Notes from Practice

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.

Bupropion, sold under the brand name Wellbutrin, is one of the most interesting and frequently misunderstood medications in psychiatry. Patients hear "antidepressant" and assume it works like everything else they've tried. It doesn't. Understanding what makes bupropion different can help you have a much more informed conversation with your prescriber about whether it makes sense for you. How It Works: The Dopamine and Norepinephrine Story Most antidepressants work primarily o

Lately, Lion's Mane is everywhere. Supplements, coffee blends, wellness ads. Patients ask me about it all the time, so I want to share what I actually think, based on the research, without the hype in either direction. So What Is It, Exactly? Lion's Mane is a mushroom. Not a psychedelic one. It looks a bit like a white pom-pom and has been used in Asian traditional medicine for a long time, mostly for gut and brain health. It is edible and completely legal. What makes it inte

Sexual functioning during perimenopause and menopause is rarely one simple problem with one simple answer. This guide is written from a psychiatric perspective to help you identify which part of the system is changing, and why. Many women come in saying, “My libido is gone.” But libido is not one single switch. Sexual functioning is a system made up of several parts, and different factors affect each one. When something changes, especially during perimenopause or menopause, i

Why self-reflection matters for mental health The start of a new year often comes with pressure. New goals, new habits, new versions of ourselves. While New Year’s resolutions can be motivating, they can also quietly reinforce shame, self criticism, or unrealistic expectations. From a mental health perspective, the new year can be far more helpful when approached as a moment of reflection rather than reinvention. Self reflection gives us a chance to pause, look honestly at wh

By twenty-one, most women have sat through countless health classes. Nutrition, exercise, and sleep- all covered. But when it came to sexual health, the real kind involving desire, arousal, and pleasure, there was mostly silence. What they did hear revolved around avoiding pregnancy or infection. No one talked about what actually makes sex feel good or why so many women feel disconnected from their own desire. The truth is, female sexual health is not a mystery. It is a livin

In your 40s, life can feel like a balancing act between growth and maintenance. You may be hitting your professional stride, supporting a family, or planning the next chapter of your life, all while noticing subtle shifts in energy, focus, and motivation. In this chapter of life, resilience and longevity become more than buzzwords; they’re essential skills. Resilience is your ability to stay steady through uncertainty, and longevity is not just about living longer but about

Artificial intelligence (AI) is transforming nearly every field, including psychiatry. From symptom tracking apps and virtual therapy companions to medication monitoring and diagnostic support, AI is reshaping how we understand and deliver mental health care. But as technology advances, new questions arise: Can AI also influence how we think, feel, or even become unwell? Recently, the term “AI psychosis” has started appearing in psychiatric discussions, media articles, and c

When most people think about autism, they picture children who struggle with language, eye contact, or social interactions. But autism in...

Psychedelic-assisted therapies are getting a lot of attention lately. From news headlines to podcasts, people are curious: could these...

Obsessive-Compulsive Disorder (OCD) is more than worries or habits; it’s a brain-based condition where the brain gets “stuck” on certain...

Many people with mood swings, distractibility, or impulsivity wonder: Do I have ADHD, bipolar disorder, or both? The question comes up...