#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.
Release Date: 08/17/2026
#407 ‒ Preventing cardiovascular and Alzheimer’s disease: lowering LDL early, APOE4, and promising new therapies | Michael Davidson, M.D.
The Peter Attia Drive
Michael Davidson is a world-renowned cardiologist, lipidologist, and the founding CEO of NewAmsterdam Pharma. He begins this episode by sharing how his family history shaped his interest in lipidology and primary prevention. He explains why prevention should focus on causal drivers of disease rather than near-term risk and examines the causal relationship between LDL and atherosclerotic cardiovascular disease. Michael then traces the complicated history of CETP inhibitors—from the original rationale that raising HDL would reduce cardiovascular risk to the failures of torcetrapib,...
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Blood pressure: how to measure, manage, and treat high blood pressure (AMA #48 rebroadcast)
The Peter Attia Drive
In this “Ask Me Anything” (AMA) episode, Peter delves into the critical subject of blood pressure, which is one of the three primary causes of atherosclerosis, along with high apoB and smoking. He begins by unraveling the nature of high blood pressure, its prevalence, and why it often goes undiagnosed. Peter describes in detail the proper way to accurately measure blood pressure and what determines a diagnosis. Next, Peter discusses the actionable steps one can take in response to high blood pressure, shedding light on the extent to which factors like weight loss, exercise, and...
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#406 ‒ Migraine, cluster headache, and tension headache: symptoms, causes, prevention, and treatment | Brian Grosberg, M.D.
The Peter Attia Drive
Brian Grosberg is a world-renowned headache specialist who joins Peter to provide a master class on the diagnosis and treatment of headache disorders. In this episode, Brian explains the distinction between primary and secondary headaches and breaks down the defining features of the "big three" primary headache types (migraine, cluster, and tension headache)—highlighting how often they are misdiagnosed and how they are treated. He explores the epidemiology of headaches, describing migraine as an invisible disease affecting about 12% of the population, disproportionately affecting women,...
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#405 ‒ AMA #88: Metabolic liver health: how to assess risk, catch dysfunction early, and prevent or reverse liver disease
The Peter Attia Drive
In this "Ask Me Anything" (AMA) episode, Peter takes a deep dive into the liver and its central role in metabolic health. He explains why the liver can serve as a "canary in the coal mine" for metabolic dysfunction and explores how insulin resistance, visceral fat, alcohol consumption, genetics, and hormones contribute to liver disease, along with how increasing muscle mass can benefit liver health. Peter provides a framework for understanding the progression of liver disease, highlighting which stages are reversible and why early detection matters. He explains why normal liver enzymes can...
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#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.
The Peter Attia Drive
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...
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#403 ‒ Peptides: separating scientific promise from marketing hype
The Peter Attia Drive
In this episode, Peter returns to the topic of peptides, offering a clear and accessible guide to a field surrounded by both genuine scientific promise and widespread misinformation. Peptides are increasingly marketed for everything from injury recovery and muscle growth to longevity and improved appearance, often with claims that extend far beyond the available evidence. Rather than promoting or dismissing peptides as a category, Peter presents a practical framework for evaluating any peptide: what it is, how it is supposed to work, and where the science is strong, weak, or simply absent....
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#402 ‒ NMR blood analysis: how heart disease risk, insulin resistance, inflammation, and mortality risk can be assessed from a single blood sample | Jim Otvos, Ph.D.
The Peter Attia Drive
Jim Otvos is a biophysical chemist who pioneered the use of nuclear magnetic resonance (NMR) spectroscopy to measure lipoprotein particles and developed the first FDA-cleared method for directly quantifying LDL particle number (LDL-P), a technology that has since expanded to provide broader insights into metabolic health, inflammation, insulin resistance, and mortality risk. In this episode, Jim recounts the unlikely story of transforming a flawed cancer test into a new way of measuring lipoproteins, explains what standard cholesterol tests can miss and why LDL-P and apoB can inform...
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#401 ‒ How curiosity transforms medicine: extraordinary discoveries that changed modern healthcare
The Peter Attia Drive
In this episode of The Drive, Peter explores how seemingly obscure basic science discoveries have laid the foundation for some of the most important medical breakthroughs of the past half century. Rather than focusing on the clinical applications of modern therapies, he traces the fascinating stories behind the scientists, experiments, and unexpected discoveries that ultimately led to transformative drug classes, revealing how groundbreaking advances often emerge from research with no obvious clinical goal. Through these historical case studies, Peter provides a new perspective on the...
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#400 ‒ AMA #87: Environmental pollution and longevity: air pollution, noise, light, EMFs, and practical strategies to mitigate health risks
The Peter Attia Drive
In this “Ask Me Anything” (AMA) episode, Peter explores the evidence behind environmental pollution and its impact on long-term health, separating well-supported risks from less substantiated claims while providing a practical framework for deciding which exposures deserve attention. He explains what environmental pollution encompasses, where it fits within the broader hierarchy of longevity interventions, and why studying its health effects is uniquely challenging. Peter examines the evidence linking air pollution to disease and shares actionable strategies for improving indoor and...
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#399 ‒ The evolution of Alzheimer's disease and dementia care: how early detection, personalized treatment, new therapies, and a multimodal approach are changing the landscape | Gayatri Devi, M.D.
The Peter Attia Drive
Gayatri Devi is a nationally recognized neurologist specializing in memory disorders, including Alzheimer’s disease and related dementias. In this episode, Gayatri explains how to think about dementia as a spectrum—including Alzheimer’s disease, vascular dementia, Lewy body dementia, and mixed presentations—while exploring the evolving biology of amyloid, tau, and neuroinflammation and why brain pathology does not always correlate with symptoms. She discusses her approach to detecting subtle cognitive decline in high-functioning individuals, the role of biomarkers and APOE4 testing...
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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. Linus explains the powerful roles of estrogen, progesterone, testosterone, and thyroid hormone in regulating mood and cognition across the lifespan. Finally, Peter and Linus review the promise and limitations of ketamine and psychedelic therapies, and why the future of psychiatry may lie in integrating neuroscience, endocrinology, and whole-body physiology to better understand, diagnose, and treat mental illness.
We discuss:
- Linus's passion for understanding his patients and going beyond traditional psychiatry [2:45];
- A short primer on the different classes of drugs used in psychiatry [12:45];
- Evaluation of a patient with bipolar disorder [26:00];
- An evolutionary perspective on depression [33:30];
- Changes in the modern world triggering mental health problems [41:00];
- An evolutionary perspective on insomnia [48:15];
- Peter's window analogy to understand distress tolerance and irritability [49:45];
- The impact of foundational biological factors on psychiatry: nutrition, exercise, sleep, and endocrinology [52:30];
- The effect of estradiol on neurotransmitters in the brain [58:15];
- Options for increasing testosterone in men, and why clomiphene is inferior to exogenous testosterone [1:11:00];
- The rapid drop in progesterone is linked to both premenstrual dysphoric disorder (PMDD) and postpartum depression [1:14:30];
- Treatment of postpartum depression [1:18:00];
- Hypothyroidism presenting as depression: how Linus makes the diagnosis and what he uses for treatment [1:26:00];
- The link between hyperarousal and chronically elevated cortisol [1:39:30];
- A case where the menopause transition uncovers bipolar disorder [1:44:15];
- Ketamine as a tool to treat recalcitrant depression, and concerns about its recreational use [1:49:15];
- Case study: an Alzheimer's patient who improved after psilocybin, and why Linus is cautious about drawing conclusions from it [1:55:15];
- Peter's experience with psychedelics, and the myth that estrogen is bad for men [2:00:30];
- The therapeutic potential of psychedelics in psychiatry [2:11:00]; and
- More.
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