All Writing
Everything published on psychiatry.help, newest first. Showing 181-216 of 297 posts.
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, Explained
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, Explained
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
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, Explained
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, 2025Group Therapy: what actually happens in the room
Group therapy is the treatment I refer to most often and the one patients fight me hardest on. The fight is almost always the same: I don’t want…
Jun 4, 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, Explained
Addiction is what happens when the brain's reward wiring gets dragged hard in one direction.
May 31, 2025Acceptance and Commitment Therapy (ACT)
ACT (acceptance and commitment therapy, a “third-wave” behavioral therapy that grew up out of the CBT lineage in the late 80s and 90s) has built itself into a…
May 30, 2025