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.

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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 No. 5” was well over 50 when seeing a doctor changed his life.

He had diabetes and agreed to participate in a study to see if statins, a cholesterol-lowering drug, 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.

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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 one day it dawned on “Patient No. 5.” “It suddenly dawned on him that all these problems started after I started participating in the study,” says Beatrice Golom, who leads a team of scientists at the University of California (San Diego).

Alarmed, the husband and wife turned to the study organizers for clarification. “They behaved very hostilely. They said it could not be related to the medication and the man should continue taking it and remain part of the study,” Golom says.

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. For years, Golom has collected stories from patients all over the United States—of broken marriages, ruined careers, and a surprising number of men who have come close to killing their own wives.

And in almost every one of these cases, the menacing symptoms appeared after people started taking statins. And they immediately disappeared as soon as they stopped drinking this medicine. One man even quit and started again five times 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 French father of two sued the pharmaceutical company GlaxoSmithKline, claiming that the drug he was taking for Parkinson's disease turned him into a gambler and avid gay sex enthusiast, and that it was the reason for his risky behavior. which led to him 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.

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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.

Research on this influence could not come at a better time. Our world is mired in a crisis of overmedication. In the United States alone, up to 49 thousand tons of paracetamol are purchased every year (that's about 298 paracetamol tablets per person), and the average American consumes $1 worth of 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.

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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 Golom. She began to carefully study the scientific and medical literature on this topic. “I found an amazing 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.

Even a potential mechanism has been described: lowering cholesterol in animals appears to affect levels of serotonin, an important neurotransmitter, the “mood hormone,” involved in regulating behavior.

Even fruit flies start fighting if you change their serotonin levels. And it doesn't have the best effect on people either - studies have linked it to violence, impulsiveness, suicide and murder.

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, much new evidence of this has emerged. Several studies have supported the hypothesis of a potential link between irritability and statin use, including Gol's randomized controlled trials (RCTs) of more than 1000 participants, which are considered the gold standard for generating scientific evidence for 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.

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In 2018, one study found a similar effect in fish—the mechanism linking cholesterol levels and aggression appears to have 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 Golom made was not the possible impact of conventional drugs on our personality. There is a general lack of interest in such impact.

“The emphasis is on things that doctors can easily test for,” she explains. For a long time, research into the side effects of statins focused on the muscles and liver because any problems in those organs can be detected with standard blood tests, she said.

Ohio University researcher Dominik Miskowski noticed this too. “We know a lot about the physiological effects of drugs,” he says, “but we don’t understand how they affect human behavior.”

Miszkowski's own research has revealed ominous side effects from taking paracetamol. Scientists have long known that the drug reduces physical pain by reducing activity in certain parts of the brain, such as the insula, 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, pain centers 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 them 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).

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The result was that paracetamol significantly reduced our ability to be happy for others - now think about how this drug can affect the formation of relationships for millions of people around the world every day.

“I’m no longer a novice researcher,” says Mishkowski, “and, frankly, the results of these experiments are the most disturbing that I have encountered. Especially because I am well aware of the huge number of people who are exposed to this. When you give someone medicine, you are not just giving it to an individual - you are giving it to a social system. And we don't really understand the impact of these drugs in a broader 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, including a more stable relationship with a loved one, children who are more adapted to life, and a more successful career.

Some scientists have even suggested that empathy is the reason for the success of humans 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.

“Just as we know we shouldn’t drive when we’re drinking, we shouldn’t take paracetamol if we’re going to be in a situation where we’re required to respond emotionally—say, a serious conversation with a partner or a colleague.”

One of the reasons why drugs have such a psychological effect is that our body is not just a bag of different organs bathed in bodily 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 particularly interested in neuroticism, a personality trait that manifests itself in anxiety, fear, jealousy, envy and guilt.

For their study, the researchers recruited a group of adults suffering from moderate to severe depression. A third of the participants received the antidepressant paroxetine (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 caused significant changes in neuroticism. Placebo and therapy had little effect on this personality 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, it will allow us to avoid unnecessary risks. Or even improve work efficiency.

“The American psychiatrist Peter Kramer warned us that when people are on antidepressants, they may begin to worry less about the things that they usually worry about,” DeRubais emphasizes. If so, should patients be warned that medications may change their personality?

“If a friend of mine asked me for advice, I would definitely warn him in the same way that people warn about common side effects of medications, such as possible weight gain,” DeRubais says.

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 to treat Parkinson's disease, increases the risk of developing impulsive personality disorder. (A person with impulse control disorder is often unable to resist sudden, violent urges to do something that might violate the rights of others or cause a conflict with social norms. - Note translator.)

Consequently, taking this medication can have devastating consequences on the lives of some patients who suddenly begin to take unnecessary risks in everything - they may experience pathological gambling, revel in shopping, or become a sexaholic.

In 2009, the media reported on a drug with similar properties after a man with Parkinson's disease blamed the drug for completely changing his personality and even causing him to commit fraud - he sold tickets to non-existent rock concerts on eBay, helping out thus $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 symptoms of Parkinson's disease. It is prescribed to thousands of people across the United States every year—despite a long list of possible side effects. This list specifically mentions the risk of developing unusually strong desires - for example, to gamble in a casino or have 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 give the example of alcohol, which can also be a 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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