Treatment Philosophy
Welcome! When you come to see me as a new patient, the first visit is usually an
introduction where we can learn about each other, ask questions, and figure out if we
would be a good fit in working together toward your treatment goals. You will receive an
individual evaluation based on your history, symptoms, and goals. I will give you my
best recommendations based on research, science, and your individual situation. My
recommendations may include psychotherapy, lifestyle recommendations, starting a
new medication, or changing or stopping a prior medication. We will discuss this and
together, we will figure out the next steps. Your thoughts, emotions, and life
circumstances are important factors that affect your mood, so I like to spend part of our
time together discussing these things.
I’d like to share some thoughts about medications and my treatment philosophy. I
receive many questions about controlled medications such as stimulants (Adderall,
Ritalin) and benzodiazepines (Xanax, Klonopin, Ativan, Valium) and medications
commonly used for sleep (Ambien, Restoril, Lunesta). Stimulants are sometimes used
to treat Attention Deficit Hyperactivity Disorder (ADHD). In the past few years, the use of
this diagnosis for adults has exploded by several thousand percent and the condition is
frequently being over-diagnosed. In reality, only a very small percentage of adults meet
the clinical criteria for ADHD, and stimulants should be reserved for severe cases
because the risks often outweigh the benefits. Many of us have traits of ADHD or may
have other conditions that have symptoms similar to ADHD. For this reason, I
recommend a thorough evaluation, and in some cases, neuropsychological testing.
Education, cognitive and behavioral skills training, psychotherapy, mindfulness are all
important parts of a holistic treatment approach to ADHD.
Benzodiazepines such as Xanax, are sometimes used to treat anxiety. They can be
effective when used short-term and appropriately. However, long term use of
benzodiazepines can create more problems, as they can lead to dependence,
tolerance, and withdrawal symptoms. Withdrawal symptoms can range from feeling
tired, or increased anxiety as the medication wears off, to symptoms as severe as
seizures, coma, and death. Benzodiazepines can also numb you to normal emotions
and with time, may make you lose confidence in your own ability to manage anxiety.
Sedatives are not the best choice for sleep problems since they work less well over time
with repeated use. Some can cause similar problems as benzodiazepines can, as well
as produce hallucinations, delusions and sleep related behavior, like eating or driving
during sleep. They also can disrupt your body’s natural sleep rhythm.
Because of the risks associated with these medications, I will discuss safer treatment
alternatives as well as holistic ways to manage these conditions. If we do decide to use
controlled medications, I would always want to do this in the safest way possible to
provide the best care for you.