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As for endings, They are not effected by your actions througout the game. They are determined by one final decsion that you make at the end.
At first I thought the mechanic was gonna be a huge part of the game, like it'd hinder your ability to progress during stealth segments or mislead you with hallucinations and stuff like that, so I was really disappointed when, after going a whole hour of gameplay without using synchrozine, I realized it didn't actually do anything aside from making the game look like I was playing at 480p.
Edit: The only I changed, I disabled the rumble in the gamepad, it became to annoy because it was rumble with some heart beat.
I know you get an achievement for taking your meds, but I don't think there's much else to it