How is your treatment approach different from that of other psychiatrists or mental health professionals?
As an academic researcher, I have been involved for many years in formal studies of medicines as they were being developed to treat depression, bipolar disorder, psychosis, and related conditions. Research involves adopting a critical, scientific approach to deciding whether or not a potential treatment really is appropriate and effective -- and if so, how clinically meaningful and longlasting an effect might be. Research studies tell us crucial information not only about whether a drug works for a given problem, but also what types of symptom profiles might be most responsive, which kinds of patients may be the ones most likely to derive benefit, and how one possible treatment compares with another in terms of how it works and how well it works. I bring a scientifically-grounded and informed approach to assessing clinical problems and proposing treatment strategies that are logical, feasible, and evidence-based.
What exactly is a psychopharmacologist?
Psychopharmacology is one branch within psychiatry. Psychiatrists who focus their practices mainly on the medication-based treatment of psychiatric problems are, or should be, experts in the use of psychotropic medications. This means they typically have advanced knowledge about psychiatric drugs, when and how they work, the studies that support (or fail to support) their use in specific situations, dosing, side effects, laboratory monitoring, and knowledge of specific combinations that can synergize -- like fitting together the pieces of a puzzle -- to create the most effective possible result.
How are psychiatric diagnoses made, and are they important?
Diagnosis is shorthand. Sometimes, shorthand communicates enough information to adequately describe a set of problems and come up with a plan to solve them. Other times, especially in psychiatry, problems involving mental health may not fit so neatly into pre-set categories, and long-hand becomes a better way to describe a problem or set of problems that may exist. There are no established laboratory tests or other external ways to validate a psychiatric diagnosis -- disorders are recognized based on clinical interview and assessment. Diagnosis is of practical importance inasmuch as treatment follows a diagnosis; one cannot know what treatments should be used until first knowing what it is that's being treated. It is important for doctors and patients to recognize how someone's unique presentation and circumstances may differ from the kinds of problems studied in research trials, since results may be different in "real world" settings. Diagnoses can help guide thinking about possible treatments, but ultimately, choosing the right treatment strategy depends on the person, not the diagnosis.
How are decisions made about the best medicine for an individual patient?
One size does not fit all. Medicines that may well work for one person's depression may not be useful for anther's. Even when a clear diagnosis such as bipolar disorder or major depression is evident, more specific aspects about an individual may be crucial for guiding treatment decisions. How long has the problem been there? Were prior treatments appropriate and of adequate dose and duration? Did side effects cause a medicine to be stopped before its possible value could be judged? Are there additional problems present, such as anxiety, or alcohol or drug use, or personality features that may play a role? What combinations of medicines fit well together and work in complementary ways (as opposed to haphazard combinations that may even have redundant or conflicting mechanisms, and excessive side effects)? The art of psychopharmacology involves knowing what medications can and cannot do, and for which subtypes of disorders, in order to "broker" the best fit.
What do psychiatric medicines do to the brain? How do they work?
Nobody knows exactly how psychotropic medicines work, although there are many theories about their ability to increase the functional efficiency of nerve cell circuits in the brain or make brain nerve cells survive and thrive more effectively under biological stress. Psychiatric medicines do not change who you are so much as they may help to reveal who you are underneath a veil of symptoms. Even longstanding symptoms of depression or anxiety may improve when the right treatments are undertaken, or wrong treatments are eliminated. Sometimes, the best treatment involves knowing the limitations of what medicines can and cannot do.
If medicines are helpful, does someone have to take them forever?
Once again, one size does not fit all and questions about how long someone should continue a medicine for problems with mood or anxiety depends very much on their unique circumstances. Has the original response to treatment been very dramatic, or only subtle? Have there been prior episodes, and is this a recurrent disorder, or a first time episode? Have many prior appropriate treatments been tried unsuccessfully? Have medicines caused significant side effects? Are there compelling reasons to stop a medicine, such as a medical complication, or a planned pregnancy? Important decisions such as these hinge on frank dialogue and deliberation between doctor and patient . My goal is to help patients make the most informed decision they possibly can about matters involving their physical and emotional health.
Isn't medication just a "quick fix" substitute for psychotherapy?
Medicines for psychiatric disorders usually don't work "quick" but they can help to remedy or improve the emotional, behavioral or cognitive problems that interfere with everyday life. Pharmacology and psychotherapy often blend together in a complementary way to produce the best outcomes, depending on someone's individual circumstances. Serious forms of depression or anxiety can interfere with the process of doing work in psychotherapy, and sometimes, the right medication regimen can be enormously helpful for improving energy, attention, concentration, motivation and outlook. Psychotherapy is a process that involves examining problems from new points of view and challenging one's attitudes, beliefs, and motivations in order to bring about new ways of problem-solving and coping. At its best, good treatment often involves a complementary mix of pharmacology, psychotherapy, and sometimes other treatment approaches as well.
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