As a Board-certified psychiatrist in private practice in New York City, I specialize in integrating psychopharmacology and psychotherapy. I am often asked by colleagues for consultation on difficult-to-treat patients. Contrary to what many say, I have found that depression and most mental health disorders are highly treatable. No one needs to feel hopeless or helpless about being depressed. The advances made in psychopharmacology, the effective array of psychotherapeutic modalities, and the increased recognition and understanding of the benefits of mind-body practices, provides us with the ability to take a highly effective, comprehensive approach for treating mental health challenges. My areas of expertise include:
- Marital/Family/Relationship Counseling
- Attention Deficit Disorder (ADHD)
- Mood Disorders
- Post-Traumatic Stress Disorder (PTSD)
- Obsessive-Compulsive Disorder (OCD)
- Advanced Psychopharmacology (complex issues involving medication)
- Stress Management
I usually allow extra time for the initial visit. In my experience, most people who come for a consultation have been struggling with their condition for some time. They may have already tried and failed at treatments. There is always a lot of information to cover. By taking a careful history and reviewing relevant outside reports and laboratory studies, I tease apart three separate factors that may be contributing to the patient’s problem: 1) the biological, 2) the situational and interpersonal and, 3) the intra-psychic or psychodynamic issues. Each factor will be addressed slightly differently in treatment. It’s important that we be thorough and review everything that has been tried, what’s worked, what hasn’t, and benefit from all the prior experience one may have had at attempting to solve their problem. This enables us to pull together all someone has gone through into a diagnosis of the problem which he or she can understand. The treatment options will flow from that.
In my experience, patient education is a key contributor to treatment success. In the consultation I diagnose the condition and offer explanations about the patient’s condition and treatment options. I take the time to provide a roadmap for the patient so that he or she will know what to expect during the course of treatment–how long it will take to be effective, what side effects may crop up along the way and how we will manage them, and what the outcome of treatment will look like.
People who are very depressed or anxious often feel lost in their emotional despair. Gaining understanding is empowering and helps patients be more active partners in their treatment. Patients often need to be reassured that their clinical depression is not an inevitable or hopeless state, no matter what his or her life circumstance are. When they become “undepressed” they stop ruminating over the same thoughts and feelings and are finally able to work through challenges in their lives in a productive way. For instance, people who are depressed can’t mourn. It is only once patients become “unstuck” from depression that they can go on to mourn and, ultimately, build more satisfying and fulfilling lives.
The Course of Treatment
It is often only after the biological roots of depression have been addressed, that patients can benefit from healthy habits like exercising and meditating and are able to address issues that have been festering for a long time beneath the surface. Many patients gain surprising insights into what makes them “tick,” helping them more successfully handle relationships at home and in the workplace. There is a settling in period during which one is learning how to channel this newfound strength and relate to family and friends around them. I encourage patients to integrate mind-body practices, like mindfulness meditation, breathing, and yoga to strengthen their sense of a healthy self.
Psychopharmacology can be extremely effective but successful treatment is never just about medication. There are many kinds of talk therapy approaches—some insight-oriented, some very practical and problem solving—from which patients benefit. I also encourage my patients to explore the benefits of exercise, nutrition and spiritual disciplines including tai chi, yoga, and meditation—all of which an be important additions to the therapeutic mix for those who engage in them.
As co-author of the first and most comprehensive book on the developmental transition to marriage, The First Year of Marriage: What to Expect, What to Accept and What You Can Change, I’ve conducted research on how hundreds of couples make the transition to marriage. I have also taught courses on couples therapy, been a guest speaker at numerous conferences where I’ve addressed marital topics, and have seen many couples in consultation and treatment over the years.
By the time couples come into therapy there is usually a failure of empathy. Neither feels or even wants to accommodate the other’s wishes and needs. A seemingly trivial issue can blow up. A mole hill becomes a mountain.
When I meet couple together in consultation I listen carefully to both partners. At some point, I will speak to each individually. This way they can unburden themselves, express their fears, hurt and anger without having to inflict further pain or do further damage to the injured relationship.
In counseling, we explore ways to recognize the couples relationship dynamics and what might be done to improve it. I also screen each partner for depression. Often, one partner’s underlying depression is prompting the couple’s bond to unravel. If a couple truly wants to stay together, much progress can be made. Rebuilding trust and love can take time but it can be done. If couples are set on separating we work on ways to make that process as amicable as possible.
Family members of loved ones who are struggling with depression, anxiety, and other mental health conditions also find it helpful to talk with a professional. I provide consultation to family members who have questions about their loved one’s diagnosis and/or treatment, want to know how they can best be supportive, and need support themselves as they deal with their loved one’s condition.
Read about “The Ripple Effects of Depression,” “10 Things Everyone Should Know About Depression” and other topics related to the integrated diagnosis and treatment of depression on my blog “Depression: A Guide for the Perplexed.”