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Serious adverse effects requiring immediate medical attention include: Severe abdominal pain that may indicate pancreatitis (inflammation of the pancreas) Persistent nausea and vomiting leading to dehydration Changes in vision or eye pain (particularly in patients with type 2 diabetes and pre-existing retinopathy) Signs of thyroid tumors (neck mass, difficulty swallowing, persistent hoarseness) Symptoms of gallbladder disease (upper right abdominal pain, fever, jaundice) Severe allergic reactions (rash, difficulty breathing, swelling) These medications carry a boxed warning regarding thyroid C-cell tumors observed in rodent studies, though there is no definitive evidence of this risk in humans

Further, they had no previous history of depression, use of antidepressants in the previous year, or type 1 diabetes