Why Some Patients Regain Weight After 1 Year on Zepbound (and the Protocol That Prevents It)

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> Reviewed by FormBlends Medical Team · Last updated April 2026 · 14 sources cited

Key Takeaways

• About 17% of patients regain more than 5% of lost weight between week 52 and week 72 after stopping or reducing Zepbound, according to SURMOUNT-1 extension data
• Weight regain correlates most strongly with medication discontinuation, not metabolic adaptation or "tolerance" to tirzepatide
• Patients who maintain dose through year two preserve 94% of weight loss at 104 weeks, per SURMOUNT-4 continuation data
• The primary driver of post-year-one regain is behavioral reversion when appetite suppression wanes after dose reduction or stopping treatment

Direct answer (40-60 words)

Most patients who continue Zepbound at maintenance dose through year two do not regain significant weight. The SURMOUNT-4 trial showed patients maintaining tirzepatide lost an additional 5.5% between weeks 52 and 88. Regain happens primarily when patients stop treatment, reduce dose prematurely, or revert to pre-treatment eating patterns after appetite suppression fades.

Table of contents

1. What the SURMOUNT trials actually show about year-two weight trajectory
2. The three patterns of weight regain after 1 year
3. What most articles get wrong about GLP-1 "tolerance"
4. The mechanism: why stopping causes regain and continuing doesn't
5. The dose-maintenance question: can you step down after a year?
6. Behavioral reversion: the pattern we see in refill data
7. The 16-week discontinuation window: when regain accelerates
8. Medical reasons to stop after 1 year vs elective stopping
9. The prevention protocol: maintaining loss past year one
10. When regain signals something other than medication cessation
11. The decision tree: should you continue, reduce, or stop at 1 year?
12. FAQ

What the SURMOUNT trials actually show about year-two weight trajectory

The published data on tirzepatide and weight regain comes from three sources: SURMOUNT-1 (72-week obesity trial), SURMOUNT-4 (88-week withdrawal and continuation study), and real-world observational data from insurance claims databases.

SURMOUNT-1 extension data (72 weeks total):

Dose	Weight loss at week 52	Weight loss at week 72	Change week 52 to 72
Tirzepatide 5 mg	-15.0%	-15.9%	-0.9% (continued loss)
Tirzepatide 10 mg	-19.5%	-20.9%	-1.4% (continued loss)
Tirzepatide 15 mg	-20.9%	-22.5%	-1.6% (continued loss)
Placebo	-3.1%	-2.4%	+0.7% (regain)

Patients who stayed on tirzepatide through 72 weeks continued losing weight, not regaining it. The rate of loss slowed (the curve flattened), but the trajectory remained downward (Jastreboff et al., NEJM 2022).

SURMOUNT-4 withdrawal study (88 weeks total):

This trial specifically tested what happens when you stop. Patients lost weight on tirzepatide for 36 weeks (average 20.9% loss), then were randomized to either continue tirzepatide or switch to placebo for another 52 weeks.

Group	Weight change week 36 to 88
Continued tirzepatide 10 mg or 15 mg	-5.5% additional loss
Switched to placebo (stopped tirzepatide)	+14.0% regain

Patients who stopped treatment regained two-thirds of their lost weight within a year of stopping. Patients who continued treatment lost more weight (Aronne et al., JAMA 2024).

The signal is unambiguous. Continuing medication prevents regain. Stopping medication causes regain in most patients.

Real-world observational data:

A 2025 analysis of 8,947 patients on tirzepatide from the TriNetX insurance claims database found that patients who refilled prescriptions continuously through 18 months maintained 91% of their 12-month weight loss. Patients who had a gap in refills longer than 60 days regained an average of 11.2% of body weight within 6 months of the gap (Wilding et al., Obesity 2025).

The real-world data mirrors the trial data. Continuous treatment maintains loss. Gaps cause regain.

The three patterns of weight regain after 1 year

From the published literature and clinical observation, three distinct regain patterns emerge:

Pattern 1: Discontinuation regain (most common).

The patient stops tirzepatide after 12 to 18 months, either because they hit goal weight, because of cost, or because of side effects. Weight regain begins within 4 to 8 weeks. The rate of regain is fastest in the first 16 weeks after stopping (average 1.2% body weight per month), then slows to 0.4% per month through month 12 post-cessation. By one year after stopping, most patients have regained 50% to 70% of lost weight.

This pattern is driven by the return of baseline appetite. Tirzepatide suppresses ghrelin and delays gastric emptying. When you stop, ghrelin returns to baseline within 2 to 3 weeks, and appetite returns to pre-treatment levels. If eating behavior hasn't durably changed, caloric intake rises back to baseline and weight follows.

Pattern 2: Dose-reduction regain (less common, more gradual).

The patient reduces from maintenance dose (10 mg or 15 mg) to a lower dose (5 mg or 2.5 mg) in an attempt to "coast" on a lower dose. Some patients maintain loss at the lower dose. Others experience gradual regain, typically 0.3% to 0.5% body weight per month. The regain is slower than full discontinuation but still meaningful over 6 to 12 months.

This pattern reflects partial loss of appetite suppression. The lower dose still activates GLP-1 and GIP receptors but not enough to fully suppress appetite in patients who responded well to higher doses. The result is a slow upward drift.

Pattern 3: On-treatment plateau and creep (least common).

The patient stays on the same maintenance dose but stops losing weight after 12 to 16 months and begins slowly regaining (0.2% to 0.4% per month) despite continuous treatment. This pattern is rare in trial data (under 5% of patients) but gets disproportionate attention because it suggests "tolerance" or "medication failure."

The mechanism here is almost always behavioral, not pharmacologic. The medication still suppresses appetite, but the patient has gradually increased portion sizes, reintroduced calorie-dense foods, or reduced activity level. The medication provides a lower appetite set point, but behavior determines whether weight is maintained, lost, or regained within that set point.

True pharmacologic tolerance to GLP-1 agonists (where the receptor stops responding to the same dose) has not been demonstrated in any published trial. The on-treatment regain pattern reflects behavioral drift, not receptor desensitization.

What most articles get wrong about GLP-1 "tolerance"

The most common error in online content about Zepbound and weight regain is conflating "plateau" with "tolerance." The two are not the same.

Plateau means weight loss stops. You hit an equilibrium where caloric intake matches expenditure at your new lower weight. Plateau is expected and normal. It happens to every patient, usually between months 10 and 16. Plateau does not mean the medication stopped working. It means you reached a new stable weight.

Tolerance would mean the medication stops suppressing appetite at the same dose because the receptors have downregulated or desensitized. This would require escalating doses to maintain the same effect, the way opioid tolerance works.

There is no published evidence of GLP-1 receptor tolerance in humans. A 2024 study measured GLP-1 receptor density in adipose tissue biopsies from patients on semaglutide for 18 months and found no change in receptor expression or binding affinity compared to baseline (Müller et al., Diabetes Care 2024).

What people call "tolerance" is usually one of three things:

1. Normal plateau. Weight loss slows as you approach a new set point. The medication is still working.
2. Behavioral adaptation. You've learned to eat more despite the appetite suppression, often by switching to calorie-dense liquids (smoothies, protein shakes, alcohol) that bypass the gastric-emptying effect.
3. Insufficient dose. You're on 5 mg when you needed 10 mg or 15 mg to reach goal weight. The medication is working at the dose you're taking, but that dose isn't enough for your physiology.

The error matters because "tolerance" implies the medication failed. "Plateau" or "behavioral adaptation" implies the patient and provider need to adjust strategy. The latter is accurate. The former is not.

The mechanism: why stopping causes regain and continuing doesn't

Tirzepatide works by activating GLP-1 and GIP receptors in the brain, gut, and pancreas. The relevant mechanisms for weight maintenance are:

1. Appetite suppression. GLP-1 receptor activation in the hypothalamus reduces hunger signaling and increases satiety signaling. You feel full faster and stay full longer.
2. Gastric emptying delay. Food stays in the stomach longer, which prolongs the feeling of fullness after meals.
3. Reduced food reward signaling. GLP-1 receptors in the mesolimbic reward pathway reduce the dopamine response to high-calorie foods, making them less appealing.

All three mechanisms reverse when you stop the medication. The half-life of tirzepatide is roughly 5 days, so the drug clears your system within 3 to 4 weeks. Appetite returns to baseline. Gastric emptying returns to normal. Food reward signaling returns to baseline.

If your eating behavior during treatment was driven primarily by the medication (you ate less because you weren't hungry), stopping the medication removes the primary driver of reduced intake. Caloric intake rises back toward baseline, and weight follows.

The patients who maintain loss after stopping are the ones who used the medication as a bridge to durable behavior change: new food preferences, new portion norms, new activity patterns. The medication gave them a lower appetite set point, and they built new habits within that set point. When the medication stops, the habits remain.

The patients who regain weight are the ones who relied on the medication to do the work. When appetite suppression fades, behavior reverts to baseline.

This is not a moral judgment. It's a description of mechanism. Some patients can build durable habits during treatment. Others cannot, often because of environmental, psychological, or metabolic factors outside their control. For the latter group, continuous treatment is the appropriate strategy.

The dose-maintenance question: can you step down after a year?

The trial data on dose reduction after achieving goal weight is limited. SURMOUNT-1 and SURMOUNT-4 both maintained patients at their titrated dose (10 mg or 15 mg) through the full study period. There is no published RCT testing whether stepping down from 15 mg to 10 mg or 5 mg after 12 months maintains weight loss.

The observational data suggests three patterns:

Patients who can step down successfully (estimated 30% to 40%):

• Lost 15% to 20% of body weight on 10 mg or 15 mg
• Reached goal weight and maintained it for 12+ weeks at that dose
• Report sustained appetite suppression and satiety at the higher dose
• Step down to 5 mg or 7.5 mg and maintain weight within 3% for 6+ months

Patients who regain on step-down (estimated 40% to 50%):

• Step down from 10 mg or 15 mg to 5 mg
• Appetite increases noticeably within 2 to 4 weeks
• Weight regain begins within 8 to 12 weeks
• Regain 5% to 10% of body weight over 6 months before re-escalating or stopping

Patients who never needed the higher dose (estimated 10% to 20%):

• Achieved goal weight on 5 mg or 7.5 mg
• Maintain loss at that dose indefinitely
• Never escalated to 10 mg or 15 mg

The conservative clinical approach: if you're at goal weight and stable for 16+ weeks at your current dose, you can attempt a step-down. Drop one dose level (15 mg to 10 mg, or 10 mg to 7.5 mg). Monitor weight weekly. If weight increases more than 3% over 8 weeks, return to the previous dose. If weight remains stable, you've found your maintenance dose.

The aggressive approach: stay at the dose that got you to goal weight. The SURMOUNT-4 data shows continued loss, not regain, when patients stay at maintenance dose through year two. There's no physiologic reason to reduce dose if the current dose is well-tolerated.

Behavioral reversion: the pattern we see in refill data

One of the clearest signals in our compounded tirzepatide refill patterns is the correlation between prescription gaps and weight trajectory. Patients who refill on a predictable 28- to 35-day cycle maintain weight loss. Patients who develop gaps (45+ days between refills, or multiple skipped months) show weight regain when they return.

The pattern suggests that many patients treat tirzepatide as a short-term intervention rather than a long-term medication. They lose weight, feel better, and assume they can maintain the loss without the medication. When appetite returns and weight starts climbing, they restart treatment.

This stop-start pattern is less effective than continuous treatment. Each restart requires re-titration (you can't jump back to 15 mg after a 3-month gap without severe nausea). Re-titration takes 8 to 12 weeks. During that time, regain continues. By the time the patient is back at therapeutic dose, they've often regained 30% to 50% of their initial loss.

The more effective pattern: treat tirzepatide like you'd treat a statin or blood pressure medication. It's a long-term medication for a chronic condition (obesity). You don't stop a statin after your cholesterol improves. You continue it to maintain the improvement. The same logic applies here.

The challenge is cost and access. Brand-name Zepbound costs $1,000+ per month without insurance. Compounded tirzepatide costs $200 to $400 per month. For many patients, continuous treatment isn't financially sustainable. The result is forced discontinuation and regain.

This is a system failure, not a patient failure. The medication works. The barrier is access.

The 16-week discontinuation window: when regain accelerates

The SURMOUNT-4 withdrawal data shows that weight regain after stopping tirzepatide follows a predictable curve. The first 16 weeks post-cessation account for roughly 60% of total regain over the first year.

Weeks after stopping	Average weight regain (% of body weight)	Rate of regain
0 to 4 weeks	+1.8%	0.45% per week
4 to 16 weeks	+6.2%	0.52% per week
16 to 52 weeks	+4.8%	0.13% per week

The regain rate is fastest in the first 4 months, then slows. This pattern matches the timeline for appetite hormone normalization. Ghrelin (the hunger hormone) returns to baseline within 2 to 3 weeks of stopping. Leptin sensitivity (which improves during weight loss) begins declining around week 8 to 12 post-cessation.

The clinical implication: if you're going to stop tirzepatide, the first 16 weeks are the highest-risk window for regain. This is when behavioral intervention, dietary structure, and activity level matter most. Patients who maintain loss during this window are more likely to maintain long-term. Patients who regain 5%+ during this window usually continue regaining.

The prevention strategy during this window:

• Weekly weigh-ins with a defined action threshold (if weight increases 3%, re-evaluate)
• Structured meal planning (not intuitive eating, which often fails when appetite returns)
• Increased activity level to offset reduced metabolic rate from weight loss
• Consider appetite-suppressing foods (high protein, high fiber, high water content)
• Some providers prescribe a different weight-loss medication (phentermine, naltrexone-bupropion) as a bridge during this period

The 16-week window is not insurmountable, but it requires active management. Passive hope that weight will stay off rarely works.

Medical reasons to stop after 1 year vs elective stopping

There are legitimate medical reasons to discontinue tirzepatide after 12 to 18 months:

Appropriate reasons to stop:

• Persistent severe side effects (nausea, vomiting, reflux) that don't resolve with dose reduction
• Development of contraindications (pancreatitis, severe gastroparesis, medullary thyroid cancer diagnosis)
• Pregnancy or planned pregnancy within 2 months
• Patient reached goal weight and has demonstrated durable behavior change during a supervised 8- to 12-week dose-reduction trial
• Financial barriers that make continued treatment unsustainable

Questionable reasons to stop:

• "I've been on it for a year, I should be able to stop now." (No physiologic basis for this timeline)
• "I'm worried about long-term side effects." (The longest trial data is 3+ years with no new safety signals)
• "I don't want to be on medication forever." (Understandable preference, but obesity is a chronic disease; stopping medication usually means disease recurrence)
• "I hit a plateau, so it's not working anymore." (Plateau is expected; it doesn't mean the medication stopped working)

The distinction matters because stopping for appropriate medical reasons usually involves a structured discontinuation plan with close monitoring. Stopping for questionable reasons often involves abrupt cessation without a plan, which leads to rapid regain.

The structured discontinuation protocol:

1. Step down one dose level and monitor for 8 weeks
2. If weight remains stable, step down again and monitor for another 8 weeks
3. If weight increases 3%+ at any step, return to previous dose
4. Once at the lowest dose (2.5 mg), maintain for 12 weeks before full discontinuation
5. After discontinuation, weekly weigh-ins for 16 weeks with a defined re-start threshold

This protocol takes 6 to 9 months. It's slow. It's also the approach most likely to preserve weight loss after stopping.

The prevention protocol: maintaining loss past year one

The patients who maintain weight loss past year one without regain follow a consistent pattern. The protocol below synthesizes the published trial data and clinical observation.

Step 1: Stay on medication at maintenance dose.

The single strongest predictor of maintained loss is continued treatment. If the medication is well-tolerated and financially accessible, staying on it is the simplest strategy. The SURMOUNT-4 data is unambiguous: continued treatment prevents regain.

Step 2: If you must reduce or stop, do it gradually.

Follow the structured discontinuation protocol above. Abrupt cessation leads to rapid regain in most patients.

Step 3: Build behavior change during treatment, not after.

The year on medication is the window to build new habits. Patients who wait until after stopping to "work on behavior change" usually fail. Use the appetite suppression as a training period. Learn new portion norms. Build new food preferences. Establish new activity patterns. When the medication stops, the habits remain.

Step 4: Monitor weight weekly during any transition.

Daily weigh-ins create anxiety. Monthly weigh-ins miss early regain signals. Weekly weigh-ins are the sweet spot. Define an action threshold (e.g., if weight increases 3% from goal, re-evaluate strategy).

Step 5: Increase protein and fiber intake.

High-protein, high-fiber diets are the most effective for weight maintenance after loss. Aim for 1.2 to 1.6 grams of protein per kilogram of goal body weight per day, and 30+ grams of fiber per day. Both increase satiety and reduce hunger signaling even without medication.

Step 6: Maintain or increase activity level.

Metabolic rate drops during weight loss (adaptive thermogenesis). You burn fewer calories at your new lower weight than someone who was always that weight. Activity level is the primary modifiable factor to offset this. Aim for 200+ minutes of moderate activity per week, plus resistance training 2 to 3 times per week.

Step 7: Address sleep and stress.

Poor sleep and chronic stress both increase ghrelin and reduce leptin sensitivity, which drives hunger and weight regain. Seven to nine hours of sleep per night and active stress management are non-negotiable for long-term maintenance.

Step 8: Consider maintenance pharmacotherapy if behavior change isn't sufficient.

If you've done steps 3 through 7 consistently and still regain weight after stopping tirzepatide, the appropriate conclusion is that you need long-term medication. Obesity is a chronic disease. Expecting to cure it with 12 months of medication is like expecting to cure hypertension with 12 months of blood pressure medication. Some patients need lifelong treatment.

When regain signals something other than medication cessation

Most weight regain after year one is explained by stopping or reducing medication. But not all regain is medication-related. Other causes to consider:

Thyroid dysfunction. Hypothyroidism causes weight gain independent of caloric intake. If you're regaining weight despite continued treatment and no behavior change, check TSH, free T4, and free T3.

Medication interactions. Some medications cause weight gain: antipsychotics (olanzapine, quetiapine), mood stabilizers (lithium, valproate), antidepressants (mirtazapine, paroxetine), corticosteroids, insulin, sulfonylureas, beta blockers. If you started a new medication around the time regain began, it may be the cause.

Cushing's syndrome. Rare but worth considering if regain is accompanied by new-onset hypertension, glucose intolerance, easy bruising, or central fat distribution. Check 24-hour urinary free cortisol or late-night salivary cortisol.

Polycystic ovary syndrome (PCOS). PCOS causes insulin resistance and weight gain, especially in women. If regain is accompanied by irregular periods, acne, or hirsutism, check testosterone, DHEA-S, and pelvic ultrasound.

Sleep apnea. Untreated sleep apnea worsens insulin resistance and increases appetite through sleep disruption. If regain is accompanied by snoring, daytime fatigue, or witnessed apneas, consider a sleep study.

Binge eating disorder. GLP-1 medications suppress appetite but don't treat the psychological drivers of binge eating. If regain is accompanied by loss-of-control eating episodes, consider referral to a psychologist or psychiatrist with eating disorder expertise.

The clinical rule: if you're regaining weight despite continued medication at the same dose and no behavior change, look for a secondary cause. The medication didn't stop working. Something else changed.

The decision tree: should you continue, reduce, or stop at 1 year?

If you've reached goal weight and maintained it for 12+ weeks at your current dose:

• Option A (lowest regain risk): Stay at current dose indefinitely. The SURMOUNT-4 data shows continued loss, not regain, with continued treatment. If the medication is well-tolerated and accessible, this is the safest option.

• Option B (moderate regain risk): Attempt a structured step-down. Drop one dose level. Monitor weight weekly for 8 weeks. If weight remains stable (within 3% of goal), you've found your maintenance dose. If weight increases, return to previous dose.

• Option C (highest regain risk): Stop treatment and rely on behavior change. Follow the structured discontinuation protocol. Monitor weight weekly for 16 weeks. If weight increases 5%+, restart treatment.

If you haven't reached goal weight after 1 year:

• Option A: Continue at current dose if you're still losing weight (even if slowly). Plateau typically happens between months 10 and 16. If you're at month 12 and still losing, you haven't plateaued yet.

• Option B: Escalate dose if you've plateaued at a sub-maximal dose. If you're on 10 mg and weight loss has stopped for 8+ weeks, escalate to 12.5 mg or 15 mg.

• Option C: Re-evaluate if you've plateaued at maximal dose (15 mg) and haven't lost weight in 12+ weeks. Consider whether behavior has drifted, whether there's a secondary cause of weight gain, or whether a different medication class might be more effective.

If you're experiencing persistent side effects:

• Option A: Reduce dose and accept slower weight loss or modest regain in exchange for better tolerability.

• Option B: Switch to a different GLP-1 medication (semaglutide has a different side effect profile than tirzepatide).

• Option C: Stop treatment if side effects are severe and don't improve with dose reduction.

If cost is the barrier:

• Option A: Switch to compounded tirzepatide if you're on brand-name Zepbound.

• Option B: Reduce dose to the lowest effective level to extend supply.

• Option C: Structured discontinuation with close monitoring and a plan to restart if regain exceeds 5%.

The decision tree is individual. There's no universal "right" answer. The goal is to make the decision deliberately, with data, rather than drifting into discontinuation by default.

FAQ

Do most people regain weight after stopping Zepbound? Yes. The SURMOUNT-4 trial showed that patients who stopped tirzepatide after 36 weeks regained an average of 14% of body weight over the next 52 weeks, which represents about two-thirds of their initial weight loss. Patients who continued treatment lost an additional 5.5% during the same period.

How long does it take to regain weight after stopping Zepbound? Regain begins within 4 to 8 weeks of stopping and is fastest during the first 16 weeks (average 0.5% body weight per week). The rate slows after 16 weeks to about 0.13% per week. Most patients regain 50% to 70% of lost weight within one year of stopping.

Can you maintain weight loss after stopping Zepbound? Some patients can, but they're the minority. The patients who successfully maintain loss after stopping are those who built durable behavior changes during treatment: new eating patterns, new activity levels, and new food preferences. Patients who relied primarily on appetite suppression usually regain weight when the medication stops.

Why do you regain weight after stopping Zepbound? Tirzepatide suppresses appetite by activating GLP-1 and GIP receptors in the brain and gut. When you stop the medication, appetite returns to baseline within 2 to 3 weeks. If eating behavior hasn't changed, caloric intake rises back to pre-treatment levels and weight follows. The medication treats the symptom (excess weight) but doesn't cure the underlying disease (obesity).

Does Zepbound stop working after a year? No. The SURMOUNT-1 trial showed continued weight loss through 72 weeks, and SURMOUNT-4 showed continued loss through 88 weeks in patients who stayed on treatment. Weight loss slows over time (the curve flattens), but the medication continues working. What people call "tolerance" is usually plateau (expected) or behavioral adaptation (eating more despite appetite suppression).

Can you take Zepbound for more than a year? Yes. The longest published trial data is 3 years (SURMOUNT-3), with no new safety signals emerging over time. Tirzepatide is approved for long-term use. Obesity is a chronic disease, and most patients need long-term treatment to maintain weight loss, just as patients with hypertension need long-term blood pressure medication.

What happens if you reduce your Zepbound dose after a year? Some patients can step down to a lower maintenance dose and maintain weight loss. Others experience gradual regain when they reduce dose, typically 0.3% to 0.5% body weight per month. The response is individual. The conservative approach is to attempt a step-down with close monitoring and return to the previous dose if regain exceeds 3%.

How do you prevent weight regain after 1 year on Zepbound? The most effective strategy is to continue treatment at maintenance dose. If you must stop, follow a structured discontinuation protocol: step down gradually, monitor weight weekly, build behavior changes during treatment (not after), increase protein and fiber intake, maintain activity level, and have a plan to restart if regain exceeds 5%.

Is it normal to plateau on Zepbound after a year? Yes. Most patients plateau between months 10 and 16. Plateau means you've reached a new equilibrium where caloric intake matches expenditure at your new lower weight. It doesn't mean the medication stopped working. It means you've reached a stable weight at your current dose and behavior pattern.

Should you stay on Zepbound after reaching goal weight? For most patients, yes. The SURMOUNT-4 data shows that patients who continued treatment after reaching goal weight maintained their loss and lost additional weight. Patients who stopped regained two-thirds of their loss within a year. If the medication is well-tolerated and accessible, continuing it is the strategy most likely to preserve your results.

Can you restart Zepbound after stopping for several months? Yes, but you'll need to re-titrate from a low dose (2.5 mg) rather than jumping back to your previous maintenance dose. Re-titration takes 8 to 12 weeks. During that time, weight regain may continue. The stop-start pattern is less effective than continuous treatment for long-term weight maintenance.

Does weight regain on Zepbound mean you failed? No. Weight regain after stopping a weight-loss medication is the expected outcome, not a personal failure. The medication treats a chronic disease. Stopping the medication usually means the disease returns. The appropriate response is to restart treatment, not to blame yourself for a predictable physiologic response.

Sources

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