All clients receive a thorough psychiatric assessment to fully understand both the symptoms that are present and to rule out other conditions. It is an opportunity to be seen and also to receive a second opinion if there are concerns that something has been missed in the past.

Occasionally, a client or family wants a thorough assessment and diagnosis and is not interested in treatment or medications. The psychiatric assessment can provide answers and clarity as to the nature of a mental health concern. We will review recommendations for treatment, but any treatment offered will be done only with the client’s consent.

Integrative psychiatry uses evidence-based treatments to reduce symptoms and help the body heal. Clients learn ways to reduce stress, improve sleep, eat healing foods, and use tailored supplements to address concerns. Integrative psychiatry will prioritize natural and less invasive treatments whenever possible but is agnostic about whether the best treatment is conventional, like a medication, or alternative. Integrative approaches include:

• Sleep hygiene education and sleep training

• Animal therapy

• Aromatherapy

• Eco therapy and forest bathing

• Meditation and mindfulness training

• Movement and exercise

• Supplements and nutraceuticals

• Acupuncture

• Massage

• Circadian rhythm support

• Herbal and plant medicine

• Art and creative practices

• Humor and laughter

Traditional psychopharmacotherapy treatment is available. If a client would prefer alternatives, these will be discussed and recommended when alternatives to conventional care are appropriate.

I offer thoughtful medication management for nearly all psychiatric conditions and prescribe most psychiatric medications that are appropriate for outpatient settings. Please note that I am conservative with medications that have a high risk profile or potential for harm.

Most of us feel better when we eat nutrient-dense foods. Many, but definitely not all, psychiatric conditions can be improved or treated with improved nutrition. Several randomized controlled trials have demonstrated that nutritional interventions, such as the Mediterranean diet, are associated with reduced depressive symptoms and enhanced mood regulation. One in particular, the MIND trial, demonstrated significant improvements in depression, anxiety, and cognitive function among participants. Specifically, depression decreased by an average of 35% over 12 weeks, and anxiety symptoms showed a 30% reduction in severity scores. Cognitive outcomes were also notable, with participants exhibiting a 20% improvement in executive function and memory tasks, as measured by standardized neuropsychological assessments.

These results highlight the benefits nutrition can provide across multiple domains of mental health. Nutritional psychiatry is a durable and effective way to improve someone’s mental health, and I find it very rewarding to help clients get started on this path.

After a period of stability, or when a prescription is poorly tolerated, many clients would like to get off a medication. In other cases, clients would like to stop a medication but want to ensure that the process will be successful and that all of the hard work they have been doing in their life and in therapy is working. Stopping medications like citalopram, venlafaxine, escitalopram, and others, abruptly or even as prescribed by an uninformed provider, can result in discontinuation syndrome. Lasting weeks, or occasionally months, discontinuation syndrome is a type of withdrawal that can manifest as flu-like symptoms, poor sleep, dizziness, and electric shock sensations in the head or body. Benzodiazepines like alprazolam, diazepam, and clonazepam also warrant special care in helping clients stop and are discussed below.

Unfortunately, sometimes a prescriber will start a psychiatric medication and later not know how to help someone get off the medication without problems. In all of these cases, you should have an informed and experienced provider to assist you in the careful, gentle, and comfortable cessation of prescriptions. Helping clients gently discontinue medications while preventing withdrawal and relapse into mental illness is something I have been helping clients with for years. This is a specialty that I offer, and I would be honored to support you in your process of getting off of medications successfully and the right way.

Benzodiazepines are often prescribed with the intention to help a client manage an acute stressor, cope with a form of anxiety, sleep through the night, or treat seizures. They are popular for their calming and sedative effect, regularly used for non-medicinal purposes, and have household name status. While US pharmacies are dispensing enough benzodiazepines for one out of three Americans to receive a prescription, many individuals obtain benzodiazepines from other sources.

After decades of research showing harm and advocacy work from injured clients and their loved ones, the FDA has determined that patients are not adequately warned and providers are not sufficiently aware of the risks of this class of medications. Xanax (alprazolam), Klonopin (clonazepam), Valium (diazepam), Librium (chlordiazepoxide), Ativan (lorazepam), Restoril (temazepam), and Halcion (triazolam) all may cause fatigue, sedation, impair cognition, interfere with memory consolidation (part of how we benefit from psychotherapy), worsen anxiety and depression, cause suicidal ideation, benzodiazepine-induced neurological dysfunction (BIND), abuse, dependence, death, and more. These risks are possible for clients even when taking the medications as prescribed, without a history of substance use, and after only two weeks of adherence.

As a provider, I offer treatment for benzodiazepine dependence and use benzodiazepines to support safe and gradual tapering for clients who wish to discontinue them. This process is best done gently, often over an extended period, and is typically well-suited for outpatient care. Compared to inpatient, rapid detox approaches, a slow, supportive taper can be more successful and prevent long-term issues like BIND. I am deeply committed to helping clients heal from benzodiazepine dependence and welcome individuals seeking care in Virginia, Colorado, and California. Find more information here.

Ideally, we want to feel well as a whole person. Often, what helps us feel good physically supports our mental health, but sometimes there are injuries or chronic conditions that need care and attention. Together we will look at your goals and discuss a variety of treatment options from talk therapy, eco therapy, mindfulness or meditation, exercise, sleep hygiene, nutritional psychiatry, and as well as other modalities or specialty care referrals when needed. You will be the decider of what feels like the right fit for you and what the priorities are.

For many women, perimenopause and menopause are fraught with mental health symptoms beginning in their 30’s or 40’s:

• Anxiety and Panic Attacks: Intense, unexpected worry, fear, or panic.

• Depression and Low Mood: Sadness, hopelessness, or loss of interest in activities.

• Irritability and Mood Swings: Sudden, severe emotional changes.

• "Brain Fog" and Cognitive Issues: poor focus or concentration, memory lapses, and mental fatigue.

• Insomnia and Sleep Problems: broken sleep that causes fatigue and exacerbates emotional reactivity.

• Low Motivation and Poor Energy: low drive and emotional apathy.

• Low Self-Esteem: decreased confidence and sense of competence.

• Increased Tearfulness: Crying more frequently.

Bioidentical Hormone Replacement Therapy (HRT or BHRT) is supported by strong evidence as the most effective, low-risk treatment for menopausal symptoms and for preventing osteoporosis, particularly when initiated by women under 60 or within 10 years of menopause. Evidence indicates, BHRT tailored to the individual, improves quality of life, reduces fracture risk, and lowers cardiovascular disease risk when started early.

In psychiatry, BHRT is an evidence-based intervention to address the symptoms that declining hormones creates for mid-life women often offering other benefits to health and wellness.

Serum or blood testing as well as testing of the gut microbiome and hormone metabolites are required for clients undergoing BHRT to tailor treatment and increase successful outcomes. I do not offer birth control or synthetic hormones.

Functional medicine works to identify and address the underlying causes of mental health conditions rather than just treating symptoms. It involves a comprehensive evaluation of biological, environmental, and lifestyle factors that influence brain function and emotional well-being. Specialized testing is used to identify nutrient deficiencies, inflammation, infection, toxins, issues with organic acids, hormone imbalances, and problems with hormone metabolism. By focusing on root causes and holistic care, functional medicine aims to treat mental health symptoms while reducing the reliance on pharmaceuticals.

Integrative psychiatry blends conventional, or standard, psychiatry - ie, medications and therapy - with complementary interventions such as mindfulness, acupuncture, yoga, nutrition, and other modalities. Often supplements or nutrients are used to help alleviate symptoms of anxiety, depression, irritability, and poor sleep. Standard laboratory testing may also be a part of both conventional and integrative psychiatry. Typically, practitioners will recommend evidence-based interventions; occasionally, there may be options or referrals for less studied or science-based practices that have proven beneficial.

Functional psychiatry prioritizes evaluating and treating biochemical and physiological imbalances found on testing of various systems in the body that help regulate biological processes. Typically, these would include evaluation of:

• Hormones, including the Hypothalamic-Pituitary-Adrenal axis, but also sex steroids such as estrogens, testosterone, and other androgens, and how they are metabolized by the body. Limitations in these areas can manifest in hormonal symptoms (PMS, PMDD, acne, hair growth, bloating, constipation), anxiety, poor sleep, depression, irritability, and low stress tolerance.

• Gut Microbiome Testing, the gut-brain axis is proving to hold a critical role in mental health. Neurotransmitters like serotonin and dopamine are produced in the gut. The microorganisms that hold court in the gastrointestinal system influence cognition, mood, and your ability to respond to stress. Diagnosing and treating infections, inflammation, and digestive challenges can improve moods, sleep, immune health, metabolic health, and the absorption of nutrients.

• Organic Acid Testing (OAT) can reveal nutrient deficiencies that, if present, will limit the body from building hormones, neurotransmitters, and maintaining homeostasis, which is necessary for mental wellness. OAT will show imbalances in neurotransmitters like serotonin, dopamine, and norepinephrine, which are crucial for mood regulation, focus, and managing anxiety. It provides another view of gut dysbiosis and gut health, which can increase the practitioner’s ability to assess and treat problems in the digestive tract. It also provides information on how effective the body is with detoxification on a cellular level, which is necessary to protect all those important cells and keep the body healthy, so that the mind can be healthy.

Additional testing may include food intolerances, amino acid testing, toxins (heavy metals, environmental, mycotoxins), and gluten sensitivity.

In providing holistic care, psychiatrists and psychiatric nurse practitioners are asking about and listening to the client’s full experience in their lives and working to elevate the individual’s health from all angles. I want to know about your relationship with exercise, do you feel satisfied with your relationships, how often do you wake in the middle of the night, where is your energy compared to where you want it to be, what percent of what you think and feel are you talking about in therapy?

As holistic providers, we focus on treating mental health by considering the whole person—mind, body, and environment—rather than just symptoms. We integrate traditional psychiatric methods, such as medication management and psychotherapy, with complementary approaches like nutrition, exercise, mindfulness, and stress reduction techniques. My goal is to promote overall wellness and balance, addressing underlying factors that affect mental health, including lifestyle, physical health, and social dynamics. This comprehensive approach aims to support long-term mental and emotional well-being for children, adolescents, and adults.

Each individual who goes through depression will often share certain symptoms, but will also have their own very personal and painful experience. These differences and similarities warrant care and attention to help a client feel understood and also to help the clinician provide meaningful and effective treatment decisions. In determining how to treat an individual with depression, integrative psychiatry providers will start with a comprehensive evaluation to understand the client’s medical, social, academic, and psychiatric histories. They will ask about family mental health history and may ask to speak to a family member or spouse to gain additional information on the client’s symptoms. They will order relevant lab studies for evaluating depression, including:

• Complete Blood Count (CBC): To check for anemia or infection that might contribute to mood symptoms.

• Thyroid Function Tests (TSH, Free T4): Hypothyroidism or hyperthyroidism can mimic or worsen depression.

• Basic Metabolic Panel (BMP): To assess electrolytes, kidney function, and glucose levels, which can affect mood.

• Liver Function Tests (LFTs): Important if considering medication metabolism and to rule out hepatic causes.

• Vitamin B12 and Folate Levels: Deficiencies can present with depressive symptoms.

• Vitamin D Levels: Low levels have been associated with depression.

• Inflammatory Markers (e.g., ESR, CRP): Sometimes assessed if systemic inflammation is suspected.

• Screening for Lyme Disease or other infections: In endemic areas or if clinically indicated.

These labs will help differentiate primary depression from medical causes or contributing factors to mood symptoms.

Once the assessment is complete, the provider will discuss the diagnosis, prognosis, treatment options, risks and benefits, and recommendations for care. Depending on the severity of symptoms, a medication may be recommended. Often, the client will receive referrals for psychotherapy, recommendations for lifestyle interventions that we have discussed, including exercise, nutrition, social engagement, creative endeavors, spiritual practices or meditation, time in nature, and other interventions depending on the provider’s specialty and what the client is amenable to.