General and addiction psychiatry, ketamine therapy

I offer both general and addiction psychiatry services, and specialize in the use of ketamine for psychiatric indications, such as treatment resistant depression (TRD) and post-traumatic stress disorder (PTSD).   For a detailed listing of procedures and different modalities that I offer, please read below.  Detailed information specific to ketamine treatments is available here.  First visits tend to be longer and are typically at 1 hour in duration, which includes an extensive history, diagnosis, creating a collaborative treatment plan, various treatment options (including lifestyle changes, psychotherapy, and medication options), and discussion on these topics.  If indicated, medications can be prescribed on the first visit.  Frequency of follow up is adjusted to the needs of the individual:  for someone recently hospitalized or desiring psychotherapy the next follow up session could be the following week. In contrast, someone on a stable dose of medications, without any pressing issues could manage with appointments every couple months.  I am also available for one time consultation visits, to provide a second opinion on diagnosis or treatment, or for addiction evaluations mandated by licensing boards.

General psychiatry

  • evaluation
  • diagnosis
  • treatment planning
  • consultation / diagnostic clarification / second opinion
  • medication management / psychopharmacology
  • psychotherapy - individual, couples, family
  • anxiety disorders:  post-traumatic stress disorder (PTSD), generalized anxiety disorder, social phobia / social anxiety, performance anxiety / fear of public speaking / stage fright, panic disorder / panic attacks, obsessive compulsive disorder (OCD)
  • mood disorders:  major depressive disorder / episodes, dysthymia, adjustment disorder, bipolar disorder, depression, mania, hypomania, treatment resistant depression (TRD)
  • psychotic disorders:  schizophrenia, schizoaffective disorder, psychotic depression, bipolar I disorder
  • substance use disorders, and substance induced disorders
  • attention deficit hyperactivity disorder (ADHD)
  • insomnia and sleep disorders
  • personality disorders
  • sexual dysfunction / treatment of sexual side effects
  • forms / letters, including for emotional support animals and more

Addiction psychiatry

  • addiction evaluations, licensing/employment evaluations (ie, for nursing, medicine, transportation)
  • substance use disorders / "drug and alcohol problems"
  • dual diagnosis; ie, overlap between general psychiatry and substance use disorders
  • substance induced disorders: mood, depression, anxiety, psychosis
  • tolerance, withdrawal, dependence
  • detoxification, including evaluation for inpatient or outpatient level of care
  • maintenance treatment / relapse prevention (opioid agonist treatment / suboxone, naltrexone / Vivitrol, disulfiram, acamprosate)
  • psychotherapy - motivational interviewing and more
  • drug use monitoring / urine toxicology testing and interpretation
  • opiate / opioid use disorder (oxycodone / Percocet, hydrocodone / Vicodin, methadone, heroin)
  • alcohol use disorder / "alcoholism"
  • sedative-hypnotic use disorder (Valium, Xanax, Ativan, Klonopin, benzodiazepines, quaaludes, barbiturates, gamma hydroxy butyrate)
  • cannabis use disorder / "marijuana addiction" (including synthetic cannabinoids such as "Spice") 
  • cannabinoid hyperemesis syndrome
  • hallucinogen use disorder (LSD, psilocybin, ibogaine, mescaline, 2C-series, 25-I, "club drugs", and various other substances such as synthetic phenethylamines and tryptamines)
  • hallucinogen persisting perception disorder (HPPD)
  • methamphetamine / amphetamine use disorder 
  • cocaine use disorder / crack cocaine use disorder
  • tobacco use disorder
  • caffeine use disorder
  • gambling disorder / gambling addiction
  • behavioral addictions / sex addiction / video game addiction
  • expert witness / court testimony / forensic consultation

Specific treatments

  • ketamine infusions / injections for treatment resistant depression (TRD), post-traumatic stress disorder (PTSD), and more.  See the ketamine page for detailed information
  • buprenorphine / Suboxone for opiate use disorder
  • depot naltrexone / Vivitrol for opiate use disorder, see Alkermes website with patient information and more
  • naloxone / Narcan rescue kits for opiate use disorder
  • Vascepa / Lovaza / fish oil for depression and/or psychosis
  • propranolol / Inderal for performance anxiety
  • N-Acetylcysteine, for treatment of skin picking, hair pulling, impulse control disorders, gambling, and cannabis use disorder; see this article
  • clozapine / Clozaril for treatment refractory schizophrenia and bipolar I disorder
  • thyroid hormone supplementation for treatment resistant depression
  • light therapy for depression (blue blocking glasses, light box treatment)
  • preparatory and integrative therapy sessions for psychedelic sessions (e.g., ayahuasca, psilocybin)
  • complementary psychiatry (for example, vitamin D and/or L-methylfolate supplementation)