Off Script, unfiltered.
Essays and observations from working clinicians. Mental health, broader than a diagnosis.
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Jump to what you came for, instead of scrolling. 12 topics, each linking to every essay tagged with it.
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
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
Why some clinicians won’t take insurance
I take insurance. A lot of psychiatrists in private practice don't.
Jun 17, 2025
Freedom Costs Blood. Mental Health Costs Choices.
Freedom isn’t free. Neither is good mental health.
Jun 13, 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
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
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
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
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