Notes from Practice

Side effects usually show up before an SSRI starts helping. What the first few weeks really look like, how soon it starts working, and which early symptoms mean you should call your prescriber.

A genetic test can show how your body processes certain psychiatric medications. It can't tell you which one will work. What GeneSight-style testing actually measures, how to read the red and green results, and when it's worth doing.

You can believe in therapy and understand that psychiatric medication is legitimate treatment, and still feel ashamed when you're the one who needs it. Often that discomfort comes from what your family taught you about mental health long before you had an opinion of your own.

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

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?

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.

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

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.

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.

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

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

Menopause is often talked about in terms of hot flashes and night sweats. But for many women, the biggest changes show up in mood,...

Anxiety is one of the most common mental health struggles. According to the National Institute of Mental Health , nearly one in three...

Walking into a first psychiatry appointment can feel intimidating. Many people worry they’ll be judged, labeled, or rushed into a...