Ozempic makes users kick addictions; understand – 06/09/2023 – Balance

“I can’t drink beer. I completely lost the will. I don’t even go down. And I love beer”, writes a patient undergoing treatment with Ozempic in one of the many groups on social networks on the subject. “I was a chocoholic and now I can’t eat chocolate anymore. My life is eating oranges”, says another user of the medicine.

Created for the treatment of type 2 diabetes and used off-label for weight loss, Ozempic has as its active ingredient semaglutide, a substance that mimics the hormone GLP-1, produced by the gastrointestinal system, and has as one of its functions to warn the brain that the body is satiated.

The substance, however, has generated side effects that intrigue doctors, users and scientists, such as reducing addictions and compulsions far beyond food.

Although not everyone faces these reactions, reports of patients who have stopped smoking, consuming alcoholic beverages and even biting nails and picking their skin are common. Most behaviors are related to anxiety and stress. Science still doesn’t know why this happens or how to control this effect, but studies indicate that the synthetic hormone may be acting on the body’s reward system in relation to addictive substances.

According to psychiatrist Rodolfo Furlan Damiano, a researcher at the Faculty of Medicine at USP (University of São Paulo), the first tests already pointed to the possibility that drugs acting on GLP-1 receptors could modulate impulsive behavior. With the reports that have reached the clinics, the hypothesis has been gaining strength.

“Preclinical studies in rats and humans currently point in the same direction, of a direct effect of GLP-1 agonists on the reward system, most likely by decreasing the release of dopamine after the consumption of substances with the potential to cause dependency,” says Damiano.

This reaction, according to the psychiatrist, is even more curious because it occurs regardless of BMI (body mass index), glucose levels or other markers of satiety. Damiano points out that dopamine is not the only neurotransmitter related to addiction, but it is considered the most important for causing a feeling of well-being.

This dopaminergic circulation happens mainly in a part of the brain called the mesolimbic, located right in the center of the head. “Drug consumption, as well as all behaviors that generate pleasure (and in some cases relief, which is cerebrally confused with pleasure), have the potential for abuse because they hyperactivate this area”, says the researcher.

“The brain tends to want to recover this state of false balance that the substance or behavior causes. In the case of endocrinology, it is important to emphasize that one of the behaviors that gives us the most pleasure and can unbalance this area is the act of eating, especially with food that hyperactivate the above circuitry, like sugar”, says the doctor.

Endocrinologist Carolina Rocha Betônico, a member of Sbem (Brazilian Society of Endocrinology and Metabology) and of the Department of Renal Disease and Diabetes of the SBD (Brazilian Society of Diabetes), observes clinically that semaglutide mainly affects alcohol consumption.

“Many patients report that the habit of drinking alcohol has become less frequent and report not being able to ingest the same amount they consumed before, because they are satiated more quickly”, says the doctor.

Doctor in Health Sciences from USP and professor at the Faculty of Medicine of Assis, Betônico says that in addition to controlling blood glucose levels, medications that act by increasing the concentration of GLP-1 in the body delay the emptying of the stomach.

“They act in the central nervous system on receptors that are involved in appetite control. Consequently, patients have less hunger and control of food compulsion. But recently these drugs have received attention as a potential treatment for some addictions”, points out the endocrinologist .

For the professor, the scientific search should be for confirmation that the reduction in alcohol intake, reported in studies with animals, especially rodents, is also reflected in humans.

“The feeling of satiety that the drug causes, delaying stomach emptying, associated with the situation in the brain, may be the key to explaining the potential reduction in consumption, especially of alcohol”, he indicates.

Betônico reinforces that these drugs still do not have approval for the treatment of smoking, alcoholism or drug abuse.

“The GLP-1 agonists have an action in the regulation of neurotransmitters such as dopamine and GABA, which act by decreasing compulsive eating and, possibly, in part, the impulsivity of other compartments, such as the use of alcohol and drugs. These mechanisms, however, , still need to be better studied”, he evaluates.