Nine out of twenty patients in Dr. Brittany Albright's psychiatry practice were taking GLP-1 medications—not for weight loss, but because metabolic and psychiatric disease share the same pathophysiology. About 43% of patients with major depression have obesity, and GLP-1 receptors throughout the brain's mesolimbic reward system explain why these medications reduce alcohol cravings, tobacco cravings, and compulsive eating. A February 2024 JAMA Psychiatry study showed semaglutide significantly reduced drinking episodes in alcohol use disorder at relatively low doses. Dr. Will Sauvé and Dr. Brittany Albright discuss the neurobiological mechanisms, evidence-based patient selection beyond BMI, and why psychiatrists need to stop asking whether they're "allowed" to treat their patients' metabolic dysfunction. By 2030, over 50% of US adults will have obesity—the question isn't whether psychiatrists should prescribe GLP-1s, it's how we've gotten away with ignoring metabolic health for so long.

Timestamped Show Notes

[00:00:00] Introduction - Brittany's home office with plants and dogs

[02:02] The "holistic" medicine debate

[04:02] Why Brittany opened Sweetgrass Psychiatry

[07:00] Bringing family medicine in-house

[10:01] The economics of integrating primary care

[11:08] Scaling to 30 clinicians

[13:41] Full suite of interventional services offered

[15:08] Nine out of twenty patients on GLP-1s

[16:15] Depression and metabolic syndrome: 50/50 overlap

[19:03] GLP-1s and the mesolimbic system

[20:24] JAMA Psychiatry study on semaglutide for alcohol use disorder

[21:17] Dr. Stahl quote: "Follow the FDA label and never get anybody better"

[22:10] When GLP-1s aren't appropriate

[24:01] Case study: patient on paliperidone gaining weight despite tirzepatide

[25:52] Discovery of nucleus tractus solitaris

[28:26] The "are we allowed to prescribe this?" debate

[29:10] Valproic acid, propranolol, and scope of practice

[30:01] Bipolar disorder, obesity, and mood episode frequency

[30:49] Moving beyond the monoamine hypothesis

[31:19] UK paper: no proof depression is serotonin deficiency

[33:23] Alternative treatments: TMS, ketamine, GLP-1s

[34:03] Dr. Stahl's prediction: MDD is five different illnesses

[36:11] 2030 projection: over 50% of adults with obesity

[37:27] Starting with clinicians practicing what they preach

[38:44] Wild 5 Wellness program

[40:34] Force multipliers: treating populations, not just individuals

[43:06] Equipping other clinicians rather than scaling

[43:48] Private practice summit planned for Vegas 2026

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