In this episode, Peter sits down with Dr. Linus Abrams, a psychiatrist with nearly 35 years of clinical experience specializing in mood disorders and psychopharmacology, to explore how our understanding of mental health is evolving beyond the traditional neurotransmitter model. After decades in practice, Linus began questioning many of the assumptions underlying modern psychiatry, leading him to investigate how hormones, metabolism, inflammation, circadian biology, and the endocrine system shape mood and cognition. Together, Peter and Linus examine why psychiatric care should aim not only to reduce symptoms but also to restore the full human experience. They discuss how psychiatric medications work, where they fall short, and why distinguishing bipolar disorder from unipolar depression is essential for effective treatment. The conversation also explores the growing mental health burden of social isolationn associated with digital devices and social media, along with the biological factors—nutrition, exercise, sleep, and chronic stress—that influence resilience and distress tolerance. 0:00:00 - Intro 0:00:11 - Linus's passion for understanding his patients and going beyond traditional psychiatry 0:10:24 - A short primer on the different classes of drugs used in psychiatry 0:24:12 - Evaluation of a patient with bipolar disorder 0:32:00 - An evolutionary perspective on depression 0:39:41 - Changes in the modern world triggering mental health problems 0:47:15 - An evolutionary perspective on insomnia 0:48:54 - Peter's window analogy to understand distress tolerance and irritability 0:51:46 - The impact of foundational biological factors on psychiatry: nutrition, exercise, sleep, and endocrinology 0:57:54 - The effect of estradiol on neurotransmitters in the brain 1:11:05 - Options for increasing testosterone in men, and why clomiphene is inferior to exogenous testosterone 1:14:37 - The rapid drop in progesterone is linked to both premenstrual dysphoric disorder (PMDD) and postpartum depression 1:18:18 - Treatment of postpartum depression 1:26:53 - Hypothyroidism presenting as depression: how Linus makes the diagnosis and what he uses for treatment 1:40:47 - The link between hyperarousal and chronically elevated cortisol 1:45:52 - A case where the menopause transition uncovers bipolar disorder 1:50:58 - Ketamine as a tool to treat recalcitrant depression, and concerns about its recreational use 1:57:07 - Case study: an Alzheimer's patient who improved after psilocybin, and why Linus is cautious about drawing conclusions from it 2:02:37 - Peter's experience with psychedelics, and the myth that estrogen is bad for men 2:13:36 - The therapeutic potential of psychedelics in psychiatry View show notes here: https://peterattiamd.com/linusabrams/ Become a member to receive exclusive content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ -------- About: The Peter Attia Drive is a deep-dive podcast focusing on maximizing longevity, and all that goes into that from physical to cognitive to emotional health. With over 90 million episodes downloaded, it features topics including exercise, nutritional biochemistry, cardiovascular disease, Alzheimer’s disease, cancer, mental health, and much more. Peter Attia is the founder of Early Medical, a medical practice that applies the principles of Medicine 3.0 to patients with the goal of lengthening their lifespan and simultaneously improving their healthspan. Learn more: https://peterattiamd.com Connect with Peter on: Facebook: http://bit.ly/PeterAttiaMDFB Twitter: http://bit.ly/PeterAttiaMDTW Instagram: http://bit.ly/PeterAttiaMDIG Subscribe to The Drive: Apple Podcast: http://bit.ly/TheDriveApplePodcasts Overcast: http://bit.ly/TheDriveOvercast Spotify: http://bit.ly/TheDriveSpotify Google Podcasts: http://bit.ly/TheDriveGoogle Disclaimer: This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional healthcare services, including the giving of medical advice. No doctor-patient relationship is formed. The use of this information and the materials linked to this podcast is at the user's own risk. The content on this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they have, and they should seek the assistance of their healthcare professionals for any such conditions. I take conflicts of interest very seriously. For all of my disclosures and the companies I invest in or advise, please visit my website where I keep an up-to-date and active list of such companies. For a full list of our registered and unregistered trademarks, trade names, and service marks, please review our Terms of Use: https://peterattiamd.com/terms-of-use/