---
type: source
title: "GLP-1 Agonists Are Psychiatric Drugs. Psychiatry Should Start Acting Like It."
author: "Dr. Will Sauvé, Dr. Annette Bosworth, Dr. Brittany Albright (Osmind)"
url: https://www.osmind.org/blog/glp-1-psychiatry
date: 2026-03-17
domain: health
secondary_domains: []
format: article
status: processed
processed_by: vida
processed_date: 2026-05-07
priority: high
tags: [glp-1, psychiatry, competency-gap, anhedonia, addiction, dosing]
intake_tier: research-task
extraction_model: "anthropic/claude-sonnet-4.5"
---

## Content

Osmind CMO Dr. Will Sauvé, Dr. Annette Bosworth (internal medicine, developer of Dr. Boz Ratio metabolic monitoring protocol), and addiction psychiatrist Dr. Brittany Albright argue that GLP-1 receptor agonists are functionally psychiatric drugs — engaging VTA, nucleus accumbens, insula, and prefrontal cortex to directly regulate reward pathways and reinforcement learning.

**Core argument:** GLP-1 receptors in these brain regions directly regulate reward pathways. These are psychiatric tools, not just metabolic agents.

**Competency gap:** Dr. Sauvé (CMO, Osmind): "If our field of psychiatry does not get a hundred percent ahead of how this GLP thing works, then we're going to be left behind." Current problem: psychiatrists managing GLP-1-prescribed patients without understanding central mechanisms, dosing nuances, or psychiatric side effects — drugs prescribed by primary care.

**Key clinical evidence cited:**
- Hendershot trial (JAMA Psychiatry 2025): Semaglutide in 48 adults with AUD showed effect sizes exceeding naltrexone or acamprosate
- Eli Lilly brenipatide Phase 3 trials (RENEW-ALC): 2,200 patients with moderate-to-severe AUD
- All of Us observational (March 2026): GLP-1 exposure associated with 75% lower odds of any SUD

**Monitoring recommendation (Dr. Bosworth "Dr. Boz Ratio"):**
Track blood glucose ÷ blood ketones: >80 = glucose metabolism; 40-80 = moderate ketosis; <40 = deeper therapeutic ketosis.

**Low-dose psychiatric protocol:**
- Low-dose tirzepatide: 0.6mg weekly (one-quarter standard starting dose)
- Paired with ketogenic diet
- No emotional blunting reported in ~100 patients per cohort
- Dr. Bosworth: structured resistance training + adequate protein (1.6–2.3g/kg/day) prevents lean mass loss

**Anhedonia mechanism:** Tonic vs. phasic receptor activation. Natural GLP-1 half-life ~1-2 minutes (phasic). Long-acting GLP-1 agonists: days-long tonic activation → sustained dopaminergic suppression → anhedonia. Dosing strategy — not inherent pharmacology — determines anhedonic outcome. Parallel drawn to ziprasidone: 20mg produces one effect; 120mg the opposite.

**Drug specificity:** Tirzepatide (GLP-1+GIP) vs. semaglutide (GLP-1 only) may have different neurochemical profiles because of GIP component.

## Agent Notes
**Why this matters:** Single authoritative synthesis from a psychiatric platform (Osmind = psychiatric practice management + TMS/ketamine) arguing directly that GLP-1 is a psychiatric drug class. The competency gap framing and low-dose protocol recommendations are the most concrete clinical guidance for psychiatric prescribers available as of March 2026.

**What surprised me:** The Bosworth metabolic ratio monitoring protocol (blood glucose ÷ ketones) is highly specific and operational — more concrete than anything from professional societies. Suggests clinical protocols are being developed in practice before guidelines exist.

**What I expected but didn't find:** Specific prevalence data on anhedonia rates in clinical cohorts. The ~100 patient cohorts are real but anecdotal; no formal incidence figures.

**KB connections:**
- [[human-in-the-loop clinical AI degrades to worse-than-AI-alone]] — the competency gap is structurally similar: a clinical tool being used without the cognitive architecture to govern it safely
- [[value-based care transitions stall at the payment boundary]] — Belief 3 parallel: primary care prescribing at weight-loss doses without psychiatric monitoring is a structural misalignment problem, not a knowledge problem
- [[GLP-1 receptor agonists are the largest therapeutic category launch in pharmaceutical history]]

**Extraction hints:**
1. Claim about prescribing competency gap and how it's being addressed (CME pathway vs formal guidelines)
2. Claim about low-dose tirzepatide psychiatric protocol (0.6mg weekly + ketogenic diet = no anhedonia)
3. The dosing = anhedonia relationship is a distinct claim from the tonic/phasic mechanism

## Curator Notes (structured handoff for extractor)
PRIMARY CONNECTION: [[GLP-1 receptor agonists are the largest therapeutic category launch in pharmaceutical history but their chronic use model makes the net cost impact inflationary through 2035]]
WHY ARCHIVED: Documents the emerging psychiatric prescribing context and competency gap — a Belief 3 (structural misalignment) instance where a powerful drug is being prescribed without the competency to govern its psychiatric effects
EXTRACTION HINT: Focus on (1) the competency gap claim itself, (2) the monitoring protocol specifics, (3) the low-dose protocol — these are three distinct potential claims
