Services

Every service below starts from the same premise: get an accurate picture first, give an explicit reason for each decision, and build in a way to tell whether it is actually working.

Foundation

Comprehensive Psychiatric Evaluation

The first appointment is a [Initial evaluation length — e.g. "90-minute". Give the actual scheduled duration, and note whether it is ever split across two visits for complex or treatment-resistant histories.] diagnostic evaluation. We go through your current concerns, psychiatric and medical history, family history, sleep, substance use, and the context you are living in — work, relationships, stressors, and the things that are going well.

A large part of that first visit is a careful reconstruction of what has already been tried. For each prior medication or treatment: the dose, how long you stayed on it, whether you could take it as prescribed, and why it was stopped. This matters more than it sounds. A treatment often gets recorded as a failure when it was never given a fair test, and the difference changes what should happen next.

Where it is useful, and with your consent, I review prior records, speak with current or previous treaters, and order laboratory work to rule out medical contributors.

I also establish a baseline you can be measured against, rather than relying on memory of how bad things were three months ago[, using standardized rating scales — name the instruments you actually use, e.g. PHQ-9, GAD-7, ASRM, QIDS, or delete this clause]. You leave with a working diagnosis explained in plain language and a written plan we have built together, including what we expect to see and by when.

Ongoing Care

Medication Management

Medication can be genuinely life-changing when it is the right tool, and unhelpful or harmful when it is not. My prescribing is conservative and evidence-based: start low, change one variable at a time, give each change enough time to declare itself, and never continue a medication without a reason I can state out loud.

Follow-up visits are [Follow-up visit length — e.g. "30 minutes". If you use different lengths for stable maintenance versus active titration, say both.] — long enough to actually talk, not just refill. We track response and side effects the same way at each visit, so that "a little better" becomes a number we can compare against your baseline instead of an impression.

If a medication is not earning its place, we taper it deliberately. Deprescribing is as much a part of good psychiatry as prescribing, and polypharmacy accumulated over years is one of the most common reversible problems I see.

When several adequately dosed, adequately long trials have not worked, that is information rather than failure. It is also the point at which it is worth discussing whether a circuit-level treatment belongs in the plan, what the evidence for it actually supports, and who is best positioned to deliver it. That conversation is described below.

Focus

Interventional Psychiatry & Neuromodulation

Interventional psychiatry is the part of the field that treats the brain circuit directly rather than only through systemic medication. It exists because a substantial number of people with depression, OCD, and related conditions do not get well on medication and psychotherapy, and running further medication trials past a certain point has diminishing returns.

These modalities differ in how established they are, and a physician's relationship to any one of them — delivering it, referring for it, or studying it — differs too. [READ BEFORE PUBLISHING — nothing below says you deliver any of this, and it must not until you write it here. For each modality (TMS, fMRI/connectivity-guided targeting, LIFU, kTMP) state exactly one of: (a) "I provide this clinically at [site/practice name]"; (b) "I do not provide it myself — I evaluate candidacy, refer to [named centers], and co-manage"; (c) "Research only, available to me solely through an IRB-approved trial."]

Beyond that, anyone considering one of them needs the practical detail before they can act on it. [Add, per modality: which diagnoses and patient populations you accept, whether a referral is required, any device or site credentialing that applies, and — for anything you deliver clinically — where sessions happen and who supervises them. State separately whether you provide or coordinate ketamine/esketamine or ECT, since patients assume an interventional practice does.]

The modalities most often discussed:

Transcranial magnetic stimulation (TMS) — magnetic pulses delivered through the scalp induce electrical activity in a targeted region of cortex. It is noninvasive and given awake, without anesthesia. The core FDA clearance is for the treatment of major depressive disorder in adults who have failed to achieve satisfactory improvement from prior antidepressant medication in the current episode; individual devices carry additional cleared indications, including obsessive-compulsive disorder. "FDA-cleared for treatment-resistant depression" is a common shorthand, but it is not the clearance language, and the distinction matters when you are deciding whether it applies to you. [If you provide or refer for TMS, name the specific cleared indication(s) and device(s) you work with, the typical course length, and what a course involves at the site that delivers it. If you do neither, say so plainly — patients arrive assuming an interventional psychiatrist runs a TMS service.]
fMRI-guided (connectivity-guided) targeting — conventional TMS is aimed using scalp measurements or a group-average location. Functional MRI of an individual brain can instead be used to find where that person's own network connectivity suggests the coil should sit. The premise is simple: brains differ, and the target should follow the person rather than the average. Individualized connectivity-based targeting is a defined element of one FDA-cleared accelerated protocol (SAINT/SNT, cleared for major depressive disorder); it is not a cleared feature of TMS generally, and outside that specific protocol it remains an active research question rather than a settled standard of care.
Low-intensity focused ultrasound (LIFU) — acoustic energy focused through the intact skull onto a small volume of tissue, without an incision. Its distinguishing feature is reach: it can address deep structures that TMS cannot. For psychiatric indications LIFU is investigational. It is not FDA-cleared or approved as a psychiatric treatment, and the only way a patient can receive it is by enrolling in an approved research study.
Kilohertz transcranial magnetic perturbation (kTMP) — a newer class of noninvasive electromagnetic brain stimulation. It is investigational: not FDA-cleared or approved for any indication, not available as clinical care from anyone, and studied only under research protocols.

I want to be direct about the limits of this. Neuromodulation is not a last-resort miracle, response rates are meaningful but far from universal, and the honest version of the conversation includes who it is unlikely to help. Describing these methods here is background, not an offer to provide them — see the note below on where clinical care ends and research begins. My own research involving these methods is described on the Research page.

Clinical care and research participation are not the same thing

I work as both a psychiatrist and a brain-stimulation researcher, and I keep those two roles clearly separated. Clinical care is treatment I provide to you as your physician, chosen because it is the best available option for your situation. Research participation means enrolling in a study that has its own protocol, eligibility criteria, consent process, and institutional review board oversight. A study is designed to answer a question; it is not designed around one person's treatment needs, and it may involve procedures, imaging, or placebo conditions that would not be part of ordinary care.

Enrolling in a study is never a condition of receiving care from me, and declining has no effect on your treatment. Current and recent studies are listed on the Research page.

[Add your actual policy on the treating-clinician / investigator boundary: whether your own patients may enroll in studies you are involved in, who obtains consent if so, and how you separate the two roles. Your IRB and institutional conflict-of-interest office almost certainly have required language for this — use theirs verbatim rather than paraphrasing.]

Additional Services

What else may be available

[CONFIRM BEFORE PUBLISHING — not one of the four cards below is established yet. Take them one at a time: keep only what you actually offer and delete the other cards outright. A card left on the page reads as a service you provide, no matter what the brackets inside it say.]

Telehealth

Whether a visit can happen by video is a licensure question: the physician must hold a license in the state where the patient is physically sitting at the time of the appointment. [Confirm first whether you offer video visits at all — if not, delete this card. If you do: list every state where you hold an active, unrestricted license (that list is a hard limit, so keep it current), and say whether a first appointment may be by video or must be in person, and whether controlled-substance prescribing or any pre-procedure assessment requires in-person contact.]

Second Opinions

A second opinion is a one-time, in-depth review of a diagnosis and treatment history. It is most useful when several trials have not worked and the real question is which part needs to change: the diagnosis, the adequacy of those trials, or the next step. [Confirm whether you offer one-time consultations — if not, delete this card. If you do: the fee, whether a written report is included, and whether you take over prescribing afterward or return care to the referring clinician.]

Collaboration & Coordination

Care works better when the people involved talk to each other, and that matters more, not less, when a procedure or device-based treatment is in the plan and several sites are involved. [Confirm whether coordinating with a patient's therapist, primary care physician, and wider treatment team is something you actively do — if not, delete this card. If it is: say that it requires a signed release, whether you reach out routinely or only on request, and whether coordination time is billed.]

Consultation for Referring Clinicians

Referring clinicians often want a read on neuromodulation candidacy before sending a patient anywhere: whether a given patient is a reasonable candidate, what the evidence genuinely supports, and how to sequence a referral against the pharmacologic options that remain. [Confirm which this is: a formal paid consultation service, an informal professional courtesy, or not offered — delete this card if not offered. If you do offer it: how colleagues should reach you, and state explicitly that a curbside consultation does not create a physician–patient relationship with the patient being discussed.]

What I don't provide

Naming the limits of a practice up front saves everyone time — and a practice that talks about neuromodulation draws referrals it cannot serve. Three groups of limits are worth stating explicitly.

Level and scope of care. [State your position on each: emergency or crisis coverage (an outpatient practice is not a 24/7 or on-call service); inpatient, residential, or partial-hospital care; management of active withdrawal or detoxification; and care for patients located outside the states where you are licensed.]

Evaluations and letters. [State whether you take forensic, court-ordered, custody, or fitness-for-duty work, and whether you write disability, FMLA, ESA, or accommodation letters — in particular for people who are not established patients, which is where most of these requests come from.]

Prescribing and procedures. [State your controlled-substance position, including stimulants and benzodiazepines and whether you will inherit an existing regimen; and whether you accept requests for a neuromodulation procedure from people who want the procedure only, without an evaluation or ongoing psychiatric care. If you are involved in stimulation clinically, add the screening exclusions you enforce — implanted devices, ferromagnetic hardware, seizure history.]

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