Spravato (esketamine) protocol
Spravato is FDA-approved esketamine, given as a nasal spray under direct supervision in a certified clinic. It’s the only legal-and-insured version of ketamine for treatment-resistant depression (TRD, which…
Jun 1, 2026Three Months In on an SSRI: What’s Normal, What’s Not, and When to Tell Your Prescriber
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 don’t entirely…
Jun 1, 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 specific spot on…
Jun 1, 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. It’s been on TV constantly, the ads with the…
Jun 1, 2026
Prescription Education
Starting a psychiatric medication is mostly an exercise in being patient through a stretch of weeks that feel worse than baseline before they feel better. Nobody really tells…
Nov 5, 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. They say “I just want to feel like myself again,” or “I…
Nov 1, 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. Fluoxetine has a…
Oct 20, 2025
Depression Looks Different in Men
Most people think depression looks like sadness… someone crying, withdrawn, hopeless, visibly falling apart. And sometimes it does look like that, sure, the brochure version is real. But…
Oct 19, 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, because for one specific job it’s still…
Sep 9, 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. And bipolar…
Aug 27, 2025