Hydration: Nobody Likes It Dry
Here’s something everybody agrees on before we get anywhere near the science, which is that nobody’s ever hoped things would get a little drier, in any situation, ever,…
Jun 17, 2026
Azithromycin (Z-Pack)
The Z-Pack became famous for conditions it cannot treat. Here is what azithromycin actually does well, what it does not touch, and why the cardiac risk warning matters more for…
Jun 10, 2026
Doxycycline: Acne, STDs, Tick Bites
Doxycycline is one of those drugs that keeps showing up across completely different situations and you’d be forgiven for wondering what connects all of them. Treating acne in…
Jun 10, 2026
Tirzepatide
Ozempic and Wegovy got famous first, which is the main reason tirzepatide is still playing catch-up in the public conversation even though the clinical trial data says it’s…
Jun 10, 2026
Semaglutide
The drug is real. The results in the trials are real. And if you’ve spent years feeling genuinely hungry all the time, not like “I skipped breakfast” hungry…
Jun 10, 2026
Tadalafil: the 36-hour ED and prostate pill
Tadalafil is the one erectile dysfunction medication that doesn’t care what time you took it. You can take it Friday morning and it’ll still be working Saturday night.…
Jun 10, 2026
Sildenafil
Most guys who need this prescription have already been sitting on the problem for way longer than they should have. Could be a year, could be two, sometimes…
Jun 10, 2026
Confidence Is Built by Receipts, Not Vibes
Confidence is not a feeling you wait for. It is evidence you build by turning intention into specific action.
May 20, 2026
The SSRI Waiting Game
The hardest part of starting an SSRI is the lag. Side effects can show up fast, while the benefit takes weeks.
May 18, 2026
Testosterone, Honestly
Testosterone is not a magic masculinity injection. It is a hormone with real benefits, real risks, and a workup people skip too often.
May 12, 2026
Why You Can’t Sleep
Insomnia usually is not a mystery. Your body is tired, but your nervous system is still working overtime.
May 10, 2026
ADHD Is a Superpower
ADHD is not magic. It is a nervous system with real strengths, real costs, and a brutal need for structure.
May 7, 2026
Three Months In on an SSRI: What to Expect
If you're reading this, you're probably somewhere between week eight and week twelve on an SSRI, you're trying to figure out whether it's working, and you…
Apr 28, 2026
MAT (Medication Assisted Treatment)
If you have opioid use disorder, medication is the actual treatment.
Apr 26, 2026
Involuntary holds: OR/WA specifics
Oregon and Washington don't use the California 5150/5250 numbering, which confuses people who moved up here from the Bay Area expecting that vocabulary.
Apr 24, 2026
Sleep Medications
Sleep medications can be useful short-term tools, but insomnia is rarely solved by pretending sedation is the same thing as healthy sleep.
Apr 24, 2026
ECT (Electroconvulsive Therapy)
ECT (electroconvulsive therapy, the one with the bad PR from the Jack Nicholson movie) works better than any antidepressant we have, and almost nobody who…
Apr 22, 2026
Compounded ketamine lozenges
For about five years, compounded ketamine troches and lozenges (small dissolving tablets made by specialty compounding pharmacies, taken at home) were the…
Apr 20, 2026
Atypical Antipsychotic Medications
Atypical antipsychotics can be exactly right for psychosis, bipolar disorder, and depression augmentation. They are not casual sleep pills.
Apr 19, 2026
Trazodone vs Quviviq vs Belsomra
The sleep medication landscape in 2026 is in a weird place. Trazodone is still the default for most prescribers, mostly out of habit and price.
Apr 18, 2026
Benzodiazepine Medications
Benzodiazepines work fast, which is exactly why they need a narrow lane, a clear exit plan, and more respect than casual anxiety prescribing usually gives them.
Apr 16, 2026
Ozempic, GLP-1s, and mood
The GLP-1 agonists (Ozempic and Wegovy and Mounjaro and the rest, a class of medications originally developed for type 2 diabetes and now used…
Apr 16, 2026
Buprenorphine for depression and chronic pain
Buprenorphine is best known as an addiction medication, particularly for opioid use disorder, but a growing body of research and a quieter clinical…
Apr 14, 2026
Stimulant Medications
Stimulants can be life-changing for ADHD and narcolepsy, but the Schedule II, diversion, sleep, blood pressure, appetite, and misuse conversations are not optional.
Apr 14, 2026
Pharmacogenomic testing for psych meds
GeneSight and the other pharmacogenomic tests (cheek-swab panels that look at your liver-enzyme genetics to suggest which psych medications you'll handle…
Apr 12, 2026
Caplyta off-label use
Caplyta (lumateperone) is one of the newer atypical antipsychotics, FDA-approved for schizophrenia and bipolar depression, and what's more interesting…
Apr 10, 2026
Vraylar for depression augmentation
Vraylar (cariprazine) is an atypical antipsychotic that got an FDA add-on indication for major depression a few years back.
Apr 8, 2026
Insomnia Treatment
Insomnia treatment is where people learn the hard way that exhaustion and sleep aren't the same thing.
Apr 6, 2026
Auvelity (dextromethorphan/bupropion)
Auvelity is a once-daily pill that combines dextromethorphan, the cough syrup ingredient, with bupropion, which most people know as Wellbutrin.
Apr 6, 2026
Spravato (esketamine) protocol
Spravato is FDA-approved esketamine, given as a nasal spray under direct supervision in a certified clinic.
Apr 4, 2026
Doxepin for sleep
Doxepin is a tricyclic antidepressant from the 1960s that turned out, at very low doses, to be one of the best sleep medications available.
Apr 2, 2026
Panic Treatment
A practical guide to treating panic disorder with CBT, interoceptive exposure, medication, and fewer rescue rituals.
Apr 1, 2026
Pregabalin (Lyrica)
Pregabalin is gabapentin's better-looking, more expensive cousin.
Mar 31, 2026
OCD Treatment
A practical guide to OCD treatment, exposure and response prevention, medication, reassurance traps, and when to get specialty care.
Mar 29, 2026
Vivitrol (extended-release naltrexone)
Vivitrol is naltrexone in a syringe, given once a month in your butt. That's the whole pitch.
Mar 28, 2026
Naltrexone for alcohol
Naltrexone is the medication that gets prescribed more than any other for alcohol use disorder in clinics that actually know what they're doing, and it's…
Mar 26, 2026
Prescription Education: Know What’s Actually in That Bottle
What Most People Don't Get ToldIf you have ever walked out of a fifteen minute med check with a new prescription and a printout from the pharmacy, you…
Mar 26, 2026
Seroquel (quetiapine)
Seroquel is the antipsychotic that gets prescribed for everything other than what it's actually approved for, and the off-label sleep use is the biggest…
Mar 24, 2026
Microdosing: what controlled trials actually show
The honest answer on microdosing is that the controlled trials don't show much, the open-label data shows a lot, and the difference between those two…
Mar 22, 2026
Ibogaine: Real Promise, Real Risk
Ibogaine might be the strangest substance in the whole psychedelic treatment conversation, because the promise is real and the risk is real and they sit…
Mar 21, 2026
Online ADHD clinics & the regulatory crackdown
Done and Cerebral are the two names everybody remembers from the great pandemic ADHD telehealth boom, and the story of what happened to them is most of…
Mar 20, 2026
Ketamine clinics: legit vs sketchy
The ketamine clinic boom of the last five years is two different things wearing one storefront.
Mar 18, 2026
TMS (Transcranial Magnetic Stimulation)
TMS (transcranial magnetic stimulation, an in-office procedure where a magnetic coil sits against the side of your head and pulses a magnetic field into a…
Mar 16, 2026
EMDR
EMDR stands for eye movement desensitization and reprocessing, which is a mouthful and also kind of misleading because the eye movements may not actually…
Mar 14, 2026
Is my penis normal?
Most guys who worry they're too small aren't actually too small, they're comparing themselves to porn, bad angles, lies, memory, locker room mythology,…
Mar 13, 2026
Suboxone (buprenorphine/naloxone)
Suboxone is the closest thing we have to a miracle drug in psychiatry, and most of the people who need it spent years being talked out of taking it by…
Mar 12, 2026
Kegels: when they help and when they backfire
A lot of men hear pelvic floor and immediately think kegels, which is how this whole topic gets dumbed down fast, because the pelvic floor is a real…
Mar 11, 2026
Abilify (aripiprazole)
Abilify is the drug I add to an antidepressant when the antidepressant is doing maybe sixty percent of the job and we need to find the other forty.
Mar 10, 2026
Lamictal (lamotrigine)
Lamictal is one of those medications I actually like prescribing, which is not a sentence I get to write very often in psychiatry.
Mar 8, 2026
Weed and Your Sex Life: The Honest Read
Weed and sex is not a simple good or bad story. Acute use may help some people, chronic use can start costing you, and the evidence is mixed.
Mar 8, 2026
Lithium
Lithium is the best mood stabilizer we have for bipolar I, and we don't use it nearly enough. That's the whole post, more or less. The rest is detail.
Mar 6, 2026
Stress, Cortisol, and a Flat Sex Life
Stress can flatten desire and wreck erections, but the clean cortisol story is usually too neat. What stress actually does to libido and performance.
Mar 5, 2026
Klonopin (Clonazepam)
The pitch for Klonopin, the one I hear from prescribers and from the guys who've been on it for years, is that it's the cleaner benzo.
Mar 4, 2026
Morning Wood: What It Means and When Its Gone
Morning wood is a clue about whether the hardware still runs on its own. What it means, when it doesn't mean much, and when to pay attention.
Mar 3, 2026
Xanax (Alprazolam)
I prescribe Xanax rarely, and when I do I usually regret it within six months.
Mar 2, 2026
Perseris
Perseris is basically a more modern delivery system attached to a very familiar drug, and if we’re being honest that’s how it should be understood from the start……
Feb 28, 2026
Armodafinil (Nuvigil)
Armodafinil is one of those drugs that lives in two different stories at once. In the boring real clinical story, it’s a wakefulness medication for excessive sleepiness in…
Feb 15, 2026
Lofexidine (Lucemyra)
Lofexidine is one of those medications that makes more sense the more honestly you describe what it isn’t. It isn’t methadone. It isn’t buprenorphine. It isn’t treatment for…
Jan 20, 2026
Ramelteon (Rozerem)
Ramelteon is the sleep medication people often want to be more dramatic than it is. It isn’t a knockout pill. It isn’t a benzodiazepine. It isn’t a Z-drug…
Jan 12, 2026
Acamprosate (Campral)
Acamprosate (Campral) helps you stay sober after detox, not get you there. Non-addictive, renally cleared, six pills a day. Who it fits and who it doesn't.
Dec 18, 2025
Phenelzine (Nardil)
Phenelzine is the antidepressant people start talking about only after they have already admitted that the easy options weren’t enough. That is usually the right place for it.…
Dec 17, 2025
Minoxidil (Rogaine)
Minoxidil (Rogaine): what it does, who it works for, topical foam versus low-dose oral minoxidil, the dread shed, and the side effects worth knowing.
Dec 9, 2025
Quviviq (Daridorexant)
Quviviq (daridorexant) is a newer orexin-blocker for insomnia with a shorter half-life than Belsomra, so less morning fog. What it does and who it's for.
Dec 3, 2025
Mood stabilizers and the math of staying in the lane
Lithium, lamotrigine, valproate, carbamazepine, oxcarbazepine. What each one does, what it does not, and why the drug is the line and the work is yours.
Nov 30, 2025
PDE5 inhibitors and the men’s sexual health math
Viagra, Cialis, Levitra, Stendra, Trimix. What each one does, when it fits, and why the pill is leverage, not a substitute for the cardiovascular work.
Nov 29, 2025
Sleep meds, ranked by what works
Trazodone, Silenor, Belsomra, Ambien-class, mirtazapine, Seroquel. What actually helps, what borrows time you pay back later, and where the benzo trap is.
Nov 27, 2025
SNRIs: energy and pain in one drug
SNRIs are SSRIs with a norepinephrine kick. Effexor, Cymbalta, Pristiq, Savella. When the lane fits, what to expect, and how to taper without the brain zaps.
Nov 25, 2025
GLP-1s and the math of getting lean
People are fat because they eat too much, eat the wrong stuff, and don't move their body. That's the equation. Eat less and move more.
Nov 22, 2025
The meds that actually move opioid use
Where I refer for detox and methadone I do not run detox here. Do not run a methadone clinic either. Different programs, different regs, different rhythm.
Nov 17, 2025
SSRIs: what they actually do
SSRI stands for selective serotonin reuptake inhibitor, and the name basically describes the trick.
Nov 16, 2025
Stimulants: real talk on what works
Stimulants are the most effective class of medication in modern psychiatry, and they're also the class that earned the worst reputation the fastest,…
Nov 16, 2025
Therapy for Men Who Think Therapy Is Bullshit
The guys who think therapy is bullshit are not wrong about most of what they've been pitched.
Nov 15, 2025
Guanfacine (Intuniv)
Guanfacine is one of those drugs that quietly does a lot of work and almost nobody talks about, which is sort of par for the course in psychiatry...
Nov 14, 2025
What “Trauma-Informed Care” Actually Means
Trauma informed care is the most successful piece of mental health branding of the last decade, and for a crowd that never shuts up about how…
Nov 12, 2025
The Quiet Damage Addiction Does to Others
Addiction doesn’t just live in a person’s body. It moves into the spaces between people.
Nov 10, 2025
Motivation Is Overrated
People wait to feel motivated before they do things. They wait for inspiration, for the right mood, for the moment when they feel like doing it...
Nov 7, 2025
What Medication Can and Can’t Do
People come in wanting a pill that fixes their life. They don't say it that way.
Nov 1, 2025
The Problem with “I Can’t Help It”
"I can't help it" is one of the most common sentences people bring into a psychiatry office, and one of the most expensive things they can say out loud...
Oct 30, 2025
Anxiety Isn’t the Enemy
Anxiety isn't malfunctioning. The wiring is fine.
Oct 29, 2025
Consequences Aren’t Punishment
Consequences are just what happens next. You don't sleep, you feel like shit, that's biology.
Oct 27, 2025
It’s Just a White Lie. So What?
Most lies don't look like lies.
Oct 27, 2025
Olanzapine (Zyprexa)
Olanzapine is one of the most effective oral antipsychotics we’ve got, and that’s the first thing worth saying because people tend to start with the weight gain and…
Oct 26, 2025
Risperidone (Risperdal)
Risperidone is one of the workhorse antipsychotics. It isn’t fashionable, it isn’t subtle, and it doesn’t get talked about the way the newer branded drugs do, but when…
Oct 23, 2025
Prozac (Fluoxetine)
Prozac came out in 1987. Almost forty years later it's still on the short list of SSRIs I reach for, and not because of nostalgia.
Oct 20, 2025
Depression Looks Different in Men
Most people think depression looks like sadness... someone crying, withdrawn, hopeless, visibly falling apart.
Oct 19, 2025
Sexual Performance
Sexual performance is one of those topics where guys sit on a problem for years before bringing it up, and then when they finally do, it's at the end of…
Oct 12, 2025
Vyvanse
Vyvanse is Adderall with a seatbelt.
Oct 10, 2025
Topamax (topiramate)
Topiramate has a nickname that does most of the explaining: Dopamax.
Oct 10, 2025
Stop Asking What’s Wrong With You
People walk in thinking something is fundamentally wrong with them all the time.
Oct 8, 2025
Modafinil (Provigil)
Modafinil has a reputation that runs way ahead of what the drug actually does.
Oct 7, 2025
How to Transfer Your ADHD Prescription to a New Provider
Maybe you moved. Maybe your provider retired.
Oct 1, 2025
OCD (Obsessive-Compulsive Disorder)
OCD is not neatness. It is intrusive thoughts, compulsions, relief, and a loop that treatment can break.
Sep 30, 2025
Children, Sports, and the Developing Mind
Think about the last time a kid came home from practice and something was just different. Quieter. More settled. Not because sports fix everything.
Sep 25, 2025
Prazosin
For a certain kind of trauma, the worst part of the day is the night.
Sep 22, 2025
Gabapentin (Neurontin)
Sit in on enough appointments and you will notice gabapentin everywhere, handed out for anxiety, for sleep, for back pain, for restless legs, for more or…
Sep 19, 2025
Adhd Treatment
Adult ADHD treatment is one of the parts of psychiatry where the gap between what works and what most patients actually get prescribed is genuinely wide.
Sep 18, 2025
You Already Know You Have a Problem
If you're reading this and wondering whether your drinking is a problem... it is. You wouldn't be reading this otherwise.
Sep 15, 2025
Cymbalta (duloxetine)
Cymbalta gets pitched as an antidepressant and an anxiety medication, which is fine, but duloxetine stays interesting because it also has a real pain…
Sep 14, 2025
Testosterone
Testosterone is the most over-prescribed hormone in American medicine right now, and it's not close.
Sep 12, 2025
IV Wellness Therapy
The IV wellness industry is one of the strangest things to watch from inside medicine.
Sep 12, 2025
Lexapro (escitalopram)
Escitalopram is the SSRI a lot of people get handed first, and for once that is not lazy prescribing, it is usually a reasonable call.
Sep 11, 2025
ADHD: when stims don’t fit
Strattera, Qelbree, Intuniv, Kapvay, Wellbutrin, Modafinil. What each one does, who it fits, and why most patients should not switch off a working stim.
Sep 10, 2025
Fluvoxamine (Luvox)
Fluvoxamine is the SSRI (selective serotonin reuptake inhibitor, the Zoloft/Lexapro/Prozac class) nobody thinks of first, and that's sort of a shame,…
Sep 9, 2025
Trimix and Penile Injections for ED
The reliable second-line ED treatment most men flinch at: how penile injection therapy works, the in-office test dose, and the real risks.
Sep 6, 2025
Shockwave Therapy for Chronic Pain: What Holds Up
Where shockwave therapy genuinely helps chronic musculoskeletal pain (plantar fasciitis at the top) and where it is oversold.
Sep 3, 2025
Hydroxyzine
Hydroxyzine has been sitting in the pharmacy for sixty years doing useful work, and most prescribers act like it doesn't exist.
Sep 1, 2025
What to Expect in Your First Appointment
Nobody walks into a first psychiatric appointment relaxed and anybody who claims they did is lying. The fears stack up the same way for almost everyone...
Aug 28, 2025
ADHD in Men: Why It Gets Missed
The version of ADHD that gets diagnosed in childhood is the loud version.
Aug 28, 2025
Bipolar Treatment
Bipolar treatment goes wrong in the first appointment more often than in any later one. Get the diagnosis wrong and every prescription after it is wrong.
Aug 27, 2025
Single Case Agreements (SCA): How to Get Out-of-Network Coverage at In-Network Rates
Here is the situation almost nobody tells you about. You finally find a psychiatrist or a therapist who actually fits, who actually has openings, who actually understands what…
Aug 27, 2025
Wellbutrin (Bupropion)
Wellbutrin is the weird cousin in the antidepressant family.
Aug 27, 2025
Why So Many People Are Rethinking Their Careers Right Now
Most people do not decide all at once that their work no longer fits. It usually starts smaller than that.
Aug 25, 2025
Sobriety Isn’t the Hard Part (It’s Everything After)
People think getting sober is the hard part. Yeah, detox sucks, early sobriety is uncomfortable, breaking the actual habit is genuinely difficult...
Aug 25, 2025
Weight Isn’t Always Emotional.
Sometimes the first good clue is physical.
Aug 24, 2025
ACA Marketplace Plans: Picking One for Mental Health Coverage
If you’re self-employed, between jobs, contracting, running a small business, or stuck with an employer plan that costs more than your rent, the ACA marketplace is where you…
Aug 24, 2025
Lorazepam (Ativan)
Ativan has a reputation, and half my new patients walk in with strong feelings about lorazepam before I've said anything.
Aug 24, 2025
ICD-10 Coding for Psych: The Crash Course Nobody Gave You
Here is something nobody told you in grad school, residency, or your post-grad fellowship: the diagnostic codes you slap on a claim are not a clinical…
Aug 21, 2025
Men’s Health
Men don't usually walk into a psychiatrist's office and say they're depressed.
Aug 20, 2025
Documenting Medical Necessity in Psych Notes
What "medical necessity" actually means, legally Medical necessity is not a vibe, it is a legal standard, and the people who decide whether you met it are…
Aug 19, 2025
Why “Self-Care” Misses the Point (And What Actually Works)
I'm not against bubble baths. If a hot bath and some candles make you feel better, great, do that, nobody's coming for your candles.
Aug 18, 2025
Ambien
Ambien gets handed out like Tic Tacs. Primary care hands it out, urgent care hands it out, the dentist hands it out before a crown.
Aug 16, 2025
ERISA vs State-Regulated Plans (Why It Matters When You Appeal)
If you have ever fought a health insurance denial for a psychiatric medication, an inpatient stay, or a residential program, you have probably noticed…
Aug 16, 2025
Ritalin and Methylphenidate
Methylphenidate has been around since 1944 and is still, in 2026, one of the most reliable molecules in psychiatry. Ritalin is the original brand.
Aug 14, 2025
Beating Prior Authorization Denials in Psych (The Clinician’s Survival Guide)
Why prior auth exists, and why your psych patients get hit twice as hard Prior authorization (PA) is the process where, before an insurance company will…
Aug 13, 2025
Medicare for Patients Under 65 (SSDI Disability + Mental Health Coverage)
Medicare is not just a senior thing, and that surprises a lot of guys Most people grow up thinking Medicare is the program your grandfather is on. You…
Aug 11, 2025
Call It What It Is: The Naming Method Explained
This is the core of how I work with people, so it's worth getting on the page in plain English. The Naming Method comes down to one principle.
Aug 9, 2025
HDHPs, HSAs, and Mental Health Coverage
What an HDHP actually is, in plain English Every fall during open enrollment your HR portal lights up with a plan called something like "Choice HSA 3000"…
Aug 8, 2025
Getting On Insurance Panels: The Credentialing Game
If you’re a licensed clinician and you’ve been circling the question of whether to get on insurance panels, you’ve probably gotten a lot of advice that’s either cheerleading…
Aug 6, 2025
Propranolol
Propranolol is a cardiology drug that wandered into psychiatry by accident and stayed because it does one specific thing well.
Aug 3, 2025
Medicaid for Mental Health Care in Oregon and Washington
If you’re an adult in Oregon or Washington and you’re scraping by, there’s a real chance Medicaid covers you, and a real chance it covers more of your…
Aug 3, 2025
How to Actually Appeal an Insurance Denial
Insurance denied your mental health claim.
Jul 31, 2025
Why You and Your Partner Feel Out of Sync
There’s a part of relationships that nobody really prepares you for, and it’s not the big stuff. It’s not conflict, or trust, or anything dramatic.
Jul 31, 2025
Adderall
Adderall is amphetamine.
Jul 29, 2025
Remeron
Remeron is the antidepressant nobody picks first and a lot of guys end up grateful for.
Jul 29, 2025
Performance Anxiety Isn’t Just About Sex
Performance anxiety doesn't show up the way the name suggests it does.
Jul 26, 2025
What Every Insurance Term Actually Means (And Which Ones Matter)
Insurance companies don't write their paperwork to be understood. They write it to be unfalsifiable, which is a different problem.
Jul 26, 2025
How Health Insurance Actually Works
Health insurance is confusing on purpose.
Jul 24, 2025
Lunesta
Lunesta is the Z-drug you reach for when Ambien isn't holding the night together. Same family, different shape, slightly longer half-life.
Jul 23, 2025
Solopreneur Logistics: From LLC to PC
Most clinicians who leave a W-2 job to go solo lose money in their first year, and a fair number of them don't even notice until they sit down with…
Jul 21, 2025
PTSD Treatment
PTSD is what happens when your brain encodes a memory wrong.
Jul 19, 2025
Licensure vs Certification: What Actually Defines Your Scope of Practice
Most of us came out of training knowing how to interview a patient, how to write a note, and how to talk a guy down off a bad week, and…
Jul 18, 2025
E&M Codes for Psych: Choosing the Right Level
Most psych clinicians are undercoding their visits, and it's not because they're being modest, it's because nobody taught them how E&M (evaluation and…
Jul 16, 2025
Stimulants Help Most People Focus. That Isn’t an ADHD Test.
The single most common ADHD diagnostic story I hear in the room goes like this...
Jul 13, 2025
Modafinil and the productivity stack
Modafinil is the drug a lot of guys in tech, finance, and the productivity-bro corners of the internet are taking off-label, often without a prescription,…
Jul 10, 2025
AI girlfriends and male loneliness
The number of guys using Replika, Character.ai, and the half-dozen newer AI companion apps has gone vertical in the last couple of years, and it’s showing up in…
Jul 8, 2025
Anxiety Treatment
The public conversation about anxiety treatment and the clinical reality have drifted about as far apart as it's possible for two conversations on the…
Jul 7, 2025
IV Skin and Beauty
An IV skin-and-beauty drip is, almost without exception, a bag of saline with some combination of vitamin C, B vitamins, biotin, and (depending on the…
Jul 7, 2025
Ketamine Assisted Therapy
Ketamine-assisted therapy is what it sounds like.
Jul 6, 2025
Decline of male friendship after 40
The data on this is what it sounds like.
Jul 5, 2025
Jonathan Haidt’s Anxious Generation: what’s right and overstated
Haidt’s argument in The Anxious Generation is that smartphones and social media, hitting kids hard around 2012, broke teen mental health. The data on adolescent depression and anxiety…
Jul 3, 2025
Men’s Mental Health: Why Asking for Help Feels Impossible
You already know something's off, and you've probably known for a while... months, maybe years.
Jul 1, 2025
PCP-psychiatrist handoff: when to switch
A lot of the psychiatric medication in this country is prescribed by primary care doctors, not psychiatrists.
Jun 30, 2025
Mental health records: background checks, gun ownership, licensure
This is one of the questions that comes up in the first appointment most often, particularly from guys who own firearms or work in jobs with security…
Jun 27, 2025
Off-label prescribing: what it means
A huge percentage of what psychiatrists prescribe is off-label, and most patients have no idea, which is its own problem.
Jun 25, 2025
Low T vs. Depression: What You Actually Need to Know
Guys come in convinced they have low T when they're actually depressed, and other guys come in convinced they're depressed when their testosterone is in…
Jun 25, 2025
Long-term med use realities (20-year horizons)
The honest answer to "can I stay on this medication for the rest of my life" is: we don't fully know what happens at 30 or 40 years out, because…
Jun 22, 2025
Antidepressant withdrawal vs relapse: distinguishing
Guys stop their antidepressant, feel terrible a couple weeks later, assume the depression is back, restart the medication. Sometimes that's right.
Jun 20, 2025
Depression Treatment
Depression ≠ sadness. Sadness has a thing it's about. Depression doesn't, it just follows you around like a Dementor sucking the light out of the world.
Jun 19, 2025
Why some clinicians won’t take insurance
I take insurance. A lot of psychiatrists in private practice don't.
Jun 17, 2025
PHP vs IOP vs Outpatient
These three terms get used like everybody knows what they mean and most patients don't, so they end up in the wrong level of care.
Jun 14, 2025
Freedom Costs Blood. Mental Health Costs Choices.
Freedom isn’t free. Neither is good mental health.
Jun 13, 2025
Zoloft
Zoloft is the drug I prescribe more than anything else, and the one patients ask the most questions about before they're willing to swallow the first pill.
Jun 13, 2025
Psychiatric hospitalization: what to expect
Most people who get hospitalized for a psychiatric reason have never been inside one and have no idea what's about to happen, which makes a scary thing…
Jun 12, 2025
ADHD in Adults Isn’t About Being Hyper
Most people picture ADHD as a kid bouncing off the walls, can't sit still, disruptive in class. That's one version of it, mostly in children.
Jun 12, 2025
The Story I’m Telling Myself Is…
Most people do not get taken out by facts first. They get taken out by what the facts start to mean. You send a text and do not hear back.
Jun 11, 2025
Trintellix (Vortioxetine)
Trintellix is the antidepressant pharma reps spent a decade trying to make happen.
Jun 9, 2025
CBT-I deep dive (beyond the mention)
CBT-I (cognitive behavioral therapy for insomnia, the structured-protocol kind that actually has a syllabus, not the talk-about-your-sleep-feelings kind)…
Jun 9, 2025
Expectations Hurt Us More Than People Do
A lot of disappointment starts long before anyone actually does anything wrong. It starts in the quiet little contract we made in our own head.
Jun 8, 2025
Why Men Avoid Therapy
Men kill themselves at roughly four times the rate women do in the US, that gap has held year after year, the pandemic didn't close it, the recession…
Jun 7, 2025
Couples Therapy for substance use
If one partner has a drinking or drug problem and they're in a relationship, the partner is part of the treatment whether anybody signs them up for it or…
Jun 6, 2025
Internal Family Systems (IFS)
IFS (internal family systems, the therapy model that asks the patient to relate to different aspects of himself as if they were distinct internal parts…
Jun 1, 2025
Addiction Treatment
Addiction is what happens when the brain's reward wiring gets dragged hard in one direction.
May 31, 2025
Hair loss: what works, what is hype
Finasteride, dutasteride, minoxidil, PRP, microneedling, transplants. The math of male pattern hair loss, the meds that bend it, and the things sold to you that mostly do not.
May 29, 2025
Prolonged Exposure for PTSD
Prolonged exposure is one of the two gold-standard treatments for PTSD (post-traumatic stress disorder, the trauma-spectrum condition that follows certain…
May 27, 2025
Pristiq (Desvenlafaxine)
Pristiq is what happens when you take Effexor, skip a metabolic step, and sell it as a new drug. That's not a dig, that's the actual mechanism.
May 27, 2025
Self-Harm in Adult Men
Self-harm in adult men is a thing we don’t talk about much, because the cultural picture of self-harm is a teenage girl with a razor and her arms,…
May 24, 2025
Body Dysmorphic Disorder in men
Body dysmorphic disorder in men is more common than most clinicians catch, and it shows up differently from how the textbook describes it because the…
May 22, 2025
The Difference Between Depression and Just Being Sad
Not every bad day is depression and not every hard week means you need medication.
May 21, 2025
Alcohol Use Disorder diagnostic criteria
Most guys who have alcohol use disorder don’t think they have it, because they think alcoholism means falling-down-drunk and missing work, and they’re not doing that. They’re functional,…
May 19, 2025
Sleep, Stress, and Your Brain
You can't think your way out of being sleep-deprived, you can't positive-mindset your way through chronic stress, and you can't meditate away what happens…
May 18, 2025
Complicated Grief / Prolonged Grief Disorder
Prolonged grief disorder made it into the DSM-5-TR (the most current version of the psychiatric diagnostic manual) in 2022, and the diagnosis is useful…
May 17, 2025
Burnout (ICD-11)
Burnout picked up an actual ICD-11 (the international diagnostic codebook used outside the U.S.) designation in 2019, and the conversation since then has…
May 14, 2025
You mad, bro?
A lot of guys think anger is the problem because anger is the part everybody sees...
May 11, 2025
PMDD (for the partners who live with it)
This one's for the husbands, because most of the guys who come in with a wife who has PMDD (premenstrual dysphoric disorder, the severe, predictable mood…
May 11, 2025
Weight Management
The weight management conversation got rewritten in the last three years and most people still haven't caught up.
May 9, 2025
Persistent Depressive Disorder (Dysthymia)
Persistent depressive disorder, what used to be called dysthymia, is the diagnosis for guys who've been depressed for so long they don't remember what…
May 9, 2025
Mood Disorders Treatment
"Mood disorder" is a category, not a diagnosis.
May 7, 2025
Why “Rock Bottom” Is Bullshit
Rock bottom is bullshit.
May 6, 2025
Bipolar I vs Bipolar II vs Cyclothymia
These three diagnoses get confused constantly, including by clinicians, and the difference matters because the treatments diverge in important ways.
May 6, 2025
Loneliness as diagnosable risk factor
Loneliness isn't a DSM diagnosis and nobody's going to pretend it is, but it functions like one in terms of risk, and the data on it for middle-aged men…
May 3, 2025
Narcissist diagnosis misused: clinical reality
The word narcissist has been so thoroughly hijacked by TikTok and pop psychology that you can't use it in a clinical conversation anymore without first…
May 1, 2025
Ketamine
Ketamine has been around since 1962, doing its boring day job as an anesthetic in operating rooms and battlefield medic kits, and the depression piece is…
May 1, 2025
The Real Reason You Keep Self-Sabotaging
People sabotage themselves constantly and they can't tell you why. Get within sight of something working out and they blow it up.
Apr 30, 2025
IV Immune Support
The IV drip clinic is the chiropractor of the 2020s.
Apr 29, 2025
Sleep apnea + depression in middle-aged men
If you’re a guy in your forties or fifties who feels depressed, exhausted, foggy, and irritable, and the SSRI (selective serotonin reuptake inhibitor, the most common antidepressant class,…
Apr 28, 2025
Melatonin
Melatonin is one of the most misunderstood things sold in a drugstore, and the misunderstanding got there with help from the supplement industry, the…
Apr 26, 2025
Cannabis-induced psychosis (2025 evidence)
The data on cannabis and psychosis is no longer ambiguous, and saying so out loud is going to lose some readers in the first paragraph.
Apr 26, 2025
How to Know If Your Provider Is Actually Helping
Most people who fire their psychiatrist wait about a year too long to do it.
Apr 25, 2025
Caplyta (Lumateperone)
Caplyta is the antipsychotic that came out in 2019 and made a bunch of psychiatrists do a double-take at the receptor pharmacology, then another…
Apr 23, 2025
Post-COVID brain fog as a diagnostic entity
Post-COVID brain fog is real and we still don't have a clean blood test for it, which means most of what gets done with these patients is ruling out the…
Apr 23, 2025
High Dose Ketamine In Clinic
High-dose ketamine done in a clinic is a different animal from the troches you take at home.
Apr 22, 2025
Adult ADHD diagnostic surge
The number of adults walking into psychiatric offices in 2026 asking to be evaluated for ADHD is something nobody saw coming on this scale.
Apr 20, 2025
Stimulants and cardiovascular safety in adults
For decades the conversation about stimulant cardiovascular risk was muddled, with primary care doctors being more cautious than the data warranted and psychiatrists being maybe a little too…
Apr 18, 2025
The Playlist Changed. So Did We.
There's probably a song you still know by heart that taught you something about love before you were old enough to question it. Not in some dramatic way.
Apr 16, 2025
Lurasidone (Latuda)
Lurasidone is the drug you reach for when somebody walks in with bipolar depression and a body that's already been wrecked by Seroquel.
Apr 16, 2025
Gabapentin
Gabapentin is the drug American psychiatry is in a quiet relationship with that nobody really wants to talk about publicly. It's prescribed constantly.
Apr 15, 2025
Clonidine
Clonidine is a blood pressure medication from the 1970s that turned out to be useful for half a dozen things it was never designed for.
Apr 13, 2025
Strattera (atomoxetine)
Strattera is the non-stimulant ADHD medication that most adults don’t think about until they have to, which is usually because stimulants are off the table for some reason.…
Apr 10, 2025
Buspar (buspirone)
Buspar is the anti-anxiety drug I wish more people had heard of, mostly because it’s the answer to a lot of situations where the patient or the prescriber…
Apr 7, 2025
Paxil (paroxetine)
Paxil is the SSRI (selective serotonin reuptake inhibitor, the standard first-line antidepressant class) I almost never start a new patient on, and the…
Apr 5, 2025
Sexual Health
Men's sexual health is one of those topics where the medicine is mostly straightforward and the conversation is mostly impossible.
Apr 4, 2025
Celexa (citalopram)
Celexa is the SSRI (selective serotonin reuptake inhibitor, the standard first-line antidepressant class that boosts serotonin without much else going on)…
Apr 2, 2025
Effexor (venlafaxine)
Effexor is the SNRI (serotonin-norepinephrine reuptake inhibitor, the antidepressant class that hits both serotonin and norepinephrine instead of just…
Mar 31, 2025
Why your psychiatrist is rushed (the 15-min visit)
The 15-minute psychiatric follow-up is the unit of care in most outpatient psychiatry now, and most patients hate it and most psychiatrists hate it too. The reason it…
Mar 28, 2025
You’re Making a Choice Right Now
You're making a choice right now.
Mar 27, 2025
Provider type field guide: PA, NP, MD, PhD, LMFT, LCSW
The alphabet soup of mental health providers is genuinely confusing and there's no good reason for the patient to have to figure it out on their own,…
Mar 26, 2025
Two Quotes That Changed How Clients Think
“If the problem can be solved, why worry?
Mar 26, 2025
Trazodone
Trazodone is the most prescribed sleep medication in the United States that was never actually approved as a sleep medication.
Mar 25, 2025
Why Your Brain Won’t Shut Up at Night
It's 2 AM. You have to be up in five hours.
Mar 25, 2025
Go with your Gut
You probably know this feeling.
Mar 24, 2025
Why Asking for Help Feels Like Weakness
For most of the guys who land in a psych office, the hardest thing they did in years wasn't the appointment. It was the phone call to book it.
Mar 24, 2025
What HIPAA actually protects (and what it doesn’t)
Most of what people think HIPAA covers, it doesn’t. And most of what people actually worry about when they think about HIPAA isn’t even a HIPAA question. The…
Mar 20, 2025
IV Athletic Recovery
IV recovery is one of those wellness products that works just well enough to keep selling itself.
Mar 19, 2025
For the Elder Millenials, Gen X’rs, and Beyond
Sometimes aging announces itself in the smallest possible way. Not with a dramatic milestone. Not with a birthday that suddenly changes everything.
Mar 17, 2025
The manosphere and mental health (Tate effect)
Andrew Tate isn't really my problem in a psychiatry appointment.
Mar 17, 2025
Turn Intention Into Action
The gap between knowing what you should do and actually doing it is the most popular real estate I work in.
Mar 16, 2025
AI Therapy Is Not Therapy
The thing guys are calling AI therapy now is usually not Woebot, Wysa, or some mental health startup with a cute mascot and a CBT worksheet engine.
Mar 15, 2025
TRT clinic boom: Hone, Vault, Marek, what’s legit
Half the guys in their forties walking into a psychiatry appointment now have already done a finger-prick testosterone test through some clinic they saw on Instagram, and a…
Mar 12, 2025
988 and the gap between calling and getting help
988 is better than 911 used to be for a mental health crisis, which is a low bar and a real improvement at the same time. It’s a…
Mar 10, 2025
Suicidal Ideation, passive vs active
Passive suicidal ideation is the one that catches guys off guard, because it doesn't look like the thing they think they're supposed to be worried about.
Mar 7, 2025
Why Your Therapist Can’t Fix You
Your therapist can't fix you, and that's actually the news the whole industry is trying not to lead with. Guys come into therapy wanting to be fixed...
Mar 3, 2025
Andropause / Late-Onset Hypogonadism
Andropause is the catchier name for late-onset hypogonadism, which is the clinical term for low testosterone in older men.
Mar 2, 2025
Low Dose Ketamine At Home
At-home ketamine is the version of this treatment most people end up actually doing.
Mar 2, 2025
Adjustment Disorder
Adjustment disorder is the diagnosis most underused in actual practice, which is funny because it's the diagnosis that probably fits half the people who…
Feb 27, 2025
Disulfiram (Antabuse)
Disulfiram (Antabuse) doesn't kill cravings, it makes drinking miserable on purpose. Who the alcohol deterrent actually fits, and who should skip it.
Feb 26, 2025
Premature Ejaculation
Premature ejaculation is one of the most common sexual complaints in men and one of the least often brought up in a doctor's office.
Feb 25, 2025
Erectile Dysfunction (clinical workup)
Erectile dysfunction is the kind of complaint that gets undertreated because people are embarrassed and overtreated because they go straight to the…
Feb 22, 2025
Insomnia Disorder
Insomnia disorder is when you can't fall asleep, or can't stay asleep, or wake up too early and can't get back under, three or more nights a week for…
Feb 17, 2025
OCD
OCD is one of those diagnoses that got grabbed by pop culture and quietly butchered along the way.
Feb 14, 2025
Panic Disorder
Panic disorder is not generalized anxiety.
Feb 11, 2025
Valproate (Depakote)
Valproate (Depakote) is a heavy mood stabilizer for acute mania, not ordinary moodiness. The real side effects, labs, and pregnancy risk.
Feb 11, 2025
Generalized Anxiety Disorder (GAD)
GAD (generalized anxiety disorder, the diagnosis given to chronic free-floating worry that isn't attached to one specific thing) is the kind of anxiety…
Feb 9, 2025
Dialectical Behavior Therapy (DBT)
DBT (dialectical behavior therapy, the skills-and-group approach that came out of Marsha Linehan's lab in the 1980s) got invented to treat patients with…
Feb 6, 2025
Cognitive Behavioral Therapy (CBT)
CBT (cognitive behavioral therapy, the structured worksheet-and-homework kind, not the talk-about-your-mother kind) is the therapy with the most evidence…
Feb 4, 2025
Cymbalta (Duloxetine)
Cymbalta is the drug I reach for when the depression has a physical component...
Feb 1, 2025
Social Anxiety Disorder
Social anxiety isn't shyness, it's an anxiety disorder run by avoidance. Here's how dodging makes it worse and how exposure, CBT, and meds fix it.
Jan 30, 2025
Lexapro (Escitalopram)
Lexapro is the SSRI I start with most of the time, and the reason is boring...
Jan 29, 2025
When to switch antidepressants, and when to stay
Half the antidepressant switches that happen shouldn't have happened, and the other half should have happened six months earlier.
Jan 27, 2025
Choosing between SSRIs, SNRIs, and what comes next
The decision tree for picking an antidepressant in 2026 isn't really a tree, it's more like a workflow, and the workflow is a lot simpler than the size of…
Jan 24, 2025
Adderall vs Vyvanse: side by side
Both are amphetamines, both work, the differences are real but not enormous, and the right answer for any given patient depends on factors that the rep…
Jan 22, 2025
Belsomra (Suvorexant)
Belsomra (suvorexant) blocks the brain's wake signal instead of forcing sedation. Best for staying asleep, and the dependence math beats the benzos.
Jan 22, 2025
ADHD meds for adults: the questions I get most
Adult ADHD is everywhere now, which means I get the same set of questions from people considering a stimulant, in slightly different fonts, over and over.
Jan 19, 2025
How long does an antidepressant actually take to work?
Eight to twelve weeks at a real dose.
Jan 16, 2025
Does Wellbutrin actually not cause sexual side effects?
The short version: mostly true, the marketing is shading it slightly cleaner than it actually is, and the most useful clinical move with Wellbutrin in…
Jan 14, 2025
Finasteride (Propecia, Proscar)
Finasteride (Propecia, Proscar): how it holds onto your hair, the sexual side effects, the contested post-finasteride question, and the PSA catch.
Jan 14, 2025
What the men’s mental health movement gets wrong
There are basically two wings of the men's mental health conversation in 2026 and both of them are selling stuff, which is most of the problem.
Jan 11, 2025
Schedule II is doing more harm than good
Stimulant medications are currently Schedule II, which is the same legal category as fentanyl, oxycodone, and morphine.
Jan 8, 2025
The Adderall shortage isn’t what you think it is
The Adderall shortage that's been going on for the last three-plus years is not caused by telehealth mills, not caused by hoarding anxious parents, not…
Jan 6, 2025