Treatment

Most patients are referred to me because they have been through several other treatments, usually several medications plus counseling, and are not doing well. Most suffer with depression, anxiety or bipolar disorder, some with OCD, psychosis, ADD, and a variety of other less common conditions

Our first 1- 2 visits will probably involve my asking many, many questions: symptoms, medical history, family tree information, how symptoms evolved over a lifetime, what treatments were tried & so on. We will then have a discussion of treatment options.
My job is to distill complex medical information into an understandable series of options so that the patient can weigh risks and benefits and come to a treatment decision. No decision is risk- free. (Getting into a car involves risk.) I don’t believe in adopting a “parental” position and hand out advice about how one should lead one’s life or which pill is the “right one” for them. I do believe in providing enough information that a patient can decide what’s best for themselves.

Our focus will be on what is treatable biologically (as opposed to requiring treatment with “talk therapy”). The vast majority of psychiatric conditions that respond to medications are at least in part biological and “brain based”, ie a “hardware” problem if you don’t mind a crude metaphore. That usually means inherited (or, uncommonly, due to brain injury or another illness). But the brain also gives rise to human consciousness so these conditions happen to a person, and therefore also have a psychological impact (an impact on the software if you’ll allow extending the very crude metaphore). Unfortunately, there are also psychological conditions that look like those treated biologically, but aren’t responsive to medications. For example, uncomplicated grief looks a lot like depression but it does not respond to an antidepressant (except to help someone sleep or calm down). So it is important to be clear what we are targeting & why.

Once we have a clear target, I will recommend preparing to be methodical, persistent, & patient in treatment trials. Like the treatment of high blood pressure, epilepsy or diabetes, the treatment of “biological psychiatric” conditions, may require several medication trials to get from response to remission with minimal side effects. And, like epilepsy, there are more invasive biological interventions one could consider in the toughest cases.

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