Ozempic, again

Yes, this is about Ozempic again. I saw a tweet today sharing a recent study on the weight loss drug and a Reddit forum where people are sharing their experiences with behavior modification while on it. Reading this new information made me wonder if this drug acts like a chemical lobotomy. (LOL)

Ozempic is a GLP-1 agonist. GLP-1 receptors are widely expressed in the brain, it is neuroprotective. GLP-1 receptors are in reward areas of the brain known as the mesolimbic dopamine system. GLP-1 decreases palatable food intake, and incidentally also reduces cocaine, amphetamine, alcohol, and nicotine use in animals. Also, many people are reporting similar experience with Ozempic either curing or significantly reducing their other addictions. GLP-1 is known to modulate dopamine levels causing behavioral changes. In humans, GLP-1 alters activity deficits in the insula, hypothalamus, and orbitofrontal cortex. Once again, is every impulse control issue or psych problem a derivative of dementia? GLP-1 reduces food cravings partially by decreasing anticipation of food. This is interesting as most of the reasoning behind fasting is related to retraining your brain to not be in expectation of food constantly or at certain times. Our brains love insulin surges, it’s a huge bolus of dopamine, so we often aren’t in need of calories or fuel. Most of the time our brain just wants a dopamine hit and uses the mesolimbic system to give us a nudge. Actual physical hunger has a different and more acute feeling than impulsive craving. Psychostimulants like cocaine and amphetamine hijack dopamine reward pathways in the same way that highly palatable foods do. There is a lot of evidence supporting GLP-1 being a treatment not just for weight loss but for other disorders of the reward system or impulse control disorders, like alcoholism or even gambling.

A few minutes spent scrolling the Reddit Ozempic forum elicited dozens of testimonials related to the pleasant side effect of the drug curbing impulse shopping. One Redditor stated she was now making strides in paying off credit card debt as she was impulse shopping less on the weight loss medication. Others reported that it is improving their OCD, ADHD and that they are drinking less alcohol. Many of these people also reported being on other psychoactive medications and were doubling doses as they were concerned that Ozempic was changing the absorption of their meds.

Decision-making is one of the executive functions of the brain it manages other cognitive functions, such as memory, attention, and language. Impulse control is under the umbrella of decision-making. Impairments of the decision-making function of the brain as seen in neurological and psychiatric problems cause an immense amount of human suffering and are financially burdensome. Understanding the neural mechanisms of decision-making is one of if not the fundamental objective of neuroscience. It is essential to the understanding and management of neuropsychiatric disorders such as addiction, as well as the management of elderly people suffering from a decline in cognitive functions critical for decision-making. The frontal lobe of the brain is responsible for executive functions, controlling impulses etc. Damage to the frontal lobes and reduced ability to control impulses can be caused by trauma, alcohol and other drugs, dementia, other types of brain and mood disorders. In the early days of neuroscience, the lobotomy was often used and applied to the frontal lobe to treat impulse control issues and psychiatric disturbances with the unfortunate side effect of rendering the patient apathetic, passive and with decreased ability to concentrate etc. Now it may be that we have a new more sensitive, specific and minimally invasive way to “rewire the brain” treating the same ailments that were once approached in a less humane way more effectively as understanding of the neural pathways increases. As an aside, in the depressive brain, GLP-1 also attenuates neuroinflammation and protects neurons under oxidative stress. It also ameliorates synaptic dysfunction in the depressive brain and leads to the enhancement of cognitive function. This is interesting to watch unfold. I don’t know how sustainable all of this is as even for weight loss the drug must be taken continuously and when stopped most people regain the weight and go back to their previous eating patterns. The marketing and PR for this drug is amazing. I do wonder if many of these reported psychological benefits aren’t just an effect of losing weight in general and their body/brain remodulating in response to this. As Kate Moss infamously said, “nothing tastes as good as skinny feels.”