Did you see a decrease in people gambling / drinking when on the medication?

N=1, I'm on ZepBound and in general my brain is less likely to give in to things that give instant satisfaction.

Actually yes. Not as much as with ADHD medication, but obvious subset of addictive personalities that have relief from addictive behaviors (beyond eating addiction) with semiglutide.

Appropriately enough, (most) ADHD medications also tend to suppress appetites. So much so that weight loss is perhaps the most serious side effect for ADHD meds in children.

Yea, it's specifically warned against. Kids will just plain forget to eat on ADHD meds, which is kinda bad.

I could never eat lunch or sometimes dinner if I took it. I gained like 30 healthy pounds after stopping it at the end of my teens.

I can't drink whatsoever now. I've been on Wegovy for ~4 months. I used to be a VERY light drinker, i.e. like 10 drinks per YEAR (rum and diet coke, glass of wine, or 2-3 beers in a night). I would usually get a drink when my band played. A month or so ago, I got a bourbon, which I'll happily sip for an hour while talking, and I had to force it down, and left over half of it. Same with a beer; I went to a baseball game with some friends, someone bought the group some drinks, and it was disgusting.

It was like whatever enjoyment lightbulb that is usually activated was completely unscrewed, or like trying it for the first time as a kid when an adult lets you try a sip on a holiday. Just sitting here typing and thinking about it has me slightly nauseated. I've been telling people recently I CAN'T drink because of some new medicine I've started.

When I took Adderall in college a few times I had a very similar feeling. You could have told me my favorite restaurant was giving away my favorite food, and it would have been nauseating while I was on the meds.

Same with Naltrexone

Well, that one is used for alcohol abuse disorders.

How much does it cost right now?

Are there any alternatives coming out soon or generics?

For semaglutide, the newest and most potent GLP1.

United States: The main patent is expected to expire around 2032. Monthly Price: $950 - $1,350+ (cash price without insurance)

Norway: The main patent is expected to expire around 2031. Monthly Price: $109 - $301 (cash price equivalent in USD)

I'll note that in the US that 1000+ is the "list price". For those paying out of pocket, both zepbound and wegovy offer coupons available to anyone taking it down to $500 (and I'll note that discounted price keeps coming down, slowly, as well)

> For semaglutide, the newest and most potent GLP1.

Tirzepatide is the most potent GLP1

https://glp1.guide/content/semaglutide-vs-tirzepatide-clinic...

Can't find the post on Reddit right now, but someone broke all three down and it is more nuanced. They act slightly differently in different areas.

Before I started experiments on "my lab rat" with retatrutide, I found that combination of the about half max dose of semaglutide and 1/3 of Max dose of tirzepatide had the best combination of losing weight and lowering side effects. But another "lab rat" did not respond that well to this combo and we keep adjusting it.

Retatrutide so far looks the most compatible, but it is sample of 1.

I've had pretty good results on Tirz, definitely interested in how Reta will compare.

Retatrutide looks to be very effective, but it's not possible to get legally/safely at this point. TONS of experience/knowledge in the r/retatrutide subreddit though, a lot of pretty conscientious consumers in there that have done their research, but obviously impossible to recommend outside of finding a sanctioned study to join.

That said, Reta is a triple agonist[0] and it seems to be quite amazing with good muscle retention as well -- it's unclear if this is just the people who are taking it being more likely to be gym goers. Up until now the only formulation I've seen that specifically targets preserving muscle is GLP1s in combination with bimagrumab[1].

[0]: https://glp1.guide/content/a-new-glp1-retatrutide/

[1]: https://glp1.guide/content/preserving-muscle-glp1s-with-bima...

This is where I failed as a psychologist because I don't have extensive training in pharmacodynamics, so I forgot that "potent" is a specific term in that world. What I meant was: I subjectively believe that Semaglutide is the best choice for weight loss, given the overall profile and response in my subjective clinical experience.

A fancy way of saying: I *think* Semaglutide is best.

Ah -- the linked research trial contains evidence that it is not the best, Tirzepatide is more effective.

Unless you mean that Semaglutide worked best for you, right now the research points at Tirzepatide being most effective for weight loss (says nothing about t2d though).

No, for my patients. Again. Purely subjective and anecdotal.

That US price is way too high. No consumer pays that much. You can buy it straight from Novo for $500/mo.

Lilly also offers it direct to consumer for $500/mo

Lilly offers Tirzepatide for that price, yes. GP is explicitly talking about Semaglutide, though.

Yes.

If these things really boost life expectancy that much, this sounds like a textbook case for eminent domain.

I'm no fan of the patent system, but "patent system promises spoils for coming up with great new drug, companies comes up with great new drug, companies gets spoils" is exactly how it's supposed to work. Yes, it's sucks that you have to pay, but that's how you incentives getting the wonder drugs invented in the first place. (I have my own take on this, but if anything this is a 'textbook case' in favour of the patent system.)

Eminent domain would still require fair compensation to the company, so you'd have to pay them more or less what they'd lose from not having the patent anymore.

(Though I think the term you might be looking for is 'compulsory licensing' or so? Not sure.)

Depending on how transformative the effects are (and the price drop possible upon genericisation) then there could be a compulsory licensing trade to do here.

The drug companies are presumably pricing optimally for profit (but not for maximum public benefit, for which the optimum price is ~0). You could calculate the net present value of the drug companies' total profits attributable to the patent, add on 10% as a bonus, and pay them off. If the welfare gains of having cheap drugs are genuinely greater than the value of the patent to the holder, this would be win/win.

Citation needed for the idea that zero is the optimal price for public benefit. Among other issues, I expect medication compliance would be higher when the patient has to pay for the medication.

I think we probably have data on that (at least in general). That is assuming people react to out-of-pocket payments, and not to how much their insurance or the NHS etc is paying.

That is exactly what I have in mind. "Eminent domain" doesn't mean just taking things with no recompense, but I don't think the company should be entitled to profit maximization at the expense of literally billions of people worldwide.

Eminent domain would be on a jurisdiction by jurisdiction basis. No country has 'billions of people'.

It adds up to the same thing in aggregate.

But also, if you change it to "millions of people", the point is no less valid.

India and China each have billions of people.

India and China both have about 1.4 billion each.

To say 'billions', I'd assume you'd want at least 2?

If this research was done fully via the public system in the first place, it would be an easier nut to crack. I mean, some of it is already, and that’s the absolute worst scenario: the public paid for it via taxes, and now has to pay for it privately after the fact.

The public isn't paying for the phase 2 and phase 3 trials.

Imagine that incentive for R&D.

“If you invest hundreds of millions and it turns out to be life changing, we’re going to seize it”

Eminent domain implies fair compensation.

The point is that you don't get to withhold the drug from people to maximize profits.

Wouldn't fair compensation more or less be equivalent to medicaid paying for the drug? And if so, why eminent domain it?

No. Fair compensation means that the company doesn't end up with a loss, and gets rewarded, but it doesn't mean "give them as much money as they could otherwise extract by exploiting the monopoly that the patent gives them on the market".

Doesn't seem fair to me.

And withholding access to drugs that would extend everyone's lifespan by several years to maximize profits doesn't seem fair to me either. In fact, it's outright sociopathic.

These drugs are covered for the people whose lifespans would be extended by having them! They pay nothing! The situations where insurers/medicaid don't want to pay are more marginal cases. And even then, it's like, 1/5 the cost of child care in a major metro and only getting cheaper. If you're going to use an extraordinary mechanism to seize private property, it better have outsized impact -- seize surface parking lots and sell them to developers to build more housing.

The people can wait seven years for the patent to expire.

Patents are a form of artificial monopoly that only exists because the people (acting through their government as a representative of their will) decided to have them, and did so because they presumably are a net social benefit. Consequently, governments are not obligated to treat them as sacrosanct, and most certainly not in a case where they are not beneficial to public interests.

It's a social contract between the people and the enlightened. The people always win on a long enough timeline. But the deal is there should be some sliver of reward for a brief window of time to those who bring permanent light into our lives.

The "enlightened" are the scientists who actually developed this stuff, not the CEOs and corporate shareholders collecting economic rent from other people's hard work who pocket the vast majority of the profits. If we only had to fairly pay the people who actually did the useful work and not all the capitalist deadweight, these drugs would be orders of magnitude cheaper.

And you think scientists should be working for the communists instead of the capitalists? Well that's fine too. Scientists are like spoils of war. Scientists were treated well and able to do a lot of good work when they were all employed by the soviet state. Maybe not as good as the Americans did. They also seem to be doing well over in China. But just because you don't like someone or how they do business, that doesn't make them deadweight, and no I don't think you know how to get products to consumers cheaper.

Let's not assume self‑interested corporate monopoly rents are a necessary precondition for innovation, and let's drop the romanticized notion that statutory patent terms by themselves constitute a just moral bargain, because history shows substantial discovery emerging from publicly funded science, mission driven nonprofits, collaborative consortia, open licensing, prizes, and advance market commitments, so we should test which incentive mixes work rather than presuppose one. Your "people always win on a long enough timeline" line doesn't answer the moral question of avoidable deaths, irreversible morbidity, or financial ruin before expiry; inevitability ≠ adequacy, and harms incurred during exclusivity remain morally chargeable. Commercialization does not require locking invention behind maximal (often crude, lengthy) IP, there are workable paths via milestone or frontloaded prizes, targeted or indication specific exclusivities, compulsory or voluntary licensing, patent buyouts, tiered pricing, and public manufacturing backstops; optimal mixes will and should differ across high‑income vs low and middle income country purchasing power. The "7‑year wait" is factually thin: statutory patent term is ~20 years from filing, while effective market exclusivity depends on regulatory data protections, biologic exclusivities, secondary or evergreening patents, litigation delays, and manufacturing barriers; patients routinely face restricted access even after nominal expiry. We also shouldn't conflate discovery scientists with development firms, nor firms with shareholders; in practice, salaried scientific labor is often alienated from downstream pricing power while financialization channels can parasitically extract surplus that need not translate into new R&D. Because many medicines and virtually all software have low marginal production cost relative to monopoly price, large deadweight losses arise when willing buyers are priced out, a staggering public welfare loss (and no, "deadweight" is not necessarily a synonym for "people you dislike"). Reading int_19h's rent‑extraction critique as a demand for Soviet central planning, and pivoting to talk of scientists as "spoils of war", is a straw man and a red herring that dodges the pricing structure at issue. If you want to defend the patent regime as a "social contract," we need to see the reciprocal side, access safeguards, anti‑evergreening enforcement, affordability commitments, otherwise it's a moral bargain in name only. Claiming membership among the "enlightened" means actually shedding light on these failures.

Go vomit words at someone else. I didn't even read it lol

Noted. Given your 'Go vomit words' reply, I'll keep this short. In the spirit of good will, I'm happy to engage with anyone who wants to discuss the substance of the argument in good faith, including you, if you ever decide to change your mind. And, just as a reminder, there's no need to keep responding unless you're ready for a serious conversation.

> United States: The main patent is expected to expire around 2032. Monthly Price: $950 - $1,350+ (cash price without insurance)

While 2032 seems very far away now, its actually remarkably soon in the grand scheme of society.

My understanding is one of their defendable moats is the patent not on the compound itself, but on the injectors. Which is far longer.

> one of their defendable moats is the patent not on the compound itself, but on the injectors. Which is far longer.

That is very typical in the drug/medical industry. To the point where it is sometimes (often? usually?) an intentional strategy.

https://sites.uclawsf.edu/evergreensearch/

Yeah, the drug + the injector together are the patentable thing. When the first patent nears expiration, they work on an iteration of the injector or a time release change for the drug, then they get another few decades of product monopoly.

They have also made a business of either stifling or “catch and kill”ing of the generics for their products. It’s cheaper to pay off a generic manufacturer to not compete with the new thing than it is to lose price elasticity of the n non-generic.

This is not correct. New patents cover the new combination, but don't prevent practice of the old combination

Scroll down to the area referencing footnote 9 in this article

https://pmc.ncbi.nlm.nih.gov/articles/PMC11457043/

That articulates it better than I will

Like I said above, they don't extend exclusivity or prevent practice of expired IP. All you have to do is not infringe the new IP. this is what the article says too. I disagree with their greater claim; The patents aren't rocket science- most are extremely easy to read, and the authors are hiding behind weasel worlds like "may" and "could"

There are some bad patents that should never have been granted, like Novartis' famous 631 patent [1]. However, those are the exception, not the rule. If you want to put a generic drug into an auto injector, there are a dozen generic autoinjector companies looking to take your money. Drug + autoinjector does not pass the US patent office non-obviousness test (for obvious reasons). What gets patents is custom design features - bells and whistles. New features are part of the roadmap because customers will prefer them over competition without them, not because it magically extends prior IP (that isn't a thing).

https://www.fiercepharma.com/pharma/regeneron-advances-antit...

What I’ve noticed, is work on extended release formulations only occur close to or near the time of patent expirations.

It’s rarely because of a new technological breakthrough, but rather a way of drug companies lengthening the time they can profit off a drug.

If they released it earlier they would simply take market share from themselves, but by releasing it close to the time of generics they take market share from generics.

Why didn’t Wegovy come out 5 years sooner? Why does it use a different injector than Ozempic? I don’t know but sounds quite similar to the ER/XR strategy.

I don't disagree. That makes perfect sense. Is bad?

Most companies move to improve their product when needed to stay ahead of the competition.

That's how you get improvement.

PS, I read the rest of the paper.

Here are some choice parts:

> Drug manufacturers listed 22 patents after FDA approval of the 10 products in the cohort...Post-approval patents only extended the duration of protection on 2 products (median 4.6 years.

This is makes sense if there is actually something novel to add [keeping in mind the authors are treating any IP as if it protects the entirety of the product. A sugar coating or whatever wont protect the non-sugar coated pill.

To the extent I agree with the paper, it is that the 30 month hold is weaponized and should be reviewed and the issue with settlements should be addressed

I didn’t make the claim that the expired patent prevented the practice.

My comment was a quick and sloppy summary from my memory of an interview from several years ago. I think it was the EconTalk with the author of Drug Wars.

A more detailed and comprehensive list of these tactics to reduce competition either during or after patent expiry:

Patent-related strategies:

• Building “patent thickets” by filing multiple patents on different aspects of the same drug (formulation, dosing, manufacturing processes) • “Evergreening” - seeking new patents on minor modifications to extend exclusivity periods • Filing continuation patents and divisional applications to extend patent timelines Product lifecycle management: • “Product hopping” - making minor reformulations or switching to extended-release versions just before generic entry to move patients to the new version • Discontinuing older versions that generics would reference

Legal and regulatory tactics:

• Pay-for-delay settlements where brand companies pay generics to postpone market entry • Manipulating FDA safety programs (REMS) to make it difficult for generics to obtain necessary samples for testing • Citizen petitions to the FDA raising questions about generic equivalence

Market-based approaches:

• Launching “authorized generics” through subsidiaries to capture generic market share • Exclusive dealing arrangements with pharmacy benefit managers

where do you get that?

There are dozens of autoinjector manufacturers, and generics can and do change manufacturers. It looks like semaglutide uses an off the shelf Yposomate pen, although Novo Nordisk uses different injectors depending on the country and indication.

Novo Nordisk also has an in house pen, but this would not prevent someone from competing, unless patients simply prefer that design to a generic one.

Canada: January 2026(!)

Novo lawyers messed up, didn't renew the patent filing over a payment dispute. Hilarity is ensuing.

https://www.cnbc.com/2025/07/09/hims-hers-generic-semaglutid...

And once generics for GLP-1s are going in Canada, Section 804 of the FD&C act becomes VERY interesting: https://www.fda.gov/about-fda/reports/importation-program-un...

Reimports of generics from Canada into the US here. we. go.

All over 250 CAD

>Novo Nordisk’s lawyers requested a refund for the paid 2017 maintenance fee of $250 Canadian dollars ($185) because the company wanted more time to see if it wanted to pay it, according to letters included in the documents.

>Two years later, the office sent a letter saying the fee, which now included a late charge bringing the total to CA$450, was not received by the prescribed due date.

>Novo Nordisk had a one-year grace period to pay, but never did, and so its patent lapsed in Canada. It lapsed in 2020 when the fee was not received, but it doesn’t expire until January.

LOL, that must be one of the biggest fuck ups in pharmaceutical industry.

Grey market from China is around $250/year for tirzepatide

There are group chats with tens of thousands of people and I havent seen any issues with the drug

That's an insane cost reduction -- $250/month is a common gray market price in the US.

How do you ensure the safety and consistency of anything?

Asking for a friend.

Use stairwaytogray, find a supplier with a history of many many 99+% purity reports from 3rd party testing sent to janoshik, then order 20 vials from that supplier, then either send a vial to janoshik yourself or participate in a group buy test (or just wait for someone else to test the same batch. At that point, it is very likely your ampoules have the same purity and amount. The best supplier seems to currently be sigma audley.

That's the darknet level of drug addicts safety. For poor & desperate much better than nothing, but certainly not without its own risks

Liraglutide is now available as a generic, but it is the least effective of the big 3 (Semaglutide, Tirzepatide, Liraglutide):

Basically, Tirz > Sema > Lira

https://glp1.guide/content/semaglutide-vs-tirzepatide-clinic...

https://glp1.guide/content/semaglutide-liraglutide-continue-...

https://glp1.guide/content/another-generic-liraglutide-launc...

I used to be prescribed Victoza (for diabetes). When liraglutide (the generic) went off-patent, every pharmacy reported that both Victoza and liraglutide were "no longer available".

The generic manufacturers get paid not to make it.

https://www.theatlantic.com/ideas/archive/2023/06/pharmaceut...

Liraglutide isn't fully comparable. On aspect that's a lot touch for many is it's a daily injection. More needles is a turn off for some that can manage 1x/week.

Daily needles vs 12K a year is a tradeoff many people may consider. Especially if insurance companies mandate Liraglutide as a first line treatment.

It’s one people need to consider, but it’s one that the people needing it the most won’t do.

It’s a massive problem for several of my friends who are doctors. Patients start on something that works incredibly well for them then their insurance pushes them to Litaglutide and they loose all of their progress.

Some of it comes down to a fear of needles, some of it comes down to non-compliance, some of it comes down to access.

Daily injections are fatiguing on people. Its a big challenge with diabetes management.

It’s unlikely new meds will be approved this year (unless the FDA really does speed up approval processes) I made a tool to compare prices: https://www.glpwinner.com/ If you’re on name brand without insurance coverage you’re sitting around $499 a month. On compounded you can get between $150-300 a month. If you live somewhere expensive like the bay and eat out a lot you are likely saving money by being on the medication.

Having ADHD myself, and a bunch of friends who also have it, I have noticed that the people with this condition rarely have a healthy relationship with food. There is either a tendency to overeat indulgent foods, or a tendency to not think about food that much.

I have also heard about people with ADHD being on GLP1 agonists that it does a lot for their reward seeking behavior and impulse control.

This makes me wonder two things:

- Whether at some point these molecules will also start being used for ADHD and addiction treatment in general. I think they hold a lot of promise for issues rooted in the reward system.

- Whether a sizable portion of people who struggle with their weight have co-morbid ADHD which creates or worsens their overeating issues.

Have you noticed anything along these lines in your practice?

As someone with diagnosed ADHD. I fully agree. There's some background thread that says "you, now, eat". It's almost impossible to shut off.

That being the case, the same behaviours have led me to a compulsive need to plan meals. Doing so has helped me lessen (not eliminate) food noise. Anecdotally, I've noticed with others as well, that this is the way. Prep - be fine. Don't prep - eat a small village.

Also ADHD here, and same thing for me. Hyperfixating on meal planning and strength training has pretty much saved me. It's hard, and I still have to fight food noise daily, but having everything pre-prepped means I have easy, friction free healthy choices instead of reaching for a bag of chips and downing the entire thing while sitting at my desk, or not having the executive function necessary to cook an un-prepped, unplanned dinner and just eating a whole pizza instead.

I also used to binge, and meal planning and pre has also helped with that, as I tend to have periods of either really high food drive, or almost no food drive at all leading to not eating for an entire day, then downing 3000+ calories in one meal.

ADHD sucks. It's often trivialized in pop culture, but it makes life so difficult, and those real difficulties are almost never talked about.

I am a strong believer that the biggest "thing" in ADHD is the challenge with sustained goal-focused behavior. And that is in large part due to how fucking hard it is to stay on task when you have ADHD. It's not uncommon to hear people like you who are able to keep control by focusing on the few things that make the most sense and are the most motivating. And even with a perfect target for behavior, it's a battle to keep at it. That is why I think a lot of people get adult-onset ADHD diagnoses—because they are burned out from spending 2x the energy to keep their life and behavior on track.

Do you have kids? Even when I meal prep, tasty kids foods draws me in like a bug to a night time light.

As I wrote to another person here: Yes. Not as much as with ADHD medication, but there is an obvious subset of addictive personalities that find relief from addictive behaviors (beyond eating addiction) with semaglutide.

But to add to this, I feel like there are different kinds of addictive behaviors at play that are more susceptible to one medication or the other and are based on different systems.

For instance, the food-craving reduction in GLP-1 is almost certainly not just related to reward and goal-seeking behavior. It literally affects hormone signaling for satiety, and slows down the movement of food through the stomach, and affects, globally in the body, responses to metabolic signals. And it probably has a global effect on the way every cell in the body works, which might be why there are positive health effects beyond just the weight loss.

ADHD medication, on the other hand, targets the goal-directed activity system directly. It seems much more likely to me that reduced appetite is just as much driven by the focus and "let's get shit done" mode that is artificially increased with dopamine. Both result in reduced eating but through massively different pathways. Basically, you pay attention to the biggest wave in the pond (the waves in the pond being a metaphor for all the things your brain COULD pay attention to). So when the goal-stuff gets increased in size, the food-seeking is automatically smaller by comparison, and less likely to drive your behavior and thinking.

I don't think I can say that there is much of a pattern between ADHD and overeating, just based on how easily I can predict if someone is overeating or not if I know they have ADHD. That is, it would be a coin toss.

The simplistic answer would be: Semaglutide reduces addictive behavior if it's driven by emotional regulation needs, and ADHD medication reduces pure drug-like craving. As seen in studies where people that start lisdexamfetamine (ADHD medication common in the EU) have a huge reduction in actual amphetamine abuse.

Case in point: https://jamanetwork.com/journals/jamapsychiatry/fullarticle/... Findings In this Swedish nationwide cohort study of 13 965 individuals, lisdexamphetamine was significantly associated with a decrease in risk of hospitalization due to substance use disorder, any hospitalization or death, and all-cause mortality.

> I don't think I can say that there is much of a pattern between ADHD and overeating, just based on how easily I can predict if someone is overeating or not if I know they have ADHD. That is, it would be a coin toss.

Person you responded to suggested P( overeating | undereating ) as opposed to your P( overeating ). I expect the effects of those two conditions would tend to cancel each other out in observations.

> As seen in studies where people that start lisdexamfetamine (ADHD medication common in the EU) have a huge reduction in actual amphetamine abuse.

Perhaps I misunderstand you but lisdexamfetamine _is_ an amphetamine. That reads like saying that people prescribed an opiate exhibit reduced opiate abuse. It seems either tautological (not abuse because permitted) or obvious (cooperative supervised use reduces bad things happening) or perhaps related to drug safety (A simply being safer to use than B).

Regarding under- and over-eating: it seems you think I am a simple mathematical average that doesn't factor that in. I stand by my observation, as and observation, not fact.

Lisdexamfetamine is not amphetamine—not chemically, not in terms of its half-life, not in subjective experience, and not in any study that tracks behavioral or long-term effects. At best, it's a prodrug of an enantiomer of amphetamine. You are also mistaken about the study. Reading even the abstract would clear that up for you.

Let me clean up the unnecessary, convoluted language before I answer: Q: Does it stop being called "abuse" once a doctor prescribes it? A: No. The prescription stopped hospitalizations due to amphetamine overdose.

Q: Is it simply safer to use drugs with a doctor's help? A: That was not answerable based on the study's design. It is also not a useful question to ask in this context, since it's comparing apples and oranges. Some of the worst cases of drug abuse are created and maintained by doctors. However, taking drugs collaboratively with a doctor is probably safer on average than getting them from random webpages.

Q: Is this specific amphetamine safer than others? A: Yes, as is the case with any substance we ingest. You can quibble over the details, but beer is safer than hard liquor. Likewise, different medications in the same category or receptor affinity group have different LD_{50} doses (the ratio of the clinically effective threshold to the threshold where 50% of subjects would die).

> it seems you think I am a simple mathematical average

No, I was merely inquiring after what appeared to be a misunderstanding but apparently wasn't.

> Lisdexamfetamine is not amphetamine

Just to clarify, this topic is always needlessly confusing because "amphetamine" is used to refer to both a distinct chemical as well as an entire class of chemicals. Lisdexamfetamine is _an_ amphetamine in exactly the same way that codeine is an opiate (ie a prodrug of).

I'm not sure why you think I'm mistaken about the study nor why you are so condescending about a misunderstanding rooted in terminology. You yourself state that it is about relative drug safety and the study is also quite clear about this so it would seem that we were in agreement all along.

Because I get triggered when people are illogical while using excessively complicated language and do not try to understand the points being made. Like in this comment, I clearly laid out all the ways I think lisdex != amphetamine. But you are once again answering in an obvious way without engaging my points.

If you look elsewhere in my comments, I have no problem calling myself an idiot when I make mistakes. But I hate the noise that is bad faith arguing concealed in fancy words.

> Semaglutide reduces addictive behavior if it's driven by emotional regulation needs

Emotional regulation issues are one of the most difficult ADHD traits and it's quite under recognized for how badly it affects many of us. This is likely the reason why anxiety misdiagnoses are also fairly common.

I believe you 100%. I have a history of substance abuse with bad consequences. I quit alcohol and now my drug is food. People tell me I'm a "supertaster." I can taste many of the ingredients in my food that others can't.

I also have BPD and am in therapy for it, but man. Food is the drug that always works. When I get into a certain mode, it's like I don't care that I'm overweight and have high blood pressure. I just crave the deliciousness and the "full feeling." And it never fails to work! I always feel more calm and happy after I eat.

Reminds me of a client I had once. He said that the only thing that made him reset was to "pig out" with a carb-overdose, then just sit in front of the TV with a sugar high.

Incidentally, I had been nagging him about trying ANYTHING (in addition to the therapy we were doing to find a life goal he believes in) that might help him get SOME help. Be it Adderall or Ozempic. But people are complex, and at best, a person is a Venn diagram with massive overlapping "biological susceptibility," "life situation," "negative thinking style," and inertia. The best one can do is to pull at as many threads as possible to hope the suffering unravels. So one of the threads one can pull at are medication.

Not to give advice, but just for shits and giggles, look into "vulnerable narcissism." Many describe stuff like you do and fit those traits. And don't give a shit about the negative associations and stereotypes regarding this personality. I love narcissists! It's one of the coolest personalities there is! But when you are not allowed to be proud of yourself, and all the desire for status and power gets refocused onto self-hate and learned helplessness, then it's a monster of a situation. Had so many people become awesome versions of themselves when they stop being so afraid of being arrogant :) .

Just to remember when you read about it, that the descriptions are only in the context of things having gone wrong. Every trait can manifest as something good or negative. Even psychopaths can have good and prosocial lives. For instance, some of the best ambulance workers often have high loading on psychopathy, and that makes them better at their job. Because they don't get scared. I’d rather be picked up by an ambulance worker that is curious and thinks the situation is interesting than one that is panicking and losing due to anxiety and empathy overload.

This is just a long-shot association/pattern I noticed, though. It's not worth a dime more than the sentences you put into the machine. :P

Do you have any thoughts on GLP-1s for ADHD? I have tried the stimulants (legally) without success, and am reluctant to try the non-stimulants since their success rate seems pretty poor and side effects seem worse.

I answered it a couple of places in this thread already, but the short answer is yes, and GLP1 is not usually a good way to core ADHD treatment.

However, if you tried stimulants without success, this would be my descending list of things that need to be sorted out:

- Have you tried multiple types of medication? A lot of people give up after 1 or 2 different types. But I have seen MANY people who get completely new lives, but only after the 5th type they tried that matched their biology. - Do a diagnostic re-evaluation to make sure that one is not misdiagnosing ADHD (the most common confusion is anxiety and personality). - Map out the life situation. Circumstances might be a stronger explanation of the situation than internal psychological vulnerabilities. - Make sure that you get a blood-mirror (Norwegian concept) so you know you have proper absorption/amount in blood.

Can you talk about people who discontinue for GI side-effects? I understand they are present for a short duration, but have heard anectdata that they persist for months for some people.

Have you observed persistent GI side-effects in your own practice, and if so, do you believe these are legitimate? Or… are they a social cover for individuals to get back to eating for psychological coping?

It's not just GI side effects. Semaglutide is genuinely GI TOXICITY. That's why it's EXTREMELY important to ramp slowly. So yeah, it's a thing. But for basically everybody, it's manageable with slow and controlled ramping of dosage. There has been hard to find any lasting danger if you ramp slowly.

There has been almost a hysteria, it seems, regarding "Pancreatitis." And when I see multiple diagnoses, medications, and reports associated with Pancreatitis, I recognize a pattern I have seen many times before. Both the mental health and medical fields have periodic fixations on certain symptoms or diffuse diagnosis, and when it has the "wave-like" pattern like this, I am willing to bet it's just the latest version of "Fatigue," "Whiplash," "Repetitive Strain Injury", "lactose intolerance" or the dental amalgam controversy. Don't get me wrong. These are real things. But sometimes they just balloon beyond anything reasonable, and an unreasonable amount of people suddenly get diagnosed with it or suspect they have it. Pancreatitis is giving me that vibe over the last year or so. Copy paste this for "Stomach Paralysis".

But let's say the social benefit of alcohol has a value of 100 and a health risk score of 100. I would say that GLP-1 agonists have a health value of 500 and a risk score of 20. Nothing is without risk, but mathematically speaking, if you are overweight, I would be 25x more positive about injecting myself with Ozempic than alcohol... mathematically at least.

And to answer your question, I personally haven't seen many people stop early due to GI symptoms. And if they did stop early, I would think it was because they genuinely had a physical negative response that was horrible for them. Anecdotally, I feel the people that stop so they can get back to eating usually last at least 6 months, and probably more. I am 100% in agreement with the studies that many stop at around 1 year. So if someone stopped at 2 months, I would belive them when they said it was due to GI symptoms. But if they stopped at 1 year and CLAIMED it was due to GI symptoms, I would doubt; and guess that it was driven by missing food.

Please note that I am speculating wildly, and this is just PURELY anecdotal and stream of consciousness.

I'm in the exact situation you describe:

Overweight due to emotion-eating and stress-eating, taking GLP1.

Now I can binge-eat until I'm full or sick (mostly sick) and maintain weight. If I'd go off GLP1 now my weight would skyrocket.