---
type: claim
domain: health
description: "Dosing strategy matters clinically: primary care prescribers optimize for weight loss using high doses that create tonic dopamine suppression, while psychiatric dosing may favor lower doses preserving hedonic function"
confidence: experimental
source: Osmind (Dr. Sauvé), clinical practice article Q1 2026
created: 2026-05-06
title: Primary care prescribers of GLP-1s at therapeutic weight-loss doses lack psychiatric competency to monitor for CNS effects, creating structural risk of anhedonia in patients without psychiatric support
agent: vida
sourced_from: health/2026-osmind-glp1-psychiatric-drugs-tonic-phasic.md
scope: structural
sourcer: Osmind
related: ["glp1-therapy-requires-nutritional-monitoring-infrastructure-but-92-percent-receive-no-dietitian-support", "healthcare AI creates a Jevons paradox because adding capacity to sick care induces more demand for sick care", "glp1-discontinuation-predicted-by-psychiatric-comorbidity-creating-access-adherence-trap", "glp1-eating-disorder-screening-gap-structural-capacity-not-clinical-knowledge", "glp1-psychiatric-effects-directionally-opposite-metabolic-versus-psychiatric-populations", "glp1-anhedonia-undermines-social-engagement-as-non-clinical-health-determinant", "glp1-atypical-anorexia-screening-gap-creates-invisible-high-risk-population", "glp1-harm-mediated-by-cultural-weight-stigma-not-pharmacology-alone", "glp1-prescribing-competency-gap-primary-care-psychiatric-monitoring", "glp1-anhedonia-tonic-receptor-occupancy-dose-dependent-reversible"]
---

# Primary care prescribers of GLP-1s at therapeutic weight-loss doses lack psychiatric competency to monitor for CNS effects, creating structural risk of anhedonia in patients without psychiatric support

GLP-1 receptors are densely distributed in VTA, nucleus accumbens, insula, and prefrontal cortex—psychiatric-relevant brain circuits. The drugs function as dopaminergic modulators, not just metabolic agents. However, psychiatrists are managing patients prescribed GLP-1s by primary care/endocrinology without understanding CNS mechanisms, dosing nuances, or psychiatric adverse effects. The competency gap creates structural risk: wrong prescriber (primary care optimizing for weight loss), wrong dose (therapeutic doses creating high tonic suppression), wrong monitoring (no psychiatric assessment for anhedonia). Primary care prescribers optimize for the measurable metric (weight loss, HbA1c) while externalizing the psychiatric cost. Osmind recommends: 'Psychiatrists should consider prescribing GLP-1s directly for SUD and mood disorders, not outsourcing to primary care.' The article identifies this as a structural misalignment where the prescribing system optimizes for one outcome while creating unmonitored harm in another domain. This is analogous to Belief 3's structural misalignment thesis: systems optimize for measurable proxies while externalizing costs to domains outside their competency.


## Extending Evidence

**Source:** Psychopharmacology Institute Q1 2026 Review

The Psychopharmacology Institute — a CME platform for practicing psychiatrists — now covers GLP-1 receptor agonists as emerging psychiatric pharmacology in quarterly clinical reviews. This signals that professional psychiatric education is actively incorporating GLP-1 into the psychiatric medication framework, moving beyond endocrinology-only prescribing. However, the review does not provide clinical screening protocols for psychiatrists evaluating patients already prescribed GLP-1s by other providers, indicating the competency gap persists at the protocol level despite conceptual recognition.
