Medication Management
My Care Philosophy
My care philosophy is built on the idea that psychiatric medications are to be used thoughtfully, if at all. I won't tolerate my patients feeling "like a zombie" after taking medication. This is very unpleasant for you, as you are already struggling with the circumstances of life. Let's focus on returning to your definition of wellness, rather than labelling you as "sick."
I do have a special interest in treating Adult ADHD, which may involve the prescribing of medications with the potential for abuse.
If you are on stimulant medication like Adderall, please note I do NOT write for more than 60 mg of Adderall, or its equivalent, daily. I also will not write for combinations of controlled meds (I've noticed a lot of patients are on Adderall plus controlled meds like Ambien, Xanax, or Clonazepam).
If you are taking medication for anxiety or sleep, specifically Ambien, Lunesta, Xanax (alprazolam), Klonopin (clonazepam), or any of the benzodiazepine type medications, please look at my practice policies below. In short, if you plan to come see me, I will not continue these medications for long term use. At best, they are to be used only as needed and for the short term. Again, I won't prescribe them for long term use anymore, even if you've been on them for years. If you expect to stay on your benzodiazepine medication, I'm not the right doctor for you.
I am not writing ANY Ambien or Lunesta scripts for new patients, either, be aware of that ahead of time if you take it. ***
Policy on Anxiety (benzodiazepine) and Sleep (Z-drug) Medications
Long-term use of benzodiazepines and tranquilizers in the Z-class (Ambien, Sonata, Lunesta) can be risky due to their potential for dependency, addiction, impaired alertness and coordination. Misuse and diversion are also concerns. These medications are controlled substances subject to definite standards of clinical and ethical care as well as laws. Prescription policy for such in this practice bears reiteration. They can be especially problematic when combined with pain medications or muscle relaxants. Furthermore, because they are widespread and easy to find in the community, they may be diverted and frequently present in the mix of narcotic overdose. For some public health and law enforcement agencies, this approaches a public health hazard.
While these tranquilizing medications are effective agents for the immediate relief of acute anxiety, in most cases they should only be used short term. Contraindications would include past or current misuse of benzodiazepines and other dependency-producing substances such as alcohol, cannabis, narcotic pain meds, stimulants, barbiturates, and various street drugs. Also, any history of illegal activity (convicted or not) connected with use of such.
What we’ve learned is that the best treatment for anxiety is to learn coping skills to deal with the uncomfortable emotion. Medications like benzodiazepines just cover it up and become the coping strategy.
Many patients want to continue these long term out of fear of withdrawal, or fear of insomnia, or psychological craving. Research shows even patients who have taken these medications for years--even decades--can safely taper down on their dose. The time required can be individualized, and, as many of us have already discussed, might take months or even years. We might even decide that an inpatient detox program is needed for closer monitoring.
I am committed to learning more about functional/integrative options to assist with the management of anxiety, and have found these incredibly helpful.
I am no longer prescribing Suboxone for the treatment of Opiate Dependence.
First and foremost, I do think that the possession of small amounts of recreational marijuana should be decriminalized.
And CBD containing products, without THC, seem to be pretty safe. People ask about CBD a lot.
That being said, research into marijuana and its possible benefits in Psychiatric disorders continues. As of right now, the data does not support use of marijuana as an effective treatment for depression or anxiety, or PTSD, and it worsens motivation and focus. There is no way I can get your mood, anxiety, or concentration problems under control if you continue THC containing products (e.g. smoking weed) while we are titrating medications--we're wasting your time and money. There is no question that in certain circumstances marijuana has legitimate medical value--but research demonstrates that if you are suffering from mood, anxiety or attention problems, your marijuana use is most likely harming you. If you are willing to give this up, I can help. My policy is not because of moral or political views, this is solely because I see so many people who don't realize that marijuana is most often worsening their problems--and then want to argue with me about it.
Some patients have asked about Ketamine therapy or Transcranial Magnetic Stimulation for the treatment of Major Depressive Disorder.
These are very impressive, FDA approved therapies with immense potential in Psychiatry. If we decide one of these is an option for you, I am happy to make a referral to one of my trusted local colleagues who have the necessary resources to provide these treatments, and with whom I can collaborate closely.
I am also very interested in the future of MDMA or psilocybin assisted therapy and am tracking developments in these areas, too.