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It is important to acknowledge that the relationships we found between AC levels, MDD diagnosis, depression severity and depression profiles may be explained to some extent by shared distal environmental and lifestyle factors (e.g., comorbid somatic diseases, sedentary behavior, smoking, high-fat diet, alcohol consumption [61,62,63,64] that could act as confounder or mediators of the association

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Situations requiring healthcare provider consultation: Frequent dose timing inconsistencies that suggest adherence challenges Concurrent illness affecting medication absorption or tolerance Addition of new medications that may interact with tirzepatide Persistent or worsening gastrointestinal symptoms Any uncertainty about appropriate dose timing Patients should be aware that tirzepatide may reduce the effectiveness of oral hormonal contraceptives due to delayed gastric emptying

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