These medications are super interesting but the effect on addiction makes me wonder what negative side effects they have we don't understand yet. After all, cravings and other drug use behaviors leverage quite general mechanisms of reward, pleasure and desire in the brain and it's hard to imagine tuning those mechanisms won't affect other, potentially desierable behaviors. I certainly know that some people report anhedonia and it would be great if that could be validated or rejected with an RCT.
Those impacts aren't any reason to panic or warn people away -- there is alot of interpersonal variation in psychological traits and if consciously adjusting them helps someone live a better life great -- but I unfortunately suspect there is no free lunch here (just some good bargains).
The news on GLP-1s has seemed too good to be true, but given the strong reductions in mortality, it seems like the benefits are more powerful than any downsides for most patient populations. And these are not new medications: GLP-1s have been around for more than a decade and Ozempic came to market 7 years ago, so we have a long history of safe use already.
In practice, many patients will down titrate if they feel their dose is too high and causing anhedonia or sustained nausea. It seems that people end up at a wide range of dose levels.
An open question is whether people will be able to remain craving free from substances after discontinuation. This is difficult with food, since no one can stay abstinent, but might be possible with other substances.
Yes I absolutely agree with that re: addiction. I originally even included that in my comment but incorrectly thought it would be clear. And I agree about clear side effects like nausea and even evident anhedonia. What I was trying to raise is the possibility that it affects forms of desierable positive motivation in the same subtle way it seems to defang cravings for food and drugs.
If the effect is as subtle as it is for food I doubt most patients would realize the reason they haven't quite managed to put in the little bit of extra effort as often to get the reward of checking off your todos, pleasing a boss, finishing a project or getting up to check out the new place in town. After all shouldn't we expect that it will effect both cravings and desires that motivate us in good ways as well as bad ones? And what about the craving for exercise? And maybe it's all good but I think we should assume the drug can't tell when the craving makes us better off and since we aren't completely sure where or if that effect might pop up it's worth paying attention.
I mean my wife went on Ozympec several months ago and I agree it seems all good (to point I may ask my doc about it). But at the same time if she was experiencing the same subtle effect on some good habit she gets with food I dunno if she of I would realize it had anything to do with Ozympec. Even if it has some mild negative effect on some kinds of motivation the trade-off will likely be positive for many but I do think it's something that should be considered until it's absence is explained.
These medications are super interesting but the effect on addiction makes me wonder what negative side effects they have we don't understand yet. After all, cravings and other drug use behaviors leverage quite general mechanisms of reward, pleasure and desire in the brain and it's hard to imagine tuning those mechanisms won't affect other, potentially desierable behaviors. I certainly know that some people report anhedonia and it would be great if that could be validated or rejected with an RCT.
Those impacts aren't any reason to panic or warn people away -- there is alot of interpersonal variation in psychological traits and if consciously adjusting them helps someone live a better life great -- but I unfortunately suspect there is no free lunch here (just some good bargains).
The news on GLP-1s has seemed too good to be true, but given the strong reductions in mortality, it seems like the benefits are more powerful than any downsides for most patient populations. And these are not new medications: GLP-1s have been around for more than a decade and Ozempic came to market 7 years ago, so we have a long history of safe use already.
In practice, many patients will down titrate if they feel their dose is too high and causing anhedonia or sustained nausea. It seems that people end up at a wide range of dose levels.
An open question is whether people will be able to remain craving free from substances after discontinuation. This is difficult with food, since no one can stay abstinent, but might be possible with other substances.
Yes I absolutely agree with that re: addiction. I originally even included that in my comment but incorrectly thought it would be clear. And I agree about clear side effects like nausea and even evident anhedonia. What I was trying to raise is the possibility that it affects forms of desierable positive motivation in the same subtle way it seems to defang cravings for food and drugs.
If the effect is as subtle as it is for food I doubt most patients would realize the reason they haven't quite managed to put in the little bit of extra effort as often to get the reward of checking off your todos, pleasing a boss, finishing a project or getting up to check out the new place in town. After all shouldn't we expect that it will effect both cravings and desires that motivate us in good ways as well as bad ones? And what about the craving for exercise? And maybe it's all good but I think we should assume the drug can't tell when the craving makes us better off and since we aren't completely sure where or if that effect might pop up it's worth paying attention.
I mean my wife went on Ozympec several months ago and I agree it seems all good (to point I may ask my doc about it). But at the same time if she was experiencing the same subtle effect on some good habit she gets with food I dunno if she of I would realize it had anything to do with Ozympec. Even if it has some mild negative effect on some kinds of motivation the trade-off will likely be positive for many but I do think it's something that should be considered until it's absence is explained.