Below you'll find a list of all posts that have been categorized as “Best Practices”
Although there is reason for optimism about some of the newer medications for insomnia (orexin antagonists) that are coming to market, it remains true that sleeping medications are not the right answer for many people with insomnia. Cognitive behavioral therapy for insomnia (CBTi) has several advantages as an initial treatment. Cognitive Behavioral Therapy for Insomnia First We have been writing …
I have long been a strong proponent of generic medications. Recently, however, several of my patients have expressed concerns about the generic medications that they have received. This led me to do some research on generic pharmaceutical companies. The first thing to know about generics is that they are made by many different manufacturers in many different countries. This is …
There are many reasons why thyroid status is important in a clinic treating people with mood disorders. For one thing, hypothyroidism and hyperthyroidism can mimic some of the symptoms of mood disorders. For another, lithium, a medication we often prescribe, is associated with hypothyroidism in a significant minority of patients taking the medicine. One of the questions we wrestle with …
Inflammation and C Reactive Protein Inflammation is often seen in people with depression. And there is evidence to suggest that it predicts treatment response. The most widely accepted standard test to measure inflammation is the C-reactive protein, or CRP. This is a protein that is produced by the liver in inflammatory states. The American Heart Association and the Centers for …
Chronotherapy refers to treatments for depression, mania, or both, that focus on changing sleep and wakefulness patterns. This blog post provides an update of this important area. Background The International Society of Bipolar Disorders (ISBD) task force on chronobiology and chronotherapy published a comprehensive review of chronotherapy techniques and their effectiveness in bipolar disorder in 2019. This article summarizes the …
Gateway Psychiatric was established with the belief that in order to give our patients the best care possible, it is necessary to invest heavily in training for the clinical staff. We particularly focus on evidence based practices that have been shown to address significant problems facing our patients. Since chronic depression is one of the most common problems seen in …
One of the most perplexing things about our healthcare system is how complicated it can make even simple tasks. This is particularly true when the issue involves sharing information among providers of care. Elsewhere we have talked about the “silo” problem and why it has motivated us to develop a clinic that tries to provide integrated care. Here I want …
Sometimes our lives can become so full of the myriad items to manage and tend to that we lose track of what is most meaningful. Rarely do we afford ourselves the time to stop and ask, “How do I really want to be spending my time? What is it that I value?” The end-result of this way of functioning tends …
Recently the American Psychological Association (APA) held their annual conference here in San Francisco and Gateway staff was there to take advantage of the opportunity to update our knowledge of the most recent developments in the field. Gina Gregory, LCSW and I spent the long weekend attending workshops, presentations, and discussions in order to align ourselves with the current research …
Once again we are reminded of the power of retrospective mood charting to transform treatment. A young man who has “tried every medication” without any success and has been seriously suicidal, recently came in to see us and we convinced him to try putting together a retrospective mood chart. The process was quite time intensive, but the result was a …
