Notes from Practice

Fall officially started last week, and if you live anywhere in the northern half of the country, you've probably already noticed it's getting dark earlier. Right now we're losing a couple of minutes of daylight every day. On November 1 the clocks fall back, and suddenly it's dark by 5. This is the time of year I start bringing up seasonal depression with patients who've had it before. Not in December, when they're already sleeping ten hours and can't get off the couch. Now, w

Stimulants that help your focus can also leave you wired, but that feeling is usually one of four different problems: adrenergic activation, end-of-dose rebound, sleep loss, or anxiety the ADHD was covering up. Sorting out which one you have is most of the work, and the dose is usually the first thing to look at.

Why anxiety and IBS travel together, what visceral hypersensitivity actually means, how IBS should be diagnosed, and which medications and therapies help both.

Exhaustion, dread, and a brain that won't shut off can point to burnout, anxiety, or both. How the two differ in high-functioning professionals, and the question I ask first: what were you like before this job?

More clients are asking about ketamine. They have seen the headlines, heard a friend’s story, listened to a podcast, or come across a clinic promising rapid relief from depression or anxiety. Increasingly, they are bringing the question into therapy and asking: What do you think? If you are a therapist, you do not need to become an expert in ketamine or psychedelic medicine to have that conversation. But I do think it helps to understand what ketamine-assisted psychotherapy (

Sexual side effects are one of the most common reasons people stop antidepressants, and one of the least discussed. Here's why they happen, which antidepressants tend to be easier on sexual function, and what your options are if you're already dealing with them.

Peptides are having a moment. If you spend any time in the wellness world, you’ve probably noticed. There are peptides for muscle recovery. Peptides for weight loss. Peptides for better skin. Peptides for sleep. There is even one people use to get tan. And increasingly, I’m hearing about peptides for the brain. Patients are asking about Selank for anxiety, Semax for focus and brain fog, and BPC-157 for just about everything. Some have already found clinics that will prescribe

The Lindsey Clancy case is almost impossible to talk about without having an emotional reaction. Three young children died. Their mother is accused of killing them. Their father lost his entire family in a matter of minutes. There is no version of this story that is not devastating. As a psychiatric provider, there is another part of this case that I keep coming back to: how poorly postpartum psychosis is understood. I have watched people point to details of Lindsey Clancy's

Let me start with the obvious. Prescription stimulants are everywhere. Medications like Adderall, Vyvanse, and Ritalin have become part of everyday American life. They sit in nightstands, backpacks, office drawers, and college dorm rooms. They have their own slang, their own shortages, and for millions of people, they are simply how they get through the day. But they are not the right fit for everyone. They are controlled substances. They can increase anxiety. Some people exp

Whether Auvelity is right for you is a conversation to have with your prescriber. If you are reading this, chances are Auvelity has come up somewhere in your life. Maybe a doctor mentioned it, maybe you saw an ad, or maybe you have already tried a few antidepressants and someone told you this one is different. I want to walk through what it actually is, in plain language, so you can have a more grounded conversation with whoever is helping you. Auvelity is a newer antidepress

Ketamine can reduce suicidal thoughts within hours, but its effects often fade within days. A new study suggests that adding low-dose buprenorphine may help extend ketamine’s life-saving benefits, offering a promising new approach to treating suicidal depression.

Something unexpected has been happening in psychiatric clinics across the country. Patients taking GLP-1 agonists (the class of drugs including semaglutide and tirzepatide) are reporting changes that have nothing to do with their weight. They mention, almost as an aside, that their usual cravings have simply "gone silent." The evening glass of wine no longer appeals. The "doom-scrolling" loop has lost its grip. The constant "food noise" that once dictated their day has vanish

Guanfacine is one of those medications that sits quietly in the background of psychiatry. It is not flashy. It does not “kick in” the way stimulants do. Most adults have never heard of it. It is often overlooked, but in the right person, it can shift the tone of the entire nervous system in a way that feels relieving. People often notice they are less on edge, less reactive, a little more able to stay with things instead of getting pulled off course. You do not feel it in a b

A Significant Moment for Psychedelic Medicine. Here's What You Need to Know Last week, President Trump signed an executive order directing federal agencies to speed up research and access to psychedelic drugs for serious mental illness. Yesterday, the FDA moved quickly on that directive, issuing fast-track review status to three treatments: psilocybin for hard-to-treat depression and methylone (a compound similar to MDMA) for PTSD. The FDA also approved the first-ever US clin

Since the sentencing last week, I have heard from patients who are frightened and reconsidering treatment. Matthew Perry died because of ketamine. What is also true is that what happened to him bore no resemblance to responsible clinical care, and that distinction matters enormously for patients considering this therapy today.

If you have not seen Shrinking on Apple TV, stop reading and go watch it. I'll wait. Back? Good. Now let's talk about what is missing. The show has Jimmy, a therapist who is also quietly falling apart from grief, and decides the best way to handle that is to just say exactly what he thinks to his patients. No filter. Ethically complicated. Extremely entertaining. It has Gaby, warm and funny and somehow giving the best advice while her own life is held together with sarcasm a

Burnout and depression can look alike on the surface, but they are not the same thing, and what helps is different. Here is how to tell them apart.

If you've been struggling with stress, poor sleep, or low libido, ashwagandha might be worth a closer look. Here's what the research actually shows, and what to know before you try it.

Patients ask me about supplements constantly. Most of the time I am cautious. The evidence for a lot of what gets marketed as brain health or mood support is thin at best. Magnesium is different. It is one of the few supplements I recommend regularly, across a wide range of patients, because the evidence is real and the need is genuinely common. Why So Many People Are Deficient Magnesium is involved in over 300 biochemical processes in the body. Sleep regulation, muscle relax

Integrative psychiatry is not a rejection of medication. It is a fuller way of thinking about mental health. Jamie Solomon, PMHNP-BC, explains how she thinks about baselines, biology, therapy, supplements, and what actually happens at a first appointment.