Semaglutide – most well known as Ozempic, but also sold as Wegovy and Rybelsus – was developed to treat type 2 diabetes but has now made its name as a weight-loss drug.
However, with prescription rates increasing, reports of other potential benefits are emerging. These range from reducing addictive behaviours, to improving mood and brain function. So could there be more uses for Ozempic?
To answer this, we have to understand how the drug works. Primarily, Ozempic mimics the biological actions of a naturally produced hormone called GLP-1 (glucagon-like peptide 1), one of the major hormones that are secreted by the gut after eating. More specifically, GLP-1is part of the complex pathways that signal to the rest of the body that food has been eaten.
These pathways not only prevent over-consumption by signalling satiety (that feeling of satisfaction that comes after eating), but they additionally trigger other biological pathways that allow your body to use the nutrients that come from food. This includes an increase in the production of insulin, vital in transporting sugar (glucose) from the blood and into cells to be used as energy.
Thus, by enhancing the promotion of insulin secretion, Ozempic (and other drugs that mimic GLP-1) helps treat type 2 diabetes. It also helps treat obesity by suppressing appetite.
Ozempic is about 95 per cent similar to natural GLP-1, but the small differences make it easier for it to bind to carriers in the blood – and harder for it to be broken down. This means that instead of peaking and then dropping rapidly after a meal (like GLP-1), Ozempic can stay in the system much longer – and reach more organs.
As hinted above, reports have emerged of other potential effects of the drug. Examples include reduced alcohol consumption and behaviours like smoking and nail-biting, as well as improvements in anxiety, stress and depression. OneDanish studyfollowing users of semaglutide or liraglutide (another similar drug) for five years even found that users had a lower incidence of dementia.
These anecdotes and observations have raised the possibility that Ozempic could be repurposed to treat other difficult-to-treat conditions.
This isn’t a new concept. Drugs are often repurposed, or repositioned, from their original uses.
One well-known example: sildenafil, which you probably know as Viagra. While now a treatment for erectile dysfunction, it was originally designed as a treatment for high blood pressure and angina pectoris (a cardiovascular disease).
An even more historical example is acetylsalicylic acid, known commonly as Aspirin. It was originally marketed over 100 years ago as a painkiller, and only later discovered to be an anti-inflammatory.
Ultimately, it is biologically plausible that by mimicking the actions of GLP-1 Ozempic could have positive effects on both cravings and brain health.
True, natural GLP-1 released from the gut has an appetite-suppressing effect by influencing the gastrointestinal tract. But GLP-1 isn’t just released in the gut in response to eating. It is released by other cells, including neuronal cells. In the brain, GLP-1 has been shown to interact with reward pathways, potentially altering responses to food, alcohol and drugs.
While similar drugs may be given for their pancreatic and appetite-suppressing effect, treating diabetes and obesity, Ozempic can travel widely through the body – including crossing into the brain.
In the brain, GLP-1 may influence inflammation in the brain, which may protect against degenerative conditions like dementia and Alzheimer’s disease.
The reported reduced alcohol consumption may also be linked to changes in appetite. How alcohol impacts us, including how quickly it is absorbed and what side effects we feel changes depending on how much we have eaten. The reduced calorie intakes that could follow using Ozempic might result in changes in drinking experiences and therefore reduce its appeal.
The mood-based changes may also be explained by indirect effects. Weight stigma is linked to poorer mental health, so it is unsurprising that Ozempic users experiencing weight loss may experience improved mood.
Plus, weight-loss is related to feelings of self-efficacy, the belief that one has about their confidence in their ability to engage in particular behaviours. This is in turn an important predictor of behaviour, so Ozempic might be acting as a kick-start to feelings of control here.
Yet, despite all this, more research is needed before recommendations can be made for repositioning Ozempic as a medication for addiction, mental health or neurodegenerative conditions. Studies are needed into the possibilities of the drug, and also into the possible negative side effects. After all, Ozempic can cause nausea, diarrhoea, vomiting, constipation, thyroid tumours, pancreatitis, and kidney and gallbladder problems.
All these effects need to be weighed against the possible benefits of Ozempic. It's only by ignoring the anecdotes and media frenzy that scientists will make the correct decisions about the future of this drug.
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