Tirzepatide Brain: The Nose Knows

Not watching social media has its benefits as well as its downfalls. When something weird happens, unless I realize it is Google-able, I dwell on it all alone. That’s what has been going on with the odd olfactory (scent-based) experiences I’ve had since starting Mounjaro three months ago. With each dose, the scents are becoming more pronounced so I decided to look into what might be happening.

Olfactory Hallucinations with My Bipolar Disorder 1

I have had ongoing olfactory hallucinations since before my Bipolar Disorder 1 diagnosis in 1995, but didn’t know they were abnormal until then. I thought everyone had odd scents going on. Once I learned that my hallucinations could “measure” my mental health, it became easier to detect oncoming lows and highs in my moods.

When I am in a balanced state or with hypomania, I have lovely scents that seem to waft through my nose. Really, nothing is there, but my brain gives me plumaria, coconut oil (not just coconut, but suntan oil smells), clean laundry, peaches… like this. As depression descends, the scents shift to what I call “negative smells.” I get turpentine, paint thinner, burning plastic, cigarette smoke, and then they continue getting worse and I will randomly smell vomit or (excuse the word, but it really is necessary) shit. When horrid smells invade my mind, I know I am not going to have a good time for awhile and work hard with my doctor and medications to right things as quickly as possible.

Blessedly, my mental illness is pretty balanced and I have only had three manic episodes since 1995, each lasting 3-4 months… yes, that long. In mania, I have amazing (sometimes amazingly scary) auditory, visual, olfactory, and tactile hallucinations. They surely come along with the lack of sleep I have, but I do recognize they aren’t supposed to be there. One of the most bizarre hallucinations I had with my last manic episode was my breathing pillow. It inhaled and exhaled for hours on end. All I could do was watch, fascinated.

After each of those manic episodes comes horrific depression with terrifying hallucinations, but I have never lost my knowledge of reality and the auditory hallucinations never tell me to do anything to myself or anyone else. Thank the Universe for small favors.

And Then Comes Mounjaro

Then I started taking Mounjaro three months ago and as the scents shifted, I just assumed the hallucinations were moving to a different level. It wasn’t until I realized my usual hallucination scents had abated and I was left with only real scents (candles, cleaning products) and something I call the “Mounjaro Scent.”

I’ll address the Mounjaro Scent in a separate blog post. The real scents now.

Until Mounjaro, I burned Yankee Votive Candles every day. On my desk, in front of Buddha, less than a foot from where I sit. Since being on tirzepatide, I’ve had to move the candle further away, then further still… across the room… and for the last couple of weeks, cannot burn them at all because the fragrance is way too overwhelming. Confused, I thought I must have gotten a weird batch of the votives, so tried a couple of other ones. The same thing. Very weird.

I turned to the Essential Oils I have, delicious ones that smell like the hotels at Disney World (Yacht and Beach for one scent and the Polynesian for the other). I’ve used them for two years now, so knew if they smelled strong, it was me, not the scents. It was, indeed, me. Not the scents. Even my beloved Aloe and Green Clover (the Y&B scent) smelled ghastly strong.

I love lemon-scented garbage bags and lemon-scented Endust. Using them now, I gag from the overwhelming aroma. It was when I opened the box of garbage bags that it finally dawned on me that my smeller had changed. It wasn’t the candles or cleaning supplies, it was me!

Sniffing around wherever I’ve gone the last two weeks, including on a plane, I have been able to smell what I would never have noticed before. I could smell the dirt on the plane. The perfume on the woman next to me nearly choked me. It really is the weirdest experience, all this ability to smell so acutely.

What was up? I wanted more information. Why had my olfactory hallucinations stopped? Why had my olfactory abilities gotten so detailed and able? I wanted clinical information. Studies, if possible.

GLP-1RAs, Type 2 Diabetes, and the Olfactory Connection

With very little poking around, I found a couple of papers that talked about GLP-1RAs and their effect on the olfactory system and in the examination of the studies, cognitive abilities was included with the ability to smell. I will speak about the brain function later, but know that these examples include both the nose and the brain.

Because this is a medical review paper and speaks in medical-speak and I like to write in real-people talk, I will attempt to translate it after the technical paragraph.

These next two technical paragraphs come from the Journal of Clinical Medicine (J Clin Med. 2021 Dec; 10(23): 5637. Published online 2021 Nov 29. doi: 10.3390/jcm10235637) and is titled “Olfactory Dysfunction: A Complication of Diabetes or a Factor That Complicates Glucose Metabolism? A Narrative Review”

…the incidence of weight gain was highest among people with anosmia [49]. Moreover, 24-hour fasting appears to improve olfactory function [50]. Among females with extreme eating conditions, olfaction (assessed with Sniffin’ Sticks) was impaired in obese participants and increased in anorexia nervosa (hyposmia was observed in 54.3% of obese individuals and 6.4% of individuals with anorexia nervosa). Furthermore, ghrelin levels were significantly decreased in obese subjects and were related to smell impairment, suggesting that olfactory function and ghrelin could play a significant role in emotional eating and obesity [51].

My translation:

Gaining weight happened more with people who could not smell scents. Just fasting for 24 hours improved the ability to smell. Science uses something called “Sniffin’ Sticks” that, when unscrewed, allow scents to escape and then the person, who has been wired for sound and scents, is measured as far as what they can smell and how strong that scent is.

Women with obesity had impaired senses of smell (54.3% of the women with obesity had this issue) whereas women with anorexia had a heightened sense of smell (only 6.4% of the women with anorexia had difficulty smelling).

Not sure what an “extreme eating condition” is. People with obesity also have a low level of the hormone ghrelin (grell-lin). Ghrelin tells your stomach “You’re full!” so if we have low ghrelin, we don’t get a good message to stop eating and to not eat again soon.

Zhang et al. [52] showed that olfactory dysfunction could result in weight gain among T2DM with cognitive impairment. Among 35 people with T2DM and obesity, 35 people with T2DM without obesity, and 35 controls, obese subjects with diabetes demonstrated lower general cognition and olfactory threshold scores, decreased left hippocampal activation, and disrupted seed-based functional connectivity with right insula as compared with people with diabetes without adiposity. Interestingly, among obese people with T2DM, administration of a GLP-1 receptor antagonist for 3 months has been associated with amelioration of cognitive and olfactory function [52].

…tirzepatide dramatically alleviated spatial learning and memory impairment, inhibited Aβ accumulation, prevented structural damage, boosted the synthesis of synaptic proteins and increased dendritic spines formation in diabetic hippocampus.

My Own Brain Function Improvement