The Anxiety of Transformation
“Jamie” is a pleasant woman in her late-20s who came to me frustrated by persistent weight gain after starting a demanding job at a law firm. Roughly 25 pounds above her baseline weight and newly showing signs of insulin resistance, she wanted to improve her metabolic health and regain a sense of physical control. In the spring of 2026, I started her on a low dose of Zepbound.
Here are some of the messages that followed.
Day 1:
“I feel dryness in my mouth almost immediately after I take the shot.”
I called her to reassure her that immediate dry mouth is not a side effect from Zepbound.
Day 4:
“I woke up starving this morning - maybe the Zepbound isn’t working for me?”
I called her again to reassure her that hunger ebbs and flows and she should stay the course.
Day 10:
“I increased the dose this weekend and since then I’ve had body aches, plus this morning I woke up with a terrible sore throat and swollen glands. Is any of this potentially related to the dosage?”
I wrote her the following message:
“A severe sore throat with swollen lymph nodes would not typically be caused by Zepbound. Those symptoms are much more consistent with a viral illness or another infection. The body aches are likely related to that as well.”
Day 20:
“I ended up getting pretty sick with a throat infection a couple of weeks ago, so I skipped a dose. I restarted the 5mg this weekend and now I’m getting that same strange soreness again. Different spots on my body feel tender to the touch. It’s hard to explain, but it feels very similar to what happened before.”
My response:
“Hi there! That is very unusual but definitely not a side effect from the Zepbound. Make sure you stay hydrated, because you may be coming down with something again.”
Her immediate response:
“It has to be from Zepbound. It happened exactly 24 hours after taking the shot - same exact thing.”
Finally, I wrote:
“Okay, in that case we may need to discontinue the medication for now. I’ll notify the pharmacy.”
Cue the panic. Suddenly the tone shifted entirely:
“No, the throat symptoms are gone now, and the soreness is already improving. I really don’t want to stop taking it.”
As a doctor for the past 20 years, I encounter some version of this phenomenon with surprising regularity.
What fascinates me is that this dynamic often has very little to do with the medication itself. The medication becomes a stage upon which a much older human drama is performed: the conflict between desire and fear.
People insist they want change and pursue their vision relentlessly. Yet when change becomes imminent, when the desired outcome begins to materialize, a strange reversal often occurs. Symptoms emerge, doubts multiply, and resistance appears. The mind that consciously demanded transformation suddenly begins defending the old status quo.
Philosophers and psychoanalysts have described this tension for centuries.
Kierkegaard wrote that anxiety is “the dizziness of freedom.” We tend to think anxiety arises from limitation, but Kierkegaard argued that human beings are equally frightened by possibility itself.
Nietzsche described a related phenomenon through the concept of “ressentiment” and our tendency to prefer familiar suffering over liberating uncertainty. We cling to identities built around striving because striving itself becomes stabilizing. To finally obtain the thing one wanted risks the collapse of the narrative that organized the self. A person chasing transformation retains hope while preserving continuity. But success demands discontinuity.
Freud believed that people are rarely psychologically unified. We do not simply “want” things cleanly. Competing drives coexist within us simultaneously. One part seeks health; another seeks protection from the consequences of health. In clinical medicine this often manifests as hypervigilance toward side effects.
Medicine provides endless examples of this. Patients plead for surgery and then postpone it repeatedly once scheduled. They beg for treatment but become consumed by rare side effects the moment improvement begins. The closer one gets to transformation, the more fiercely the psyche sometimes defends the familiar self.
What made this particular interaction striking was how rapidly certainty dissolved once discontinuation became real. As long as the medication remained available, Jamie could inhabit her safe world of ambivalence. But the moment Zepbound might truly be taken away, desire clarified instantly.
Jamie is still taking Zepbound and is nearly at her weight goal. Unsurprisingly, she hasn’t had any side effects since Day 20.