Ominous paracetamol and other pills: how popular drugs affect our lives
The effect of some drugs is associated with aggressive behavior on the road, with a pathological passion for gambling, with complicated cases of fraud. Some of them make us less neurotic, others can even influence our relationships with people. Writes about it with the BBC.
It turns out that many conventional medicines affect not only our body, but also how our brain works. How does this come about and why is this not warned with warning labels on the packaging?
“Patient # 5” was well over 50 when going to the doctor changed his life.
He had diabetes and agreed to participate in a study whose authors wanted to see if statins, a medicine that lowers cholesterol, would help him.
At first, everything went fine. But soon after taking the drug, his wife began to notice sinister changes.
Previously a perfectly sane person, he began to experience bouts of anger, and for some reason, he began to behave aggressively behind the wheel.
Once he even told his family members to stay away from him if they did not want to go to the hospital.
Fearing that something terrible would happen, “Patient No. 5” stopped driving. But his behavior in the car as a passenger was such that his wife was often forced to turn home halfway.
In such cases, she put him alone in front of the TV so that he would calm down. The wife began to fear for her own safety.
And then once “patient number 5” dawned. “It suddenly dawned on him: since all these problems started after I started participating in the study,” says Beatrice Golom, who leads the team of scientists at the University of California (San Diego).
Alarmed, the husband and wife sought clarification from the organizers of the study. “They behaved very hostilely. They said that this could not be connected with taking the medicine, and the man should continue taking it and remain one of the participants in the study, ”says Golom.
For good or for worse, but by then the patient’s character had already changed so much toward grumpiness that he simply ignored the advice of the doctors. Two weeks later, his old personality returned to him.
But others are not so lucky. Over the years, Golom has been collecting patient stories from all over the United States - about broken marriages, ruined careers, about a surprisingly large number of men who were on the verge of killing their own wife.
And in almost all of these cases, menacing symptoms appeared after people started taking statins. And then they disappeared as soon as they stopped drinking this medicine. One man even threw five times and started again, until he realized that statins were the reason for what was happening to him.
According to Gol, all this is quite typical: in her experience, most patients cannot recognize the changes that occur in their nature, not to mention connecting them with the drug that they started taking.
In some cases, this understanding comes too late: many relatives of such people, including a scientist with international fame and a former editor of a legal publication who committed suicide, got in touch with the researcher.
We know that psychedelics distort the mind. But it turns out that completely ordinary medicines are also capable of this.
From paracetamol to histamine medications, from antidepressants to statins and asthma medications, they, as new studies show, can make us overly impulsive, hot-tempered, or restless.
They can reduce empathy for strangers and even manipulate the fundamental aspects of our character, our personality. For example, by how neurotic we are.
For most people, such changes are barely noticeable. But for some, they can be significant.
In 2011, a Frenchman, a father of two children, sued the pharmaceutical company GlaxoSmithKline, claiming that the medicine he was taking for Parkinson's disease turned him into a gambler and a passionate lover of same-sex sex, and that this is the reason for his risky behavior leading to his being raped.
In 2015, a man who was chasing young girls on the Internet resorted to a similar line of defense: he claimed that the anti-obesity medicine reduced his ability to control his impulses and desires.
Again and again, we are faced with the fact that the killers are trying to imagine the cause of what they did, sedatives or antidepressants.
If these statements contain the truth, then the consequences can be serious. The list of potential culprits includes some of the most widely used drugs in the world. Which means: even if at the level of an individual person the influence of such drugs is insignificant, nevertheless they change the identities of millions of people.
Investigations of this influence are most welcome. Our world is plunged into a crisis of excessive drug use. In the United States alone, up to 49 thousand tons of paracetamol are bought every year (approximately 298 tablets of paracetamol are released per person), and the average American consumes $ 1 prescription drugs per year.
As the population of our planet ages more and more, our fascination with drugs will get more and more out of control. For example, right now in the UK, one out of every ten elderly people over 65 takes eight different medicines weekly.
How do all these drugs affect our brain? And is it time to start putting warning labels on the packaging?
At first, she believed that the connection between statin intake and changes in character could be revealed a couple of decades ago, after a series of frightening discoveries that people with low cholesterol are more likely to die a violent death.
But once in a casual conversation with a cholesterol expert about such a potential connection, he dismissed her arguments as obvious nonsense.
“And then I said to myself: how do we know this?” Asked Gol. She began to carefully study the scientific and medical literature on this topic. “I found an astounding amount of evidence — more than I could have imagined,” she says.
To start with the fact that there are studies of primates, which were transferred to a low cholesterol diet, and they became more aggressive.
A potential mechanism for this was described: lowering cholesterol in animals seems to affect the level of serotonin, an important neurotransmitter, the “mood hormone” involved in regulating behavior.
Even Drosophila flies start to fight if you change their serotonin level. And this also affects people not in the best way - research connects this with a tendency to violence, impulsiveness, suicides and murders.
If statins affect the functioning of the human brain, then this is probably a direct consequence of their ability to lower cholesterol.
In recent years, a lot of new evidence has emerged of this. The results of several studies reinforced the hypothesis of a potential relationship between irritability and statin use, including during randomized controlled trials (RCTs) conducted by Gol (involving more than 1000 people), considered the gold standard for obtaining scientific data on new medical interventions.
RCT Gol showed that the drug increased aggression in women in the postmenopausal period, but, in a strange way, it did not affect the behavior of men.
In 2018, one of the studies found a similar effect in fish - it seems that the mechanism linking cholesterol levels and aggression has existed for millions of years.
Goal continues to be convinced that lowered cholesterol and, as a result, statins can cause changes in the behavior of both women and men, however, the depth of influence can vary greatly from person to person.
But the most unpleasant discovery that Gol made is not the possible effect of conventional drugs on our personality at all. This is a general lack of interest in such an impact.
“The emphasis is on what doctors can easily check,” she explains. According to her, for a long time, studies of the side effects of statins focused on muscles and liver, because any problems with these organs can be detected using standard blood tests.
A researcher at the University of Ohio, Dominic Miskowski, also noticed this. “We know a lot about the physiological effects of drugs,” he says, “but we don’t understand how they affect human behavior.”
Mishkovsky’s own research found sinister side effects from taking paracetamol. Scientists have long known that this drug reduces physical pain by decreasing activity in certain parts of the brain - such as the islet lobe, which plays an important role in our emotions.
These volunteers take part in creating a sense of interpersonal and social problems, and paracetamol can surprisingly ease our psychological pain, for example, if we are rejected.
Recent studies have shown another interesting thing: in our brain the centers of pain are also centers of empathy, empathy for the emotional state of another person.
For example, scanning with fMRI (functional magnetic resonance imaging) showed that with pain and with the so-called positive empathy (joy for another person), the same areas become active in the brain.
Based on this finding, Mishkovsky wondered: aren't painkillers weakening our ability to empathize with others?
Together with colleagues from Ohio, he recruited volunteers from university students and divided into two groups. One group of them was given a standard dose of paracetamol (1000 mg), and the other a placebo.
Then they were asked to read various inspirational stories from other people's lives, for example, about the luck of a certain Alex, who finally gathered courage and asked the girl for a date (and she agreed).
As a result, it turned out that paracetamol significantly reduces our ability to rejoice for others - now think about how this medicine can daily affect the formation of relationships in millions of people around the world.
“I am no longer an aspiring researcher,” says Mishkovsky, “and, frankly, the results of these experiments are the most disturbing that I have come across. Especially because I have a good idea of how many people are exposed to such an impact. When you give someone medicine, you give it not just to an individual person - you give it to the social system. And we do not understand the effect of these drugs in a wider context. ”
Empathy determines not only that you are a good person, or that you cry when you watch a sad movie.
This emotion has many practical advantages, among which are more stable relationships with a loved one, more adapted children to life, a more successful career.
Some scholars have even suggested that empathy is the cause of human success as a species.
All this involuntarily makes one wonder what consequences for all of humanity will be a decrease in the ability to experience empathy.
Formally, paracetamol does not change our character, since the effect of taking it lasts for only a few hours and few of us take it constantly.
But, as Mishkovsky emphasizes, we must be informed about how it affects us, which will help us make sound decisions about its use.
“In the same way as we know that you should not drive when you drink, you should not take paracetamol if we are in a situation where we will need an emotional response - for example, a serious conversation with a partner or colleague.”
One of the reasons why drugs have such a psychological effect is that our body is not just a bag with different organs washed by physiological fluids and chemical compounds. This is a system in which different processes are closely interconnected.
For example, scientists already knew that taking asthma medications sometimes affects the behavior of patients and sometimes leads to the development of attention deficit hyperactivity disorder. And recently, one of the studies found that there is a mysterious connection between these two diseases: having one of them, you increase the risk of getting the other by 45-53%.
No one knows why. There is an idea that asthma medications cause attention deficit hyperactivity disorder, as they change the level of serotonin or chemicals that cause inflammation.
Sometimes communication is easy to trace. In 2009, a team of psychologists from Northwestern University (Illinois) decided to check whether antidepressants affect our character.
In particular, scientists were especially interested in neuroticism - one of the character traits that manifests itself in anxiety, fear, jealousy, envy and guilt.
For their study, scientists recruited a group of adults suffering from moderate and deep depression. A third of the participants received the antidepressant paroxetine (a selective serotonin reuptake inhibitor), another third received a placebo, and another third received psychological therapy.
Then the scientists checked how the mood and character of the volunteers changed from the beginning to the end of the 16-week experiment.
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“We found that the drug was causing major changes in neuroticism. Placebo and therapy barely affected this character trait, says Robert Derubais, one of the researchers. “It was amazing.”
The big surprise for scientists was that although antidepressants made the participants in the experiment less depressing, the decrease in the level of neuroticism was much more serious, and the effect of drugs on the level of depression was not associated with an effect on the level of neuroticism. In addition, those who received antidepressants in polls began to gain more points on the extroversion scale.
It is important, however, to understand that this was a relatively small study, and so far no one has tried to repeat its results, so that they may not be completely reliable. But it is intriguing that antidepressants can directly affect neuroticism.
According to one hypothesis, this personality trait (neuroticism) is associated with the level of serotonin in the brain, which changes under the influence of antidepressants.
And while becoming less neurotic sounds attractive, not everything is so good with this news.
This aspect of our personality is a double-edged sword. Yes, neuroticism brings us many unpleasant moments in life, not to mention the fact that it can cause earlier deaths.
But at the same time, it is believed that excessive anxiety and a tendency to worry all the time can serve us well in some situations - for example, this will avoid unnecessary risk. Or even improve work efficiency.
“Even the American psychiatrist Peter Kramer warned us: when people are on antidepressants, they can start to worry less about those things that are usually taken care of,” Derubais emphasizes. If so, should patients be warned that drugs can change their personality?
“If my friend asked me for advice, I would definitely warn him in the same way as they warn about such well-known side effects of drugs, such as possible weight gain,” says Derubais.
And here it should be emphasized: no one calls for people to stop drinking their medicines.
Despite a subtle effect on brain function, antidepressants have repeatedly helped save a person from suicide, cholesterol-lowering drugs save tens of thousands of lives every year, and paracetamol is on the UN list of essential drugs because of its ability to alleviate pain.
But it is also important that people are informed of any potential psychological side effects.
This question looks much more serious if we take into account the fact that some changes in character can be very radical.
There is confirmed evidence that the drug L-dopa (levodopa), which is prescribed for the treatment of Parkinson's disease, increases the risk of impulsive personality disorder. (A person with an impulsive control disorder is often unable to resist the sudden, violent urge to do something that could violate the rights of others or cause conflict with social norms. - Note translator.)
Consequently, taking this medicine can have devastating consequences for the lives of some patients who suddenly begin to take unnecessarily risky things — they may experience a pathological craving for gambling, revel in shopping or become sexually addicted.
In 2009, the media reported a drug with similar qualities, after a man with Parkinson’s disease accused the drug of completely changing his character and even causing him to commit fraud - he sold tickets for non-existent rock concerts on eBay, helping out way $ 60.
The relationship of such a drug with impulsive behavior can be fully understood, since it supplies the brain with additional dopamine (which is important in Parkinson's disease). And this hormone takes part in creating feelings of pleasure and reward.
Experts agree that levodopa is the most effective treatment for many of the symptoms of Parkinson's disease. Every year, he is discharged to thousands of people across the United States - despite a long list of possible side effects. This list separately mentions the risk of unusually strong desires - for example, playing in a casino or having sex.
And Derubais, and Golom, and Mishkovsky are of the opinion that the drugs whose action they studied will be used by people further, regardless of the psychological side effects.
“We are people,” says Mishkovsky. - We do and accept a lot of things that are not necessarily useful in different circumstances. I always cite alcohol as an example, which can be painkiller like paracetamol. ”
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But in order to minimize any undesirable consequences and make the most of the amazing amount of drugs we take every day, we need to know more about them, Mishkovsky emphasizes.
Because at the moment, he says, in many ways it remains a mystery how exactly they affect individuals and society as a whole.
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