triggered deep inside them. Their insecurities are back.

Get involved

I tell my patients who feel anxious to avoid being passive and get involved. Midterms are two short years away. Theres a lot to do and look forward to. I encourage my patients to move from feeling helpless to empowered. Getting involved even at a local level politically can feel like we are doing something. Joining a group that supports them and their political views can feel comforting. Join in locally by sitting on a town or city committee.

Stay away from the News

The news is nothing more than click bait. They want us to be afraid so they broadcast the most sensational headlines. I limit myself to the first 20 minutes of a particular news show. I find the host well informed and not attempting to fuel anxiety. It’s also OK to unplug from social media entirely. Don’t argue with people who don’t share your belief system. It will go absolutely nowhere. Also, if some friends only want to talk politics, limit your time around them.

This too shall pass

We will survive this and as we all know history will repeat itself and balance will be restored.

Newsletter and Soup’s on

I will periodically be publishing a newsletter. My hope is to provide some interesting topics in Psychiatry and Psychotherapy. I will also be discussing lighter topics on occasion to mix it up a little. I find the fall to be a time for change, hence my now publishing a newsletter. The summer has come and gone. I see the leaves changing on the trees. The white hydrangeas start to go from white to pink and finally a deeper rose color. The grass begins to brown. It all signals the fall season is coming. I generally start making soups in the fall. A new favorite soup of mine is a squash soup with Massaman curry and coconut milk. Massaman curry is a rich and flavorful Thai curry that is mildly spicy. I will post the recipe for the soup later in this posting. Soup can be deeply comforting at times. We have an expression that chicken soup is like “Jewish penicillin.” I don’t think that there is a time when I am sick that I don’t want chicken soup. So why is soup so magical?

Potato, Potata

The origin of soup is debatable. One source said it originated in 20,000 B.C. The first soup was hippopotamus soup. Soup was designed to keep one full and aid in digestive enzymes. During illness because it is liquid it helps to keep us hydrated. Maybe when the winter months came and less abundance of crops were to be had it helped keep people alive? I honestly don’t know but there is plenty to learn from how food was prepared many years ago. Cantonese culture makes soup a first course and Friday night’s at the sabbath dinner table, Matzoh ball soup is the second course after the blessing of the challah and wine. It clearly is part of many traditions and cultures.

Here come’s the Soup

I find soup comforting and a way to have a meal that seems less fussy. Sure it has to be made, but once it is done it can easily be stored for days in the refrigerator. I enjoy making soup because it leaves my house with wonderful aromas. I especially enjoy coming home and smelling a slow cooking soup when I first walk through the door. During the fall finding what brings us good feelings can be helpful as we head into the darker months of the year. Walking, gathering with friends or cooking can help us feel more connected. My hope is to stay more connected through my “new newsletter.”

Here is the recipe I promised:

(please do not eat if you are allergic or sensitive to any of the ingredients)

Squash your choice, I used butternut and buttercup. I did not peel it, but remove seeds.

1/2 large Onion

3 Carrots

4 Cloves of garlic

One can full fat coconut milk

One small can Massaman curry paste or less if you want less heat.

One chicken broth box

3/4 cup lentils (I used red lentils this time)

Salt ( I didn’t salt it but up to you)

Cut the squash into large chunks along with the carrots. Slice the onion and mince garlic. I sautéed everything together until they were soft and garlic added flavor. Transfer to crockpot. Add the coconut milk, Curry paste and chicken broth. After it heats up a little I add the lentils. I cooked on high for two hours and then put down to low for three hours. You could do on high for four hours straight or eight on low, depending on how you want to cook it. Then use a hand mixer (I used an immersion blender) to blend everything together. Here is mine with some Chinese broccoli.

It’s All Greek to Me

I seemed to get away from blogging this last year as life took me in some new directions. I still have my private practice and have focused almost entirely on psychotherapy. I now only provide online services and I also had personal matters to attend to. One of those matters was getting my only child off to college. My son decided to head off to college out of state. This left me with mixed emotions. On the one hand. I was excited that he had decided to venture out of state while the majority of his friends stayed close by. On the other hand I knew this meant less visits home. He was ready to “fly.” He reminded me of myself at that age. I chose to go to college in Boston while most of my friends went to the University of Maine. What made this most difficult for me was how hard it would be to send him off on his new adventure. I knew that I wanted nothing more than for him to have an exciting life, but it would also mean redefining myself as “not someone’s mother.” Basically, I was out of a job. I had focused so much on him for the last 18 years that I had almost lost track of how to live as my previous self. Where had this “previously enjoyed” woman gone? Could I find her again? Could I bring her back to life?

Who will I become?

The question I had to ask myself was, “who am I if I’m not his mother anymore?” Of course, I’m still his mother, but I’m not the mother that he needs like he needed in the past. He no longer needs me to tell him what to do or how to do laundry or make scrambled eggs. He’s now a man. He is still my son, but who am I and and who will I become. I’m not exactly old, but I’m not the young woman I was when I became a mother. I am much smarter now about life, less anxious and I find myself enjoying the quiet in my home.

Hello, it’s your mother calling…pick up!

The first two weeks he was away at college my son was very busy, so there was not much time to even catch up. I wanted to know how his classes were. He seemed to think I was like a mosquito buzzing around his head that he wanted to get rid of. What made matters worse for me was the “local mothers” kept going back to the dorm room and bringing all kinds of things. I could not do that living so far away but I would not have. It was time to let go. It was time to let him figure out what he needed without me “making suggestions.”

It’s good to feel good

After several weeks of him being gone, I can finally say that I feel like we’re both headed in the right direction. I’m not sure why it hit me so hard. I might have been in denial all summer because I didn’t seem to be bothered by his going away. I think what was the most difficult for me was imagining my life back as a childless woman. I was no longer childless by definition, but my life would revert back to a previous time. While, I relished being on my own for many years, it was very enriching to become a mother. It was the hardest and best thing I have ever done. My life became more full than I could ever have imagined. Last night on our weekly call he told me he wants to come home this weekend, and while I’m fine with it, I’m already picturing my house being a mess again, a pile of laundry on the floor, and all my favorite cold drinks gone before I get one sip.

Napoli, Napoli, Napoli

Last spring I traveled to southern to Italy. It was the most amazing trip I have ever been on and my plan is to go back within the next year. I was there while a championship soccer match was evolving. Napoli had never won, and I had the good fortune of witnessing history. Napoli had a history changing event. As I navigate my own life changing event, I know I will find the calmer waters.

When Food is the Enemy

I see women in my practice every week who suffer from eating disorders (ED). I never used to see men with ED but that has changed. Still, the incidence is much less frequent than with women and, when it does present, it is often much less severe in nature. I used to see it more in gay men but now I see it far more in heterosexual men. I also encounter it more often as a condition on the disordered eating spectrum with most men regardless of sexual orientation, rather than a full blown ED.

In medical school I recall how many of the women I knew who would food restrict. I only knew of one male who would food restrict. I actually got very thin myself, but quickly realized I needed food to stay awake most nights on call.

What’s on the menu?

It feels like we don’t know how to eat anymore. There is Keto this, low carb that, low fat vs clean eating. In the end we are at war with our bodies and food has become the enemy. When and why did food become a moral issue? I hear my patients say they were “so bad” because they had an extra piece of pie at a holiday dinner. It’s hard to imagine a world where we would accept the bodies we have rather than the bodies we wish we had. What will this imagined body bring us? Will it provide the elusive happiness we have been searching for?

Exercise is Healthy, right?

One of the latest eating disorders that has fallen on the more acceptable realm is ” Exercise Induced Bulemia.” Make no mistake it is still a compensatory way to maintain a lower body weight, but somehow it became socially acceptable to run, cycle or attend workouts at gyms that burn many calories. I frequently see women trying to keep up with their male partners. Sometimes it is the only way to spend significant time with them especially if they too have body image issues. Granted we are a more sedentary culture, but this is beyond going for the evening walk to move those stiff muscles at the end of the day.

Novel concept: eat when hungry

I am unsure of how to win this war on our bodies and the war on food. If my patient hates her body, I will ask her what about it she hates. She will usually say her double chin or her belly that hangs too low. What ever the “perceived defect” is, it likely originates from a place of self hatred. I listen and reflect back the negative and harsh feeling she feels at liberty to use against herself. Sometimes patients leave quickly if I won’t join them in this ritual of self hatred. Hopefully they stay and we can keep going deeper to understand this vicious attack on the self.

Stayin’Alive

We all remember the Bee Gees’ song from the 1970’s movie Saturday Night Fever. Who knew the phrase would have so much meaning almost 40 years later? I certainly didn’t. Fever was now something to be feared. As I have aged another year and have more gray hair to prove it, I find my body feeling older each day. 57 wasn’t that hard of a pill to swallow. However, the stress of the pandemic certainly added more than one year for most people emotionally. We learned new ways to shop, to mask and to love. Hugs were no longer allowed unless someone was in your “bubble.”

To vax or not to vax, that is the question

Then came the question of vaccine or no vaccine. I became a doctor long before I became a psychotherapist. I am not afraid of needles at all, but this was a new vaccine unlike any other. BUT COVID-19 was also a virus unlike any other before it. I was lucky in that being on the medical staff of a local hospital gave me the opportunity for vaccination back in February .There is no doubt in my mind getting vaccinated was the right decision for me. I will always support my patients decisions on what they feel is right for them. Sometimes that can be hard because I have to leave my own bias’s and opinions out of the therapy room. I can’t say I haven’t made that mistake in the past. I am far more conscious of how important it is to let my patient decide what is right for her.

I hope you Dance

I hope you all have remained healthy and safe. I am personally feeling very hopeful now that the numbers have dropped again. If you have a fever may it be caused by dancing to some good old music!

My New Blue Door

Yesterday I finally painted my office front door a vibrant blue. It had been the black I painted it a few years ago because I thought that went better with the yellow siding. I think my contractor had suggested it and I went along with it thinking he knew better than me about what I wanted. I have never liked the black but it was “ok.” I discussed colors with my teenage son who has a very good eye for this and we decided on Benjamin Moore’s Pacific Palisades Blue. I didn’t realize it at the time we picked but I needed a change that this door would come to symbolize. Without getting into details I knew that something needed to shift inside of me. That I needed to start seeing myself differently in order to move on from something. In essence I had been stuck in one facet of my life. Yes, even us immortal therapists struggle with being stuck sometimes. I needed a new door to open and I had to have the courage to walk through it. So I did. It was quite liberating and freeing. It feels great!

Stuck feels like a four letter word

Frequently I deal with my patients who are stuck. Sometimes, but rarely it unsticks quickly. Other times it can go on for a very long time. I find it mostly in the stories they have told themselves. It usually involves their self worth. That my patient believes she deserves far less than than she does. That she must settle for crumbs. I can’t tell her she deserves more and expect she will instantly believe it. She must do the inner work and determine this for herself. I do of course tell her that she deserves everything she wants. It will require going deep inside to figure out why she doesn’t believe this in the first place. It can be a long and painful process, but the only way through it is through it.

It takes as long as it takes!

Sometimes it can take years to get unstuck and walk through the a new door. It can be terrifying. We can imagine all kinds of bad things happening. So rather than risk it we stay stuck. Getting unstuck can be a lengthy process. The insurance companies would have us believing it’s a matter of weeks , maybe a few months to unstick. I don’t agree. I also know it doesn’t matter how long it takes. In my supervision with a Jungian analyst I used to wonder how long it would take my patient to become unstuck? This particular supervisor always said “it takes as long as it takes”! He was so right. I must be patient with my patient and stick with her through her difficulties imagining a different life for herself. One where she has what she wants instead of struggling to have it. One that lets her walk through the new door and into the life she deserves. My job is to simply walk along side her while she is finding that door.

What new door do you imagine opening for yourself? What in your self proclaimed story needs to change?

Happy Thanksgiving!