When love can be interfered with by drugs

Leviathan Press:

Hormones make you fall in love with him (her) - this can be said to be a certain definition of love from a biochemical perspective. Especially when you understand the important role of dopamine, phenylethylamine and oxytocin in our love activities, you may have a new understanding of so-called love. Following this logic, can we use drugs to intervene in the various influences of love activities? For example, emotional injury.

In the 2004 film Eternal Sunshine of the Spotless Mind, Jim Carrey’s heartbroken boyfriend undergoes an experimental treatment that erases their memories after breaking up with his girlfriend, played by Kate Winslet. At the time the film was released, the idea of ​​using drugs or other techniques to modify memory to heal trauma seemed far-fetched.

However, at the beginning of 2020, memory modification really made it to the pages of major media. The focus of the report is Alain Brunet, a psychiatrist specializing in post-traumatic stress disorder at McGill University in Montreal, Canada. His experimental subjects are so-called "emotionally injured patients" who have been harassed by their exes or suddenly abandoned by their long-term partners. In order to help them erase the feelings caused by bad memories, Brunet used a drug-based treatment combined with a practical "reconsolidation therapy."

(onlinelibrary.wiley.com/doi/abs/10.1002/smi.2968)

Unlike the memory-erasing company Lacuna, Inc. in the movie, which tries to "erase" traumatic memories, Brunete and his colleagues do things in a very different way. "People never lose their memories," he stressed. "After all, who wants to give up a love story?"

The goal of this therapy is to eliminate the trauma while maintaining the integrity of the memory. Here is the process of treatment:

An hour before the start of the treatment, the patients take 50 to 80 milligrams of propranolol (a beta-blocker commonly used to treat arrhythmias caused by various reasons, translator's note), and then strictly follow the instructions to briefly write about their traumatic experiences: they must describe at least five feelings at the time of the trauma in the present tense and in the first person. After writing, they will "reactivate" the memory by reading it aloud. This treatment is carried out four to six times a week. Each time it is read aloud, the memory is "re-recorded" once, and the propranolol helps them suppress the pain.

Reconsolidation therapy has a high success rate. In a 2018 study by Brunete and colleagues, more than 70% of participants were freed from the stress caused by their breakup. After the treatment, many people said they felt like they had read "a novel" aloud. In other words, the sad story was still there, but the pain was gone.

Love and heartbreak go hand in hand. Sometimes the pain of a breakup helps us grow, forcing us to slow down, reflect on ourselves, and learn to avoid repeating the same mistakes. Sometimes, some pain can crush our souls and become unbearable, preventing us from embracing the future and the person we love.

If we can use medical tools like drugs and psychotherapy to mend broken hearts, can we also use them to eliminate the pain caused by unrequited love and bad relationships?

Philosopher Carrie Jenkins says love has a "dual nature." One dimension is social psychology: we all experience love subjectively, in a specific cultural and historical context. Art, literature, music, philosophy, poetry illuminate love in this context. The other dimension is biological: love is rooted in human nature, stemming from the mating and bonding mechanisms that drive human reproduction. Science can help us understand this dimension.

Modern neuroscience has the potential to specifically study the biology of love from the perspective of the human brain. In 2008, my colleague Julian and our good friend and colleague Anders Sandberg first published a discussion on whether it is scientifically and ethically appropriate to use chemical means to influence love. The article focused on the potential application of biochemistry in maintaining healthy relationships that would otherwise have broken down, and this breakup would have been unnecessary. In 2009, neurobiologist Larry Young discussed the possibility of using chemical treatments to influence relationships in Nature.

(link.springer.com/article/10.1007/s12152-007-9002-4)

(www.nature.com/articles/457148a)

Young sees love as a “mix of neuropeptides and neurotransmitters” and thinks drugs that can manipulate the brain to make it more or less in love may be just around the corner.

While we agree with his point, it sounds better to phrase it another way: the biology of love is an emergent property of this ancient chemical cocktail, while the psychosocial dimensions of love arise from practices, cultural norms, and institutions that are embedded in society. Understanding this, what kind of drug would achieve the effect Young describes?

To sort out the drug candidates, we’ll group the discussion around three distinct systems: desire, attraction, and attachment. Some researchers believe that these three systems form the biological basis of romantic love. They may fulfill different evolutionary purposes, and they can (and do) function independently to some degree in humans and mammals.

Drugs that reduce sexual desire are already available, including antidepressants, androgen antagonists, and oral naltrexone. Tobacco and alcohol are also well-known to suppress desire. Other drugs that reduce sexual desire include most blood pressure medications, painkillers containing butalbital, opioids such as morphine and hydrocodone, statins, cholesterol-lowering drugs, some acid blockers used to treat heartburn, finasteride for hair loss, and epilepsy drugs such as gabapentin and phenytoin.

With the exception of anti-androgen drugs used specifically for chemical castration (sometimes used on convicted sex offenders), none of the drugs mentioned above are intended to reduce sexual desire, nor do we want them to. But that is not always the case.

How do these drugs work? The answer is based on the regulation of testosterone. Testosterone is one of the important biological factors that lead to sexual desire and sexual behavior. Many studies have explored whether reducing testosterone can inhibit pathological sexual fantasies (such as sexual aggression) or pathological sexual behaviors (such as exhibitionism) (especially in men).

One study reported that lowering testosterone levels can help pedophiles reduce their sexual fantasies and suppress their sexual impulses. Neuroscientist Till Amelung has also studied the combined effects of androgen deprivation therapy and group psychotherapy (such as the "self-help pedophile group") and found that this treatment can indeed help pedophiles reduce their unhealthy sexual behaviors, increase their risk awareness and self-control, and suppress inappropriate thoughts.

(www.ncbi.nlm.nih.gov/pmc/articles/PMC4492978/) (www.sciencedirect.com/science/article/abs/pii/S0160252712000209)

Side effects are a problem. In one study, hospitalized patients with deviant sexual behaviors (including pedophilia, voyeurism, masturbation in public, the inability to resist visiting prostitutes or hiring sex workers, voyeurism, "rape tendencies" and pathological masochism) took anti-androgen drugs. The researchers found that many cases improved, and one drug was "promising to be an effective treatment for sexual deviancy." But 12 cases had complications: one had nausea and vomiting; some people became impotent; others not only lost their sexual interest completely, but also began to suffer from severe depression; all those who received long-term treatment had a decrease in bone density and a significantly increased risk of osteoporosis.

Another problem with anti-androgen drugs is that they can't affect sexual desire in a targeted way. If you just want to reduce harmful or pathological desires - such as pedophilia or adultery, you may be disappointed. Today's biotechnology is not advanced enough to target specific areas according to individual needs.

Anti-attraction drugs are trickier. There is much less research on the attraction system than on sexual desire. Although there are some chemical treatments that can weaken attraction, we don't know what makes couples attracted to each other, and the factors that influence attraction are likely to be diverse. If anti-attraction drugs are effective, they are likely to make couples lose attraction to each other in the early stages of a relationship, killing the budding romance.

Donatella Marazziti is a neuroscientist at the University of Pisa in Italy. She has been trying to test whether serotonin affects attraction in the early stages of a relationship. She was inspired by the fact that couples in the early stages of love become obsessed with each other and pay too much attention to every little detail (a bit like jealous people), almost like they have obsessive-compulsive disorder (which has been linked to low serotonin levels). “Low serotonin levels may cause someone with obsessive-compulsive disorder to touch the door five times before entering, just to be safe. Couples in the early stages of love may also be unable to kick out the fantasy of a third party.”

(pubmed.ncbi.nlm.nih.gov/10405096/)

As she expected, people who had just fallen in love (still in the first stage of love, before the couple had even laid naked) had lower-than-normal serotonin levels, as did people with OCD. “This suggests that people who are just beginning to fall in love are not normal,” Morashiti and her co-authors conclude. But after 12 to 18 months of dating, their serotonin levels returned to normal, and by then, “their obsessive thoughts had disappeared.”

Based on this finding, drugs used to treat obsessive-compulsive disorder may be able to curb obsessive thoughts at least in the early stages of a relationship. Selective serotonin reuptake inhibitors (SSRIs) are an effective treatment for OCD, but these antidepressants are known to reduce sexual desire. SSRIs can also sometimes make people “emotionally blunted,” unable to experience the higher emotions associated with love: in one study, 80% of people who used them “had difficulty crying, worrying, or getting angry about their partner, and they cared less about the other person.”

(www.ncbi.nlm.nih.gov/pmc/articles/PMC2989833/)

Again, if you want to maintain a relationship, being indifferent to your partner's feelings is not an option. But if you want to end a relationship or prevent your partner from taking it further, ignoring your partner may work.

Finally, there are anti-attachment interventions. While breakups are apparently common (just ask anyone who has moved on from an ex), there’s no concrete evidence that current technology can completely sever long-term relationships between humans. But other mammals that do have mating habits (namely voles) may be different. Research has shown that injections of oxytocin (an important factor in the formation of attachments between parents and their pups and adult voles) can cause at least one type of vole to form pair bonds with one another without any mating behavior. Crucially for us, the effect is reversible.

In one study, injecting female prairie voles with oxytocin or dopamine blockers caused them to lose their tendency to be monogamous; that is, they did not prefer any particular male when mating. As Larry Young puts it, "It didn't matter how many times they had sex with a male, or how much he wanted to establish a permanent bond. They just loved to mate, and they got tired of the old one." Similarly, injecting male mice with dopamine blockers in their nucleus accumbens (a specific part of the brain) not only killed their mate-guarding instincts, but also made them more willing to mate with other females.

(www.ncbi.nlm.nih.gov/pmc/articles/PMC6093782/)

Love makes people start to become abnormal.
Most scientists who study human attachment believe that attachment mechanisms like those of prairie voles have been preserved in mammals over evolution and have been replicated in humans. However, no scientist has yet injected oxytocin, dopamine, or other neurochemicals into the human brain to see how human attachment changes. After all, university ethics committees would not accept this approach, and most people would not want to be "guinea pigs."

There may be a way around this scientific hurdle. In 2019, VICE magazine ran a headline: “How to Hack Your Brain to Have Sex with Someone You Don’t Love.” “For many of us, this scenario is all too familiar: You hate the person you’re sleeping with and don’t want to date them, but the morning after, you feel a strange attachment,” author Sirin Kale wrote. “If you want to avoid it, the only thing you can do is think twice before you act. But if the decision is already made and you’re deeply and intensely distressed by your ambiguous decision, is there any way to prevent your brain from forming a sexually based attachment?”

(www.vice.com/en_us/article/59mmzq/how-to-bio-hack-your-brain-to-have-sex-without-getting-emotionally-attached)

Young's answer is "of course." The trick is to avoid eye contact with your partner during sex. Studies show that prolonged eye contact releases oxytocin in the brain, which increases the likelihood of forming a connection. "When you have sex with someone, you remember their face and their eyes," he explains. "That feeds back into your connection. Love and attachment are like addictions. They require most of the same chemicals. If you avoid eye contact and don't use eye contact to communicate information, it's not easy to form a connection."

Certain illegal drugs may also have an effect. According to Young's research, cocaine and methamphetamine boost dopamine, which is one of the building blocks of bonding. "If you boost dopamine levels before sex by taking drugs, dopamine won't work as well afterwards," he says. "The specificity of sex and the differences caused by dopamine won't be as apparent."

People are afraid of sick love and relationships.

Alcohol can also make sex less about attachment (which may be one reason why alcohol-induced promiscuity is so common). But the extent to which alcohol damages relationships seems to differ between the sexes. At least that’s the case with voles. “Male rats who drink alcohol have more promiscuous sex and are less likely to form close relationships,” Young says. “But the opposite is true for female rats. Alcohol increases the likelihood that they will choose a mate sooner.” Wild voles are unlikely to be heavy drinkers, so these findings are clearly from a lab.

Capgras's delusion may also interfere with attachment. People with this disorder believe that their spouse, sibling, or close friend has been replaced by an identical impersonator. They are not face-blind, but the natural emotional connection with those close to them is lost. This lack of emotional connection can lead to a sense of imposters around them.

The idea that the condition is caused by damage or degeneration of the neurons responsible for responding to familiar visual stimuli fits in with the oxytocin-dopamine attachment model, which links social identities (such as a person's physical characteristics) with positive emotions.

In the future, attachment interventions may be able to specifically reflect Capgras delusions without triggering delusional thinking.

Taken together, these findings suggest that people may soon be able to eliminate or reduce sexual desire, attraction, and/or attachment with medications. In fact, some methods are already being used to achieve this goal. But the question is: Can we ignore the side effects and abuse untested drugs to change relationships?

The ethics of prescribing a drug that has not been clinically tested are thorny. But sometimes dosages, primary functions, and side effects do change after the manufacturer's instructions are finalized. If you prescribe a drug that was originally intended to cure a disease, and the drug's function has changed since the instructions were printed, I think few people would raise a fuss about it.

Furthermore, if you prescribe a drug that is intended to cure disease B, you probably don’t have enough evidence to prove that the drug can cure disease A. Off-label use of a drug may expose the patient to unknown harm, which in itself defeats the purpose of the treatment.

Yet, current medications for specific symptoms have been shown to affect relationships, but we don’t know how or under what circumstances they do so, and most of the evidence comes from case studies and anecdotes. Of course, you can treat a jealous man with an OCD medication, as one psychiatrist did, and hope he stops nagging his wife. As long as you use the medication according to the label, if it happens to improve the relationship, that’s fine. But we need to be more cautious and more scientific.

But why don't we do this? What's stopping us from deliberately studying the dual effects of common drugs on relationships? One reason is that people are afraid of sick love and relationships. Because doctors can only prescribe drugs according to the instructions and can only prescribe drugs for the symptoms, prescribing drugs that are supposed to cure other diseases to change intimate relationships would imply that the relationship is sick - but perhaps both parties are just in the adjustment period.

Given the current state of affairs, this concern is understandable. But we need to change this paradigm. Drugs are just chemicals. You can call them drugs, but chemicals don’t know if you have the disease they’re supposed to treat (so to some extent, they can limit themselves to only work within a certain range). Whether you want to use them to cure a disease or just believe they can change your life, they just do what they can do.

In sum, under the right circumstances, we should trust that certain chemicals can increase people’s well-being without first emphasizing that they are supposed to cure a disease. The promising explosion of scientific and pharmacological research on psychotropic drugs fits in well with this view. On the treatment side, there is growing evidence that psychotropic drugs can help people with severe post-traumatic stress disorder return to a more normal life when used as an adjunct to psychotherapy. On the enhancement of positive affect, it can help healthy individuals feel that they can better navigate the vagaries of life. On the relationship side, it is important to go beyond the labeling of certain people with a disease so that these drugs can be used to cure others who need them. We need to look beyond the label and investigate whether certain drugs can be used to alter emotional connection.

About the author: Brian D. Earp is the associate director of the Ethics and Health Program at the Yale-Hasting Center and a fellow at the Yoshiro Center for Practical Ethics at the University of Oxford.

Julian Savrescu is Chair of the Ushiro Centre for Practical Ethics at the University of Oxford and directs the Oxford Centre for Neuroethics.

Text/Brian D. Earp & Julian Savulescu

Translation/antusen

Proofreader/Pharmacist

Original text/nautil.us/issue/88/love--sex/show-me-how-to-say-no-to-this

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