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Throughout her life, Victoria Rutledge considered herself a drug addict. His first addiction was alcohol. After getting drunk in her 30s, she stopped drinking and started shopping, something she had always thought about. She spends $500 on organic food, only to have it perish in her refrigerator. He told me: “I couldn’t stop doing things like that. When she went to Target, she would just throw things like candles, makeup, and skin care products in her cart.
Earlier this year, she started taking semaglutide, also known as Wegovy, after being prescribed a weight loss medication. (Traditionally, it is often referred to as Ozempic, although it’s technically the brand name of semaglutide, which is sold for the treatment of diabetes.) His thoughts on food were quiet. He lost weight. But the most surprising thing is that one day he came out of Target and realized that his cart only had four items that he came to buy. He said: “I have never done this before.” The desire to buy things had disappeared. The desire to drink, once extinguished, was no more urgent as a substitute. For the first time—perhaps the first time in his entire life—all his desires vanished. It was as if a switch had changed in his brain.
As semaglutide has grown in popularity, patients have been reporting side effects that go beyond appetite. They say they are not interested in all kinds of habits and compulsions: drinking, smoking, shopping, nail biting, skin picking. Not everyone on the drug experiences these positive effects, to be clear, but enough of them have addiction researchers paying attention. And the number of anecdotes can be really on to something. For many years now, scientists have been testing whether drugs like semaglutide can reduce alcohol, cocaine, nicotine, and opioid addiction in lab animals—with positive results.
Semaglutide and its drug relatives seem to work, especially in animals, against many drugs, says Christian Hendershot, a psychiatrist at the University of North Carolina at Chapel Hill School of Medicine. The drugs available today are specific: the opioid methadone, the smoker bupropion. But semaglutide may one day be more effective, as this class of drugs can alter important pathways in the brain. The science is still a long way off, although researchers are eager to learn more. At UNC, Hendershot is now conducting clinical trials to see if semaglutide can help people. stop drinking alcohol and smoking. Drugs that suppress the appetite can suppress the appetite.
The history of semaglutide is one of welcome surprises. Semaglutide, which was developed for diabetes, causes the pancreas to release insulin by taking a hormone called GLP-1, or glucagon-like peptide 1. GLP-1 analogues of the first type – exenatide and liraglutide – have been on the market to help diabetes. more than ten years. And almost at the same time, doctors noticed that patients with this drug also lost weight, which did not happen but is often unacceptable. Semaglutide has been announced as a highly potent GLP-1 analog.
Experts now believe that GLP-1 analogs have a greater effect on the pancreas. The exact weight loss mechanism is still unknown, but the drug may work in several ways to suppress hunger, including reducing appetite and preventing the rise and fall of blood sugar. Most interestingly, it also appears to reach and act directly on the brain.
GLP-1 analogs appear to bind to neurons in several areas of the brain, said Scott Kanoski, a neuroscientist at the University of Southern California. When Kanoski and his colleagues blocked these receptors in rats, the first-generation drugs exenatide and liraglutide. it became less on reducing food intake—as if this has ended the great practice. Food cravings are only one type of compulsion, however. The fact that the drug works at the level of the brain—as well as the gut—suggests that it can also suppress appetite.
In particular, GLP-1 analogs affect dopamine channels in the brain, known as the reward circuit. This system evolved to help us survive; Simply put, food and sex cause dopamine to hit the brain. We feel good, and we do. For people with an addiction, the process in the brain shifts as a result or because of their addiction, or maybe both. They have, for example, fewer dopamine receptors in part of the brain’s reward system, so the same reward can bring less pleasure.
In lab animals, addiction researchers have found more evidence that GLP-1 analogs alter the reward pathway: mice on exenatide. get a little hit of dopamine from alcohol; rats on the same GLP-1 treatment of choice reduce cocaine; the same for rats and oxycodone. African monkeys like to drink alcohol he takes a small amount of liraglutide and exenatide. Many published studies have been made with these two GLP-1 drugs, but researchers told me to expect more studies with semaglutide, with good results, to be published soon.
Among people, science is very limited. A two about education of exenatide in people with cocaine use were too short or too small to report. Someone learning of the same drug in people with alcohol use disorder found that the reward areas of their brains did not light up when they were shown pictures of alcohol in an fMRI machine. Patients in the whole study, however, did not drink much of the drug, even a small part that had obesity. Experts say that semaglutide, if it works incorrectly, may be more effective in some people than others. Anders Fink-Jensen, a psychiatrist at the University of Copenhagen who has done research on alcohol, said: “I don’t expect this to help anyone. (Fink-Jensen has received funding from Novo Nordisk, the maker of Ozempic and Wegovy, for separate research using GLP-1 analogs to treat weight loss in schizophrenia.) Larger and longer trials with semaglutide may prove or disprove the drug’s effectiveness in drunkenness—and knowing who is good for him.
Semaglutide does not interfere with all the happiness, people who take this drug to lose weight told me. They can still enjoy a small meal or enjoy finding a nice dress; they didn’t go any further. Anhedonia, or a reduced ability to feel happy, was not seen in the group of people who took the drug for diabetes, says Elisabet Jerlhag Holm, an addiction researcher at the University of Gothenburg. In fact, the people I spoke to said that their thoughts were no longer struggling. “It was a big relief,” says Kimberly Smith, who used to struggle with binge eating. For patients like her, the drug can control addictions that have gotten worse.
The types of behaviors that patients have reported changing unexpectedly include smoking or drinking alcohol, and compulsions, such as skin picking or nail biting. (Unlike addiction, compulsion involves behaviors that are not meaning to be interesting) And although there is a body of animal research on GLP-1 analogues and addiction, there is nothing on food-free compulsions. However, habits and compulsions must be controlled by different payment methods in the brain, and semaglutide may have an effect on both. Two months after taking the drug, Mary Maher woke up one day to find that the skin on her back, which she had compulsively picked at for years, had healed. He bled so much from picking that he avoided wearing white. Maher hadn’t realized he’d stopped deciding what to do weeks ago. He told me: “I couldn’t believe it.” The desire had melted away.
The long-term effects of semaglutide, especially on the brain, are unknown. In diabetes and obesity, semaglutide should be a lifelong drug, and its most impressive results are reversed as soon as people leave. “Wealth returns; eating disorders can be fatal,” says Janice Jin Hwang, an obesity doctor at the UNC School of Medicine. The same is true of other habits. Doctors have noticed a surprising connection between alcoholism and other treatments for obesity: Patients who undergo bariatric surgery sometimes experience “transfer of habits,” where their impulsive behavior goes from food to alcohol or drugs. Bariatric surgery it works, in part, by increasing natural levels of GLP-1, but whether the same transfer can occur with GLP-1 drugs needs to be studied in longer trials. Semaglutide is a new drug, approved for diabetes since 2017. Understanding the rise of taking it for many years, well, decades in the future.
Maher told me he hopes to stay on medication forever. “It’s very acceptable,” he said, to recognize that his problems have been a matter of biology, not strength. Before semaglutide, she spent 30 years trying to lose weight by counting calories and exercising. He ran 15 half marathons. He lost weight, but he didn’t lose weight. On semaglutide, the food cravings that bothered him even after losing weight are gone. Not only has he stopped picking his skin; he has also stopped biting his nails. His mind is quiet now, very peaceful. He said: “This has changed my thinking so much that my life has changed a lot.” He would like it to be that way.