HealthyGamerGG - We Need To Talk About Ozempic

Episode Date: August 15, 2026

In this episode, Dr. K unpacks the massive and often contradictory mental health conversation surrounding GLP-1 agonists like Ozempic. Moving past the physical weight loss, he breaks down the complex psychiatric side effects—from the "Ozempic personality" to why the medication's impact on depression depends entirely on your starting weight. What to expect in this episode: The Dopamine "Speed Limit": How GLP-1 agonists act like a speed governor on your brain's engine, capping extreme dopamine spikes without affecting your day-to-day baseline levels. This specific mechanism blocks the intense reward spikes (similar to loot boxes or the lottery) that trigger neural rewiring and severe addictions. The "Ozempic Personality" & Anhedonia: Why capping those dopamine spikes can cause a side effect known as anhedonia—the inability to feel pleasure. Dr. K explains how this blunting effect can slowly shrink a person's daily sphere of motivation and activity. Frequency vs. Quantity: Why studies show Ozempic doesn't reduce the number of days you choose to drink, but significantly drops the amount of alcohol you consume. By capping the dopamine response, it blunts the progressive craving that typically makes you want a second or third glass. The Weight Discrepancy: Why obese individuals taking the drug see no net increase in depression, while healthy-weight users face a significantly higher risk of mood crashes. Dr. K explains how the massive hormonal and social benefits of resolving severe obesity balance out the chemical blunting occurring in the brain's emotional regulation centers. Hijacking the Starvation Signal: Why GLP-1 agonists are incredibly dangerous for restrictive eating disorders like anorexia. Normally, a starving body sends strong, protective craving signals that fight against conscious restriction; GLP-1s silence these signals, enabling the anorexic mind to restrict calories down to dangerous extremes. The 5% Trigger: How losing just 5% of body weight can turn on rigid thinking and trigger atypical anorexia in individuals with healthy BMIs who are vulnerable to social media body-image pressures. The Addiction Spectrum: Why GLP-1s successfully curb substances like alcohol, nicotine, and behavioral issues like impulsive shopping, but may paradoxically worsen pornography use. Dr. K's NEW Guide to Love, Sex, & Relationships is here! Order now: https://bit.ly/4dO3x0VHG Coaching : https://bit.ly/46bIkdo Dr. K's Guide to Mental Health: https://bit.ly/44z3SztHG Memberships : https://bit.ly/3TNoMVf Products & Services : https://bit.ly/44kz7x0 HealthyGamer.GG: https://bit.ly/3ZOopgQ Learn more about your ad choices. Visit megaphone.fm/adchoices

Whether life serves you an ace or an unexpected backhand, the high-protein yogurt, Oikos Pro, is there to feed your strength and help you turn every challenge into a smash. Oikos Pro helps build strong muscles and support muscle recovery with high protein and contains no added sugar, because true strength isn't about being able to take the hits. It's about being able to bounce back. Oikos Pro, feed your strength. Visit Oikos.Ca for more details. GLP1 drugs are everywhere. GLP1. GLP1s. People scramble to get their hands on GLP1 drugs. Today we're going to talk about the psychiatric effects of GLP1 agonists or medications like OZempic.

And if you're thinking about taking a GLP1 agonist or if you're taking a GLP1 agonist, what you should be aware of because things are a little bit complicated. Some studies will show improvements in binge eating. Some studies will show increases in anorexia. some studies will show improvements in mood some studies will show triggering of depression and so what's going on here and it turns out that actually all of that is true and that's why we need to dive into it with a little bit more detail so we're going to start off by doing a quick review of glucagon like peptide and what its role is in the body so the first thing to understand is that glp is a hormone so the hormones are chemical signals that travel everywhere in your body

everywhere that blood exists. Okay? So the first thing to understand about hormones is that they have differential effects on different parts of your body. So let's use a simple example of hormone, testosterone. So testosterone has differential effects depending on the tissue that it reaches.

So the skin cells on the top of my head will make me bald. The skin cells over here will make me actually grow hair. The skin cells on my back will also start to grow hair. So it causes a different. pattern of hair growth depending on the target tissue. When testosterone travels to my brain, it'll increase my sense of protectiveness, maybe some degree of aggression, some degree of competitiveness.

When it travels down to my scrotum and testicles, it stimulates sperm production. And so depending on where a hormone travels in the body, it will have a differential effect. And when it comes to GLP1 agonists, this will explain a lot of the contradictory information. So next thing we have to understand about GLPs is what is the role of glucagon like peptide? Why does the body secrete it? What is its job? So GLP is a satiety hormone. Okay.

So satiety is to feel sated, to feel satisfied. So basically, when we eat something, our stomach stretches, glucose gets entered into our bloodstream. And so our body has these two modes. It has a hungry mode and it has a no longer hungry or satisfied mode. And GLP is one of the key signals that tells our body we are satisfied. GLP also works in concert with insulin. So you can sort of think about it like in the same way that you get a food coma from insulin. GLP1 will signal to parts of your brain that we have had enough to eat.

I keep seeing comments. Dr. Kay, how do I apply this to a situation in my life? That's literally why we created a coaching program. Our coaches are certified on an evidence-based curriculum designed to help you get, unstuck. This involves analyzing your patterns, increasing your understanding, and working with you week to week to help you develop a plan to create lasting change. So if y'all are interested, check out the link in the description below. If we look at insulin, insulin is focused primarily on glucose metabolism. So it regulates our blood sugar, okay? But GLP is not related to blood sugar,

but it is related to other parts of satiety. So GLP travels to this part of our brain called the ventral tagmental area, which is where our dopaminergic reward circuitry is. So when we have a craving, that comes from our dopaminergic reward circuitry, right? Like, I want to eat French fries. And then I eat French fries and then it feels pleasurable. So eating food is tied with pleasure. Eating fatty food, having intense cravings for sugary food, all of those are tied to pleasure. And I don't know if you guys have kind of experienced this, but like, hopefully, you know, you can eat a cookie and it tastes really good and then you eat a second one, you eat a third one, you eat a fourth one, you eat a fifth one.

And if you look at the volume of cookies you're eating, they're actually pretty small, right? Like you can eat five cookies. And it's not like the same quantity of food. It's not the same volume of food as, let's say, like a big salad that is like low calories, right? But as each subsequent cookie you eat gives you a reduction in your craving and then your pleasure starts to kind of go down. A lot of that reduction in your pleasure is.

is mediated by GLP. So GLP travels up to your brain and actually inhibits the pleasure that you get from eating foods. That same part of your brain, the ventral tegmental area or nucleus accumbens, is also where our cravings come from. So I don't know if this kind of makes sense.

The more you eat, the less you crave eating, unless you've got something like a binge eating disorder. Right? So that kind of makes sense. The more pleasure you have. So I have cravings high, pleasure low. And then as I eat, cravings go down and pleasure goes up. And the chemical signal to mediate that shift is a GLP1. So the GLPs basically

reduce our cravings and increase our sense of satiety. So now let's talk about GLPs and addictions. Because if we're reducing our cravings and blunting our pleasure, then it should have an impact on addictions, which is absolutely what we see. This is a study that was used AI to analyze people talking on the internet and basically found that people were reporting when they started GLP1 agonist like OZempec, that it affects their substance intake. So it reduces their alcohol intake, reduces their caffeine intake, reduces their nicotine intake, seems to have not a huge effect on cannabis. And then in terms of behavioral addiction, seems to reduce compulsive shopping, impulsive shopping. But according to some of these reports, may actually enhance pornography

usage. So people become potentially more addicted to pornography or use pornography more when they on GLP. So what's going on here? So in order to understand how GLP's affect addictions, we have to understand a little bit more about how they affect the dopamine or Dic Circuit Tree. Okay. So this gets a bit complicated. So this is the way that your dopamine normally works. Okay. So we have some level of dopamine that just fluctuates throughout our day. I take a sip of water. Mmm, that water's tasty. I get a little bit of dopamine. Okay. And then there are times where I'm like a little bit bored. Oh my God, this is boring. Like this guy is just like rambling on about dopamine and he's talking about science. Oh my God, that's so boring. So we get a dip in our dopamine.

So our dopamine just kind of goes up and down throughout the day. And then what happens is we sometimes get something that is addictive. So I eat a donut or I play a video game or I use cocaine. And in those three cases, right, or sometimes all three all at once, I get a spike of dopamine. So the way that GLPs work is by capping the dopaminergic signal that your brain can get. So it doesn't affect our day-to-day dopamine-ergic stuff. But if we do something that induces a spike of dopamine, it kind of caps that. Okay. So the way that you can think about it is like it doesn't affect the basic speed of our car.

It just lowers the top speed that my car is capable of going. I can hit 100 kilometers, but I can't hit 120 or 140 or 150. Now, the interesting thing is that it is the high spikes that make us addicted to things. Okay, so it's really hard to get addicted to something that has a low dopaminergic signal. So the things that are the most addictive are the things that give us the biggest spikes. So when my friend says, hey, Dr. Kay, it's great to see you. Like, are you having fun at the party? I'm like, yeah, man, I'm having fun.

He's like, you want to go into the bathroom and do some. And I'm like, sure, I'll give it a shot. Wow, that's amazing. So when we get a high spike of dopamine, that is what triggers neuronal rewax. wiring. So we can look at this in other mechanisms like loot boxes. Why are loot boxes so addictive? Because the spike in dopamine that they give us is way higher because most of the time we get nothing. Occasionally we get a big spike and then we're like, oh my God, I want that high again. This is why people who play the lottery and lose lots of money over the lottery will still continue

to play it because that spike of winning keeps us coming back. So now this is something that's like pretty cool because the GLP1, since it prevents the spike, it prevents us from getting addicted to things. It's not that simple, but that's basically the mechanism that it's blunting, which is why we see, it's really fascinating, reductions in a lot of addictive behaviors, okay? And this is what's kind of interesting about it. So now we're going to tunnel down into specifically alcohol use. So here's a study that's looking at semaglutide or ozempic on alcohol use. And what we feel, find is that people who are on GLP ones, it doesn't reduce the number of days that they drink. Okay? So if I normally have drinks three days a week, I go to happy hour on Thursday, go to

happy hour on Friday, have a wine night on Saturday. Once I start my GLP 1, that doesn't change. I still drink Thursday, Friday, and Saturday. But what it changes is how much I drink. So if you measure the average alcohol concentration in the blood before and after, some of glutide, what you find is that the alcohol concentration is way lower. The number of drinks that I have actually drops quite a bit. I still feel like drinking, right? Oh, like I'll have a glass of wine. But whereas I used to have like two, three, four glasses of wine, now I'm having like one and a half to two. And if we kind of think about it, once we understand the neurochemistry, it sort of makes sense because it's reducing my craving. It is blunting the pleasure that I get from alcohol. So I can

enjoy a glass of wine with dinner, but then after you have that first glass, you're like, man, like, top me up. Give me a hefty pour, right? After you have that second drink, you're like, fill it up all the way, baby. Like, let's go. As you start to drink a little bit, you want to drink a little bit more. As you start to eat one potato chip, you're like, man, that potato chip was really good. Let me have a second. Let me have a third. Let me have a fourth. That's what it blunts, right? Because it caps that dopamine. So it appears like we've got pretty decent evidence that it improves a lot of addictions, alcohol at the top of the list, maybe caffeine, maybe nicotine, maybe impulsive shopping, maybe binge eating, for sure. But it may not have much of an

effect on cannabis and may actually be harmful when it comes to pornography. Now remember that GLPs affect all the different parts of our brain. And so when it affects the emotional parts of the brain, it appears that it leads to a lot of mood dysregulation that is not good. So it seems to increase feelings of depression, seems to blunt our capacity. to experience pleasure. And this is what some people call kind of the ozempic personality. This is when people are on semi-glutide, like they just don't feel like doing stuff. Stuff doesn't really feel super fun to them. And that kind of makes sense. So it causes some anhadonia. So anhedonia is the inability to experience pleasure. It's one of the hallmarks of a depressive episode. And when people

are on semi-glutide, we can see how it can cause anhedonia because it is capping our dopaminergic response. right? So we're not feeling really excited about stuff. Like sure, it caps the cocaine response and the alcohol response, but maybe it's also capping the birthday party response. And since those spikes of dopamine are what encourage our behavior, right? Once I get a loot box, I want to buy another one. Once I go out and I have a blast. How was this party on Saturday night? Oh my God, bro. It was completely awesome. Some people were doing in the bathroom. I steered clear of it, but I still had a great time. But if I'm blunting my ability to have a great time at a party, that'll then shape my motivation. And over time, the Ozempic personality seems to kind of like contract people's

fear of what they do. So there's evidence that it increases feelings of depression. One study found that it increased as much as 195%. So the risk of depression is skyrockets, right? So that's almost a twofold risk. And it also appears to increase suicidality by over 100% according to this one study. And so doctors for the past several years have been noticing that when they start their patients on GLP-1s, that it seems to be increasing the risk of depression can cause relapses of depression. And what's even the scariest thing is that for people who have had no history of depression seems to drastically increase the risk that they will develop depression for the first time. time. But then there are some studies, especially things called meta-analysis. So this is when we pool

together data from lots of different studies to see if there's something that kind of floats to the surface. So here's an example of a meta-analysis that basically found that there's no increased risk of depression. So like what's going on, right? So on the one hand, you have doctors who are prescribing this medication, who are seeing people relapse onto depression or having a resurgence of their depression. You're seeing people have new onset depression, but then you have some of the these big trials that are showing, actually there seems to be no difference. It doesn't actually increase risk. So what's the deal? And this is where we get to a really fascinating, I think for me, key finding about GLPs, which is that the kind of person who takes it determines how healthy or

unhealthy it is. So here's a study that found something really interesting. For people who were obese and took a GLP1, it did not increase their risk of depression. But for people who were at a normal or healthy weight, and if they took a GLP1, there is a greater chance that it increased their risk of depression. And this is where we have to get to some like really basic, important stuff about medicine. See, any time I prescribe a medication as a doctor, there's a risk benefit, which is like, duh, but let's understand something about depression. So let's say I'm morbidly obese. I have a BMI of 30. When I need a cat scan, I have to go to the literally, I've had patients who have this.

I'm like 600 pounds or 700 pounds. And I don't fit in the cat scan at Massachusetts General Hospital. So I have to get transported by ambulance to the zoo because they have a cat scanner that will work on me. Imagine that that is what my life is like. Now, imagine what is the impact on my mood if I am very overweight and I have to, you use the zoo's cat scanner, right? So shaming, incredibly depressing. Now, let's say I take some a glutide and then what happens is I lose, let's say, 100 pounds, 200 pounds, 300 pounds, what impact will that have on my mood? So what we start to see, this is really important,

is weight loss and a reduction in obesity has a positive impact, a huge positive impact on depression. That's not just because of the shame of the zoo cat scanner. That's because we don't realize that adipose tissue, fat tissue is hormonally active. So the greater my fat tissue, the more insulin resistance I have, the more inflammation I have, there are many negative mental health benefits of being at an unhealthy weight, let alone the psychological shame and all that kind of stuff. So when we're talking about a risk benefit, being able to lose 100 pounds, being able to go outside and go to the beach and things like that, that will have such a positive impact on my mental health that even if from a chemical sense, it's messing with my affect regulation centers,

the gain that I get from the weight loss for my mental health will outweigh or balance the risk of messing up my emotional regulation centers in my amygdala and my limbic system. Whereas if I am at a healthy weight and I just start some agglutide, I'm not getting some of those benefits from the weight loss for my shame and being able to go to the beach and things like that because I can already do that. Like I already get sent to an imaging center instead of a zoo when I need a cat skin. So this is why I think it's really important to like that, and this is what the studies show is that there is a differential effect of GLPs on people's mental health. And the more overweight you are, the more helpful a GLP is. And the less overweight you are, the more potentially harmful a GLP is.

And the best place that we see that is actually when we talk about eating disorders. So the first thing, remember, is that GLPs go to the ventral tegmental area. They blunt the dopaminergic pleasurable response. So no surprise that people with binge eating disorders, right, when I can't stop myself and I'll eat 6,000 calories, in a sitting. And if we think about what's driving that, it's the pleasure. It's the dopamine. I feel addicted. I can't stop. And when we give people g-lps, it seems like they really blunt binge eating disorders. So people's binge eating goes way down. Good job. But if we look at other kinds of eating disorders that are not reward-based or not addictive or not dopaminergic,

anorexia is at the top of the list. So the neurochemistry of anorexia is not related to reward, right? It's not like people who are anorexic, they actually feel awful. They feel really bad. They're not, I've had patients who are hospitalized with anorexia, who we have to start, we have to put tube, we have to start tube feeds. We have to sometimes in really scary situations, strap them, actually physically restrain them to get calories inside their body because they are so malnourished that their heart is starting

to have arrhythmia's. The interesting thing is when someone is in that bed, getting IV fluid or getting nasogastric tube feeds, they're not high, right? They're not like pleasurable. They're not like, like this isn't fun for them. Their suffering is profound. Their suffering is intense. And even if you, you know, talk to people with anorexia, what you'll find is that like the majority of their day is like suffering. Like they're like they have all these cravings. They really want to eat. Their fucking body wants to eat something. Man, like, oh my God, I want to eat something. The cravings are so hard. I'm with my friends. And my friend brought a peanut butter, peanut butter and crackers and like a girl dinner plate with like fruit and peanut butter and

crackers. And this like triggered me so hard. Their baseline experience is suffering. Anorexia conversation for a different day is all about control, trying to exert control, trying to, hammer your body and the world around you into complying with your will. That has nothing to do with dopamine. And so what we're starting to see that's really scary is that GLP-1s, they may help with binge eating disorders, but they are actually making anorexia and restrictive eating disorders potentially way worse. And they are potentially causing a trigger, someone who didn't have an eating disorder, to have eating disorders. So here's what's really scary. One of the risk factors for causing an eating disorder is weight loss.

So if you are someone who has certain psychological vulnerabilities, especially around body image, right? So if you're someone who is at a healthy weight and you have a lot of body image issues because you spend a lot of time on the gram, on TikTok, on seeing all these people who have filtered faces and now you start to feel a little bit vulnerable, you go on dating apps, but people swipe left. Oh my God. Right? This is happening all over the place. So we have psychological vulnerabilities in people with psychological vulnerabilities who lose weight. This can actually trigger an eating disorder. Okay.

So there's something called atypical anorexia nervosa, which has all the features of anorexia. So restricted eating, you know, body image issues, but they're actually at a normal weight. So one of the key factors of diagnosing anorexia is you have to be at an unhealthy weight. That's one of the diagnostic criteria. but there are some people who have atypical anorexia, they have the mind of anorexic and the body of someone who is at a regular BMI or a healthy BMI. And even as much as a 5% weight loss can trigger atypical anorexia. So we can trigger eating disorders if we actually lose weight.

And here's what's really fascinating. There are some studies that show that patients with binge eating disorders who go through cognitive behavioral therapy, the more weight they lose, there's a binge eating disorder, so they're usually at a normal weight or potentially even overweight. The more weight they lose, the greater their risk is of developing something like anorexia. It's insane. So like if I go through cognitive behavioral therapy and I lose 50 pounds, my risk of anorexia is higher than if I lose 25 pounds. Right.

So there's something about the extremity, I don't know, the severity of like the rigidity of anorexic thinking where the more you lose weight, the more. it kind of turns on. And this is what we're seeing with GLPs is it seems to exacerbate this risk. And this is where people are sort of seeing the like the ozempic face, right? And the ozempic face is like shrunken. And they're very like severe cases, case reports of people who are able to manage 400 to 600 calories a day are getting dehydrated with using semi-glutide. And I want you all to kind of think about this for a second, okay? Because let's say I'm an anorexic and I want to lose as much way possible. I hate the fact. I look at my face in the mirror and I think that I'm obese. So in my body, there's a war, which is what anorexic suffer with, okay? There's a war between like my liver

telling me, hey, we're out of calories. Like we need food. And so there's strong craving signals that are being sent to my brain. We are starving, bro. Give us some food. And that fights against my control. So I have pro-eating signals and anti-eating signals. And how does a GLP1 work, agonist work? It reduces my cravings. It reduces, it's a GLP1 agonist. It tricks my brain into thinking we just ate. So now that I've tricked my brain into thinking that we just ate,

my capacity to restrict my calories actually increases. So at the end of the day, what is the impact of GLPs on your mental health? We kind of don't know, for sure. Should you take a GLP1, I would say, this is why we say, say, talk to your doctor. This is not just medical, legal, cover your ass. This is why what we're seeing with GLPs 1, GLP 1s, it is a highly individual decision based on your risk factors.

Do you have a lot of health benefit to gain from losing weight? Or are you trying to do this for cosmetic reasons, right? Are you struggling with certain addictions? Do you need to cut down on your alcohol? But is it porn addiction? And lastly, if you have a history of mental illness, or even don't have a history of mental illness, you should be on the lookout for things like a rise in depression

or even spike in suicidality. So potentially amazing drug, but to be used with caution. Thanks for joining us today. We're here to help you understand your mind and live a better life. If you enjoy the conversation, be sure to subscribe. Until next time, take care of yourselves and each other.