Reflections on Psychiatry, Therapy, and Mental Health

a significant technical advancement over conventional TMS I enjoy the challenge of trying to understand, and sometimes trying to help others understand complex technologies. Stanford Accelerated Neuromodulation or SAINT, the very powerful treatment for severe depression, is one technology that is worthwhile explaining to others. If I get it right in this essay, you will have a practical understanding that is not superficial but at the same time does not get into distracting

There are a number of perspectives on Ketamine as a therapeutic agent. One is to marvel at its biological activity, being an agent that can provide rapid relief of depressive symptoms and suicidal ideation. This is essentially the somewhat static box that Spravato, the branded form of Ketamine, is locked into. Pharmaceutical guidelines require its use under a so-called risk management system that restricts its use to just two indications: treatment-resistant depression and su

Not long ago a colleague chastised me when I somewhat boasted of my ability to do a 10 minute psych. eval. Being chided, of course, I had to explain myself. For years I have taken pride in trying to make the best of whatever. opportunity a patient offers me to be helpful. A striking example is the patient who show up late for an initial evaluation leaving me with only a few minutes to try and make good use of the time. It has always troubled me when some colleagues refuse

Perhaps one of the worlds most famous guides. Tenzing Norgay, guide to Mt. Everest, pictured with client Sir Edmund Hillary, As a psychiatrist and therapist I'm used to treating patients, not guiding them. Ketamine has encouraged me to get more familiar with guiding. Ketamine has a fascinating biological action- see a recent post for elaboration , yet it is also described as an 'abreactive drug,' that is, a drug that evokes feelings. Under the influence of the drug a patie

Lady Macbeth wanting to purge a stain Benzodiazepines are a class of medicines that are as widely used as they are frequently criticized. As a class they have become stained largely as a result of the decades-long opiate crisis and the association of benzodiazepines with addiction. Let's try and understand the stigma around benzodiazepines—and why it persists For the purpose of discussion, I regard a stain as a blemish, something that is not essential to the inherent proper

Ketamine may be the flower girl that is walking down the isle toward a marriage of biological and psychological psychiatry. We say this because the science tells us that Ketamine has a strong biological effect in benefiting patients. At the same time, it is somewhat of an hallucinogen, and has been described as an abreactive drug, that is, a drug that brings into consciousness thoughts and feelings that may be hard to access in ordinary states. In effect, Ketamine leads to

It's natural to wonder what role psychiatric medications should have in the treatment of mental disorders. I have, of course, thought about this for years and have come to the conclusion that our medications don't treat diagnoses nearly as much as they do dimensions of functioning. What I mean by this is that for any given diagnosis there are a cluster of symptoms associated with that diagnosis. Depression for example is characterized by sleep problems, low mood, often an