The 5-HT2C mechanism deserves more attention in how we counsel patients. “Decreased interest in reward-seeking behavior” is listed in clinical language as if it is comparable to mild nausea. It is not. It is a qualitative change in how a person experiences daily life, and we do not have good tools for measuring it or even asking about it.
From the pharmacy side, this piece names something we are not accounting for in coverage decisions either. Utilization management criteria for GLP-1s are built around BMI thresholds and comorbidities. Nobody is asking whether the patient’s experience of motivation and desire fundamentally changed, because that is not a metric. Patients are reporting it consistently enough that the pattern deserves a more honest clinical conversation than “the benefits outweigh the risks
Exactly! As i say above, I'm actually bullish on GLP1s as category as they are life saving for many and science, even though evolving, only seems to show all other benefits, incl. longevity. But there is the unspoken part of it - the desire for life. Somewhere this needs to be tracked, at least on an individual level to spot where there might be time to get off it..
I am also fascinated by the “flattening of life” side effects. For my latest piece, the six folks I interviewed hadn’t experienced it…but I still wonder how dampening hunger would not also dampen other desires! Need to do more research, thank you for this piece.
The 5-HT2C mechanism deserves more attention in how we counsel patients. “Decreased interest in reward-seeking behavior” is listed in clinical language as if it is comparable to mild nausea. It is not. It is a qualitative change in how a person experiences daily life, and we do not have good tools for measuring it or even asking about it.
From the pharmacy side, this piece names something we are not accounting for in coverage decisions either. Utilization management criteria for GLP-1s are built around BMI thresholds and comorbidities. Nobody is asking whether the patient’s experience of motivation and desire fundamentally changed, because that is not a metric. Patients are reporting it consistently enough that the pattern deserves a more honest clinical conversation than “the benefits outweigh the risks
Exactly! As i say above, I'm actually bullish on GLP1s as category as they are life saving for many and science, even though evolving, only seems to show all other benefits, incl. longevity. But there is the unspoken part of it - the desire for life. Somewhere this needs to be tracked, at least on an individual level to spot where there might be time to get off it..
I am also fascinated by the “flattening of life” side effects. For my latest piece, the six folks I interviewed hadn’t experienced it…but I still wonder how dampening hunger would not also dampen other desires! Need to do more research, thank you for this piece.