A Man Stopped Gambling, Drinking, and Watching Porn. He Wasn’t Trying To. Ozempic Was.
Big Pharma Made $26 Billion Selling a Drug That Rewires Your Brain’s Relationship With Pleasure. The Research on What That Means Is Scheduled for “Eventually.”
There’s a man on Reddit who says he stopped gambling, drinking, biting his nails, and watching porn—all within three weeks of starting Ozempic.
He wasn’t trying to quit any of them.
His credit card bill dropped by half. He left an unfinished drink at a restaurant for the first time in his adult life. He walked past a casino in Las Vegas and felt nothing. The man who once couldn’t pass a Buffalo Wild Wings without calculating how many beers he could have before his wife noticed was now strolling past slot machines like they were decorative plants at a dentist’s office.
He posted to ask if the injection was broken.
It wasn’t broken. It was working exactly as designed. The problem is nobody told him…or his doctor, or the FDA, or apparently anyone at Novo Nordisk, that the design included “may also eliminate your interest in being a person who wants things.”
I’ve been a licensed therapist for forty years. I’ve watched patients wrestle with addiction, compulsion, and the gap between what they want and what they want to want. I’ve seen every weight loss trend, every miracle cure, every “this one’s different.”
I’ve also sat across from people who came in describing something I didn’t have a name for yet — and watched the research scramble to catch up with what they were already living. And I’m telling you: this one actually is different. Not because it works—lots of things work temporarily. Because it works by changing what you are, and we’re only now starting to ask what that means.
TikTok Has Opinions. TikTok Is Wrong.
Search “Ozempic personality” on TikTok and you’ll find two narratives colliding at highway speed—like a Prius full of wellness influencers T-boning an ambulance full of psychiatrists while a pharmaceutical rep films it for LinkedIn.
Narrative One: Miracle Drug Unlocks True Self
Videos with millions of views show people claiming their “food noise” disappeared overnight. The constant mental chatter about what to eat, when to eat, whether to eat—poof. Gone. Silenced. They describe feeling “free” for the first time, like their brain finally shut the hell up after forty years of screaming about Taco Bell at 2 AM like a drunk roommate who won’t go to bed.
One user compared it to living with a toddler in her head who’d been demanding Cheez-Its since 1987 and suddenly, blessedly, fell asleep mid-tantrum.
Another said she walked past a bakery and felt nothing. A bakery. The croissants were RIGHT THERE. This is either liberation or the first fifteen minutes of a disaster movie where everyone’s laughing at brunch and the audience is screaming “WHY IS NOBODY READING THE LABEL” at their screens.
Narrative Two: Drug Steals Your Personality
Other videos show users reporting they’ve become “emotionally flat,” unable to feel pleasure in anything—food, sex, hobbies, relationships, sunsets, puppies, their spouse, their children, the existence of joy as a concept. Some describe it so severely they watched their own kids open Christmas presents and felt like they were observing strangers through a security camera.
One woman said she felt like “a character in The Sims being controlled by a player who got bored and just keeps making her go to work.”
The Daily Mail calls it “Ozempic zombie.” Reddit calls it “dopamine death.” Women’s Health calls it rare. Men’s Health calls it concerning. The New York Post has written fourteen articles about it because they’ve discovered that “Ozempic” in a headline prints money faster than the drug itself.
Nobody’s calling it understood. Because nobody understands it. Including—and I cannot stress this enough—the people who made it, sold it, approved it, and prescribed it to fifteen million Americans.
Dopamine Doesn’t Negotiate
Quick disclaimer before we go further, because I’m a therapist and disclaimers are basically my love language: this isn’t an argument against Ozempic for people who actually need it. Type 2 diabetes. Serious cardiovascular risk. Real medical indications with real benefit data. Those people should absolutely have access to these drugs. This article is not for them.
This article is for the other fifteen million. The ones who got Ozempic from an app that asked four questions and accepted Visa. The ones whose ‘medical consultation’ lasted until their credit card cleared. The ones where the most thorough part of the process was the shipping confirmation email.
Here’s the uncomfortable truth that neither TikTok narrative captures: these drugs work in the brain. That’s not a bug. That’s how they were designed.
The pharmaceutical industry created a diabetes medication that also happens to reorganize your entire relationship with pleasure, and somehow everyone is acting surprised that it reorganized people’s entire relationship with pleasure. Imagine being shocked that the sledgehammer you bought to hang a family portrait also took out the drywall, cracked the foundation, and somehow ended your marriage. The sledgehammer worked. You just didn’t read the fine print about collateral damage.
Dr. Anna Lembke, Stanford’s addiction medicine chief and author of Dopamine Nation, put it this way: these drugs reach into the brain’s motivational system and mess with dopamine — the chemical your brain uses to decide what matters right now.
And here’s what forty years of pop science got wrong: dopamine is not the pleasure chemical. It was never the pleasure chemical. It’s the significance chemical — it fires when something unexpected happens, when a prediction turns out wrong, when your brain needs to update its model of how the world works.
TikTok called it “the happy chemical” and the entire internet nodded and the actual science watched this happen from the corner of the room, weeping softly into its methodology section.
Now here’s the part that should make you nervous. Your brain’s ‘significance-tracking system’ doesn’t have clean categories. Food and marriage and ambition and joy are all running through overlapping circuits that share equipment like a college house of frat boys shares a bathroom — technically separate, absolutely interconnected, and you will absolutely regret assuming otherwise.
So when a drug walks in and starts rearranging things — nobody actually knows which rooms get hit.
The circuits that make you want a third slice of pizza overlap with the circuits that make you want to have sex, feel proud of your kid, enjoy a song, look forward to a vacation. Overlap. Not identical.
The brain is not one wire running through everything. It’s more like an old house where the plumbing and the electrical and the gas line are all running through the same wall — technically separate systems, absolutely sharing infrastructure, and you will regret assuming otherwise.
Alcohol craving has its own dedicated infrastructure — GABA, opioid pathways, systems that have absolutely nothing to do with why you want a Chalupa at midnight. Sexual motivation runs through hormonal and hypothalamic circuits that have never once consulted the food department. The brain is not one unified system that wants things. It's seventeen different departments that occasionally share a fax machine.
So what does semaglutide actually do in there?
Not what you’ve been told.
It’s not a volume knob. We all loved that metaphor — clean, scary, it explained the man on Reddit who stopped gambling AND stopped caring about his garden AND started watching his kids open Christmas presents like he was observing a nature documentary. One dial. Everything quieter. Made sense.
Wrong.
One study found the drug made people less interested in food while making them more interested in exercise — at the same time (preprint). Same drug. Same brain. The researchers stared at this data and wrote the word "complex," which is what scientists type when they want to say "what the hell" but they need grant funding.
The follow-up confirmed it's not just one system — it's doing different things in different parts of your brain simultaneously, depending on stuff we haven't mapped yet.
So to summarize: we don't have a steering wheel, we don't have a map, and fifteen million people are already in the car. Some of them are losing weight. Some of them can't feel their hobbies anymore. The scientists are in the back seat using the word "complex" and asking if anyone brought snacks.
We don’t know which ones.
Neither does your doctor, to be fair.
Novo Nordisk definitely knows — they just haven’t mentioned it yet, possibly because they’re still checking.
The “Ozempic personality” is real. The invoice for what it costs is still being calculated. By fifteen million nervous systems. In real time.
A patient I’ll call Darlene — never treated for anything psychiatric, started semaglutide through her internist after a routine checkup. She came in four months later describing what she called “the weirdest side effect.” She wasn’t sad. She wasn’t anxious. She’d just stopped being interested in her garden, her book club, her marriage, and whether her mother called her back.
She described it as her brain going on “energy-saving mode.” Everything still worked. She went to work, cooked dinner, had conversations. She just couldn’t access anything she actually cared about. Her husband said she seemed more “relaxed.” She said she felt like a house with all the lights on a dimmer. Technically lit. Not quite bright enough to read by.
She’d lost 28 pounds. She was also, somewhere around month four, not entirely sure she was still the person who’d started taking it.
She wasn’t sure which loss bothered her more. Mostly because she couldn’t feel bothered.
You hired someone to organize your closet and came home to find they’d also “organized” your marriage, your friendships, your hobbies, and your will to live. Technically they did what you asked. Technically you should have read the contract. Technically nobody showed you the contract.
They Didn’t Test It on Depressed People. Then They Gave It to Depressed People.
Here’s where the story gets infuriating. Not “frustrated sigh” infuriating. “Flip the table at Thanksgiving” infuriating.
When the phase 3 clinical trials that got Ozempic and Wegovy FDA-approved were designed, psychiatric patients were excluded. Before you aim all your outrage at Novo Nordisk — this wasn't their innovation. The pharmaceutical industry has been excluding complicated patients from drug trials for decades. It's standard practice. The logic is: messy people make messy data, and messy data is bad for stock prices. Novo Nordisk didn't build this tradition. They just inherited it, benefited from it enormously, and have since found the subject considerably less interesting than their stock price.
Let me say that again, slowly, so the full absurdity can sink in like a pharmaceutical company’s ethics sinking into a pile of money:
A drug that affects the reward system—the exact system that malfunctions in depression, anxiety, addiction, eating disorders, and basically every condition that makes people want to not be alive—was tested almost exclusively on people without any of those conditions.
The trials that got these drugs approved for obesity specifically excluded people with major depression. The very population most likely to experience psychiatric effects—and most likely to be harmed by them—was deliberately kept out of the research that determined whether the drug was safe.
Picture this: testing a new swimming pool by only allowing people who can’t swim to stand on the deck, declaring it safe based on the zero drownings, and then opening it to the public with a sign that says “PROBABLY FINE.”
We then gave it to millions of people, many of whom have brain chemistry that is already struggling, and we are now acting confused about the results.
We Named the Disease After the Drug Cured It
Before Ozempic became the main character of TikTok's health content, "food noise" wasn't a mainstream clinical term. It lived in eating disorder and ADHD communities, where people had been using it for years to describe exactly this experience. It wasn't in medical textbooks. It wasn't a formal diagnosis. It had not entered the medical literature.
Now it has over a billion TikTok views and its own Wikipedia page.
We invented a medical concept retroactively because patients kept describing something that didn’t have a name. Researchers are now scrambling to define it after the fact—writing papers, proposing frameworks, debating criteria—for a phenomenon that became medically relevant because a diabetes drug accidentally treated it and people noticed.
We discovered a new continent because a bunch of tourists kept accidentally ending up there and posting about it. Now cartographers are trying to draw maps based on Instagram stories.
In plain English: some people’s brains won’t shut up about food. And we finally named it because a diabetes drug made it go away, and people started asking what exactly had disappeared.
But here’s what neither the researchers nor the TikTok creators are grappling with:
If your brain can’t stop thinking about food because it’s trying to keep you alive—because that’s literally what brains evolved to do—and you pharmacologically suppress that signal... what happens to the other signals? The ones telling you to connect with people? To pursue goals? To feel satisfied? To want a future?
We’ve pathologized “food noise” without asking whether some of that noise serves a purpose. We’ve celebrated silencing it without asking what else gets silenced.
We threw a party because the smoke alarm stopped beeping and didn’t check whether the house is on fire.
Counterpoint: For some people, the noise was genuinely unbearable. It ran their lives. It destroyed their health.
Counter-counterpoint: We still don’t know what we turned off when we muted it. And the volume knob doesn’t have labels.
The Studies: Dangerous. Also Safe. Also ¯\_(ツ)_/¯
The research on these drugs and mental health is a contradiction machine that would give any psychology graduate student a dissociative episode.
I know what you're thinking: if the research points both ways, why am I spending 4,000 words on the scary direction? Because the good-news version is already on every pharma website. The bad-news version is what your doctor isn't mentioning before handing you the prescription.
Some large studies found users had dramatically higher rates of depression, anxiety, and suicidal thoughts. Other equally large studies found users had dramatically lower rates of suicidal thoughts.
If you’re confused, congratulations: you now have the same understanding as the researchers. The difference is they get grant funding to be confused. You just get a prescription and a “good luck out there.”
We’re making population-level safety claims based on studies that systematically excluded the populations most likely to be unsafe. We are building a skyscraper on a foundation made of “probably fine” and wondering why cracks keep appearing.
The Dragon Sleeping on $26 Billion
Yeah. Before we go further, let's acknowledge the elephant in the room.
Actually, it’s not an elephant. It’s a $26 billion dragon with a pharmaceutical degree, sleeping on a mountain of American healthcare dollars while breathing fire at anyone who suggests the gold pile might have side effects.
Novo Nordisk, the Danish company that makes Ozempic and Wegovy, generated $26 billion in sales from these drugs in 2024 alone. Seventy-one percent of those sales—$18.5 billion—came from American consumers. The company’s market value briefly exceeded $500 billion, making it worth more than Denmark’s entire GDP.
Let me repeat that: The company that makes Ozempic became worth more than the entire economic output of the country it’s headquartered in. The drug that might be reorganizing America’s reward system is literally worth more than a country.
(*A sharp-eyed reader correctly flagged that comparing Novo Nordisk's market capitalization to Denmark's GDP is technically imprecise — one is a snapshot of investor valuation, the other is annual economic output. The comparison is all over financial journalism, which is not an excuse. The underlying point stands: Novo Nordisk's quarterly results now function as a leading indicator of Denmark's national GDP, and without its pharmaceutical exports, the Danish economy would have contracted in 2023. The metric was sloppy. The strangeness it was pointing at is real.)
When independent researchers document psychiatric effects, Novo Nordisk issues statements about patient safety being their top priority. When the FDA investigates suicide reports, Novo Nordisk cooperates fully. When prescriptions double year over year, Novo Nordisk expands manufacturing capacity and pays dividends that could fund a small nation’s healthcare system.
None of this means the drug is dangerous. But it should make us skeptical of any research funded by or conducted in partnership with a company whose stock price visibly twitches every time someone tweets “Ozempic made me sad.” That’s not corruption. That’s a nervous system. The company has feelings too. They’re just denominated in kroner.
Four Minutes, a BMI Chart, and a Prayer
Most prescribers of weight-loss medications aren’t psychiatrists. They’re endocrinologists, primary care physicians, and increasingly, telehealth providers who’ve never met you, will never meet you, and have approximately four minutes allocated to your case before moving to the next patient in the queue.
The standard screening before prescribing Ozempic off-label for weight loss typically includes:
Medical history (the condensed version, not the “sit down and tell me about your relationship with food since childhood” version)
Current medications (skimmed)
BMI calculation (thorough)
Insurance verification (extremely thorough)
What it typically doesn’t include:
Psychiatric history review
Depression screening
Explanation that this drug modulates dopamine in your brain
Any sentence containing the phrase “we actually don’t know what this does long-term”
Informed consent that would survive five minutes of ethical scrutiny
Here’s a fun fact that will make you want to scream into a pillow:
Wegovy’s prescribing information mentions monitoring for depression and suicidal thoughts. Ozempic’s prescribing information doesn’t mention it.
They contain the same active ingredient. The same molecule. Semaglutide is semaglutide. The difference is which condition you’re treating—diabetes vs. obesity—and which FDA approval pathway they used.
So: The weight loss version of the drug warns about suicide. The diabetes version of the exact same drug does not mention it. Because when you’re treating diabetes, apparently your brain doesn’t count.
If you’re getting Ozempic from a telehealth app—and millions are—the screening is even less rigorous. Can you pay? Do you have a BMI over 27? Do you have a pulse? Congratulations, you’re approved. Here’s your dopamine modulator. The tracking number is in your email. Have a great day.
The Addiction Twist Nobody Expected
So here's where it gets genuinely confusing from a clinical standpoint. The kind of confusing that makes neuroscientists drink—which is ironic, given the topic.
On one hand, these drugs may treat addiction. A rigorous clinical trial published in JAMA Psychiatry showed significant reductions in alcohol craving and consumption. Animal studies show reduced cocaine-seeking behavior, nicotine self-administration, and opioid relapse. Twelve randomized trials are currently underway testing these drugs for various addictions. This could be enormous—the FDA has approved fewer than 10 medications for addiction despite 48 million Americans affected.
The FDA has approved fewer than 10 medications for addiction despite 48 million Americans affected. A few — buprenorphine among them — actually work. The rest feel like giving someone a pool noodle to fight a house fire and calling it a treatment plan. “Here, this is technically a tool. Good luck.”
On the other hand, these same drugs may trigger or worsen psychiatric symptoms in vulnerable populations. The same dopamine suppression that quiets cravings might flatten mood, reduce motivation, or delete the capacity for joy in someone already prone to depression.
This isn’t a contradiction. It’s the same mechanism producing different effects in different brains.
For someone with alcohol use disorder whose dopamine system has been hijacked by addiction—where the volume knob is stuck on 11 and the only song playing is “drink drink drink”—turning down that volume might feel like relief. Like quiet. Like peace. Like finally being able to hear yourself think.
A colleague who works in addiction medicine described a patient — ten years in AA, multiple relapses, multiple treatment programs. He’d started semaglutide for weight management and called her three weeks in, confused.
“He said the craving just... wasn’t there. Like someone had turned off a TV he’d been unable to mute for a decade. He could walk past a liquor store. He could sit at a dinner where other people were drinking. He described it as the first time in ten years he felt like he was in the same room as everyone else.”
He called it a miracle. My colleague called it promising and terrifying simultaneously…which is about as honest as medicine gets.
For someone without addiction history whose dopamine system was functioning normally—where the volume was set appropriately for a human life—suppressing that response might feel like losing yourself. Like watching your own life through glass. Like becoming a spectator in the movie of your existence, unable to feel invested in the plot.
Consider a patient I’ll call Troy — late thirties, no psychiatric history, started semaglutide through a telehealth app in under eight minutes. He came in four months later, describing what he called “the weirdest side effect.” Something was off but he couldn't name it. Then he figured it out. He'd just stopped being funny.
Other people still laughed. He just couldn't feel whether it landed.
“I used to crack myself up,” he said. “Like, I thought I was hilarious. Now I say something and I can’t tell if it’s funny. I can’t feel whether it’s funny.”
He’d lost 31 pounds. He’d also, somewhere in month two, lost whatever it was that made him Troy.
The clinical challenge is figuring out who’s who before they start the medication.
Currently, we’re not doing that. We’re prescribing based on BMI and hoping for the best.
Hope is not a treatment plan.
Hope is what you have when you don’t have data. Hope is what you offer patients when you can’t offer them answers.
We are currently treating a population the size of a small country with hope and a needle.
What We Know vs. What We’re Pretending
We actually know:
These drugs affect the brain’s reward system—that’s how they work
Many users report reduced cravings for food, alcohol, nicotine, and other substances
Some users report emotional blunting, anhedonia, and personality changes
Clinical trials excluded psychiatric populations, limiting what we can conclude
The studies contradict each other badly enough to justify concern
Novo Nordisk has made enough money to buy a small country and is now working on a medium-sized one
What we’re pretending to know is a better question. Is this safe for people with depression? Unknown. What happens to the reward system after a decade on this drug? Ask us in a decade... we’re currently on year three of a medication people are taking for the rest of their lives, which is fine, probably, we think, maybe.
What happens when people stop? The early data uses the word “rebound” a lot, which is not a word you want in the sentence right after “lifetime medication.” Whether psychiatric effects differ by dose or genetics? Genuinely no idea.
Should we be concerned? Come on.
We’re also pretending to know how to pronounce “semaglutide” consistently. (It’s se-MA-gloo-tide. I’ve Googled it four times while writing this article. The autocorrect keeps changing it to “semi-gratitude,” which is honestly how most users describe the experience.)
Nobody Gets to Be Smug About This
Ozempic and its cousins may be the most important drugs developed in a generation. For people with type 2 diabetes, they represent genuine medical progress—the kind that prevents heart attacks, strokes, kidney failure. The kind that saves lives. For people with severe obesity, they offer options that didn’t exist before, in a medical system that has historically offered nothing but judgment and 1,200-calorie meal plans. Options beyond “have you tried eating less and wanting less?” which, as therapeutic interventions go, ranks somewhere between “just cheer up” and “have you considered not having a chronic condition?”
They may also be pharmacologically suppressing the will to want in millions of people who were never studied before being treated.
Both things can be true. The world is inconvenient like that. Medicine is inconvenient like that. The human brain is inconvenient like that.
The problem isn’t the drug. The problem is the hype machine that wants every medical story to be either miracle or disaster, with no room for “complicated.” The problem is clinical trials designed to prove safety by excluding everyone who might be unsafe. The problem is a $26 billion industry racing ahead of the science that’s supposed to guide it, because the market won’t wait for answers.
If you’re taking one of these drugs, this isn’t meant to scare you. Most users report positive experiences. The clinical evidence so far is more reassuring than alarming for most people.
But if you’ve noticed changes in motivation, pleasure, mood, or desire—for anything, not just food—you’re not imagining it. You’re not crazy. You’re not making it up because you read something on TikTok.
You’re experiencing the mechanism of action in real time. You’re living data.
Your doctor should know about it. Even if they don’t know what to do about it. Even if the answer is “we’re still figuring that out.” At least your experience will be documented. At least when someone finally does the research that should have been done before this drug hit the market, your voice will be part of the data.
The Question We’re All Avoiding
The modern environment floods us with things designed to hijack our reward systems. Junk food engineered for maximum craveability. Social media designed for maximum addiction. Pornography available in infinite variety. Gambling apps in your pocket. The world has become a casino that follows you everywhere, and the house always wins.
Maybe pharmacologically dampening those circuits is reasonable adaptation.
Maybe it’s surrender.
Maybe — and I'm not sure I'm ready to say this out loud — it's the beginning of a future where we chemically modify our capacity to want things because we've built a world with too many things to want—and we've decided it's easier to fix the people than fix the world.
TikTok can call it whatever it wants. Reddit can debate whether it’s real. The New York Post can chase clicks until the heat death of the universe.
Somewhere right now, that man from Reddit is walking past a Buffalo Wild Wings. He feels nothing. His credit card bill is half what it used to be. His wife hasn’t had to count his beers in months.
Is he free? Is he missing something essential? Is he better off?
The research that could tell him is scheduled for completion in approximately “we’ll get back to you.”
The “Ozempic personality” is real.
We just have no idea what it costs. The invoice is still being calculated. By fifteen million nervous systems. In real time.
I've been doing this for forty years. I've never had less certainty about something I think about this much.
Ross Grossman, LMFT, is a licensed marriage and family therapist in California with 40 years of clinical experience. This article represents education, not medical advice—if you’re experiencing changes on these medications, talk to your prescriber. They might not have answers. Nobody does yet. But at least your concerns will be documented, and that matters more than you think.
If you found this valuable, subscribe to THE DIAGNOSIS for weekly psychological analysis that goes deeper than the headlines—and funnier than your anxiety allows.
Know someone wrestling with these drugs—or the decision to start them? Share this with them. They deserve better than TikTok’s hot takes and their doctor’s five-minute explanation.
988 is the Suicide and Crisis Lifeline available 24/7 if you’re experiencing mental health difficulties.
Sources and Further Reading
1. Hendershot CS, et al. (2025). Once-Weekly Semaglutide in Adults With Alcohol Use Disorder. JAMA Psychiatry, 82(4):395-405.
JAMA Network (full text): https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2829811
PMC (open access): https://pmc.ncbi.nlm.nih.gov/articles/PMC11822619/
2. Stanford Medicine News (April 2025). Five things to know about GLP-1s and addiction.
Stanford Medicine Insights: https://med.stanford.edu/news/insights/2025/04/ozempic-addiction-glp-1s-mounjaro-lembke.html
Stanford Report (alternate): https://news.stanford.edu/stories/2025/04/glp1-ozempic-addiction-treatment-research
3. Kornelius E, et al. (2024). The risk of depression, anxiety, and suicidal behavior in patients with obesity on GLP-1 receptor agonist therapy. Scientific Reports, 14:24433.
Nature/Scientific Reports (full text): https://www.nature.com/articles/s41598-024-75965-2
PMC (open access): https://pmc.ncbi.nlm.nih.gov/articles/PMC11489776/
4. Schoretsanitis G, et al. (2024). Disproportionality Analysis From World Health Organization Data on Semaglutide, Liraglutide, and Suicidality. JAMA Network Open, 7(8):e2423385.
JAMA Network Open (full text): https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2822453
PMC (open access): https://pmc.ncbi.nlm.nih.gov/articles/PMC11337067/
5. Brown University School of Public Health (July 2025). A turning point in addiction psychiatry?
6. Scientific American (February 2025). Ozempic Quiets Food Noise in the Brain—But How?
Scientific American: https://www.scientificamerican.com/article/ozempic-quiets-food-noise-in-the-brain-but-how/ (Note: This article appears to have originally published in mid-2024 and was updated/recirculated in February 2025 — the SA link is live and correct.)
7. Arillotta D, et al. (2024). Exploring the Potential Impact of GLP-1 Receptor Agonists on Substance Use, Compulsive Behavior, and Libido. Brain Sciences, 14(6):617.
MDPI/Brain Sciences (open access, full text): https://www.mdpi.com/2076-3425/14/6/617
RESEARCH ADDITIONS:
Dopamine tracks significance and prediction error — not simply pleasure
Schultz, W. (2016). Dopamine reward prediction-error signalling: a two-component response. Nature Reviews Neuroscience, 17, 183–195.
Lloyd, T.N. et al. (2021). Dopamine, Updated: Reward Prediction Error and Beyond. Current Opinion in Neurobiology, 67, 95–102.
Kahnt, T. & Schoenbaum, G. (2025). The curious case of dopaminergic prediction errors and learning associative information beyond value. Nature Reviews Neuroscience.
Alcohol reward involves GABA, glutamate, and opioid systems — not just dopamine
Koob, G.F. & Volkow, N.D. (2010). Neurobiology of addiction: a neurocircuitry analysis. Lancet Psychiatry. Published in PNAS as “Addiction: Beyond Dopamine Reward Circuitry.”
Abrahao, K.P. et al. (2023). GABAergic signaling in alcohol use disorder and withdrawal. Frontiers in Neural Circuits.
Different wants use different neural machinery — rewards are not a single circuit
Volkow, N.D. et al. (2019). The Neuroscience of Drug Reward and Addiction. Physiological Reviews, 99(4), 2115–2140.
Semaglutide reduced food motivation while increasing dopamine signals around exercise simultaneously
Merkel, R. et al. (2025). The GLP-1R Agonist Semaglutide Reduces Motivated Running and Alters Dopamine Dynamics in the Nucleus Accumbens. bioRxiv preprint.
GLP-1 receptor activation modulates dopaminergic, glutamatergic, AND GABAergic signaling — not dopamine alone
Merkel, R. et al. (2025). An endogenous GLP-1 circuit engages VTA GABA neurons to regulate mesolimbic dopamine neurons and attenuate cocaine seeking. Science Advances, 11, eadr5051.
Frontiers in Molecular Neuroscience (2025). Mechanisms of GLP-1 in Modulating Craving and Addiction.
988 is the Suicide and Crisis Lifeline available 24/7 if you’re experiencing mental health difficulties.
At a systems level I find it very disheartening that a large swath of our food supply was hijacked by tobacco companies looking to sell us highly processed, high sugar/salt/fat, terrible for our health, engineered to stimulate our brain reward center foods. And then, after decades of rising obesity, diabetes and chronic health conditions- another industry (pharma this time) sweeps in to sell us a fix and make more millions off us. Its like these industries are rabid dogs fighting over a steak (guess who gets to be the steak) - who will profit off us next?
As a retired RN, I lean into a genetic tendency towards addiction. I was on the same dose of pain medicine (40 mg) every evening for an autoimmune condition. I was able to stop the medicine completely in about six weeks. I don’t believe I am prone to addiction. Per this article I would be in the category of individual without a messed up dopamine system.
My experience on semaglutide meds (initially Victoza and now Trulicity) for my diabetes has resulted in 40 pound weight loss and dampened appetite. Slower gastric emptying. I order smaller amounts of food, take home half for later and pass on by fast food establishments. I’m not sure I had an issue with food noise, but I rarely get hungry now and have to make sure I’m eating enough protein every day…it’s easy to fill up on less healthy carbs.
As someone with a past history of depression and anxiety, I am feeling good. It will be interesting to see what research reveals. We are still biologically programmed as if we were hunter gatherers wandering the planet in search of food. Our bodies have not adjusted to cheap food abundance, marketed to trigger our cravings for carbs, fats and salt.