#404 ‒ Mental health beyond neurotransmitters: the role of hormones in psychiatry, why symptom reduction isn't enough, and the future of psychedelic therapies | Linus Abrams, M.D.

**Peter Attia** (0:11)
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My guest this week is Dr. Linus Abrams, a psychiatrist with nearly 35 years of clinical experience, specializing in mood disorders and psychopharmacology. After three decades in practice, Linus began rethinking many of the assumptions underlying modern psychiatry, leading him to explore how hormones, metabolism, inflammation, circadian biology, and the endocrine system reshape or shape mental health. Today, his work integrates traditional psychiatry with endocrinology, offering a broader framework for understanding the conditions such as depression, anxiety, bipolar disorder, and the profound effects of hormonal changes throughout life. I wanted to have Linus on because his work challenges some of our assumptions about how we think about mental health. We spent a lot of time talking about neurotransmitters and psychiatric medications, but I wanted to explore whether we're overlooking other important drivers of brain health and what that means for how we diagnose and treat patients. In this episode, we talk about why psychiatry should focus not only on reducing symptoms but also on restoring the full human experience, how psychiatric medications work, their limitations including why correctly diagnosing bipolar disorder versus unipolar depression is very important as one example. The role hormones including estrogen, progesterone, testosterone, and thyroid hormone play in mood, cognition, and mental health across different stages of life. How sleep, metabolism, inflammation, and chronic stress influences mental health, the promise and risk of ketamine and psychedelic therapies in psychiatric medicine, and why the future of psychiatric care may lie in integrating neuroscience, endocrinology, and whole body physiology. So without further delay, please enjoy my conversation with Dr. Linus Abrams.
Linus, thank you for coming to Austin. So wonderful to see you.

**Linus Abrams** (2:55)
Same here, Peter. Thanks for having me.

**Peter Attia** (2:58)
You have a very interesting practice in psychiatry, or at least I should say a very unique perspective on the integration of all of the traditional tools and insights of psychiatry along with those of endocrinology.
Is that a relatively recent fascination for you? You've been in practice for, what, 30 years?

**Linus Abrams** (3:18)
Going on 35

**Peter Attia** (3:20)
Okay.

**Linus Abrams** (3:21)
Yeah. Yeah. I did a pivot after 30 years.
I felt like I was in a bit of a rut. Like I was enjoying my practice, but I felt I wasn't learning as much as I wanted to learn.
And there are a number of factors that we can talk about that drove me in this direction. But the pivot is quite recent, and I'm learning about endocrinology as we speak. It's been a recently evolving trend, but I've thought about it deeply, and I hope some of that comes across in the podcast today.

**Peter Attia** (4:08)
So tell me what it was during the first 30 years of your practice that A, that gave you satisfaction and that you loved, and, sorry, B, that you were beginning to fatigue of or question or feel was insufficient to help your patients.

**Linus Abrams** (4:27)
Sure. Well, I see myself basically as a kind of humanistic, existential oriented psychiatrist who happens to be practicing psychopharmacology as a way to make a living and having an expertise in bipolar spectrum disorders. But I found that psychopharmacology was perceived ambivalently for the most part, even in very successful cases from an objective point of view in terms of symptom reduction, that the patient felt it was undesirable even if they had a spectacular reduction in symptoms.
And it led me to think about what was contributing to that. What I finally decided was the organizing principle was that psychiatry aims at reduction of symptoms, but not restoration of the full human experience that makes life most worthwhile.

**Peter Attia** (5:44)
That's a pretty profound statement.
I wouldn't say I'm pushing back on it. I'm only asking out of genuine curiosity. If you were at a dinner with nine other psychiatrists, would they share that view as well? Is that a largely and commonly held view amongst your peers?