2024 was a year of surprises and perhaps the biggest one in the world of mental health was the FDA’s decision regarding MDMA in August.  There were a lot of expectations that 2024 would be the year that the psychedelic medication, MDMA, would be approved by the FDA for the treatment of Post Traumatic Stress Disorder. However, in a startling turn of events the FDA rejected MDMA citing non-sufficient data collected. This is obviously a setback for the field and in this article I will explain what I believe went wrong and where this leaves us going forward with MDMA and other psychedelic research.

When I first wrote about microdosing lithium in October 2022, I had no idea of the widespread interest in this topic and the dearth of information available on it. I received a lot of emails with questions that were not specifically addressed in the original article. Hence, in this article, I will answer some of the most commonly asked questions, along with a couple case studies, and discuss why I believe lithium will continue to have an important role in the future.

The current psychedelic renaissance began in 1994 but no one could have predicted the cultural explosion of interest in the past 5 years and how desperate we are for new mental health treatments. However, some say we’re now preparing for the bursting of the psychedelic hype bubble and that may turn out be a good thing for the future of psychedelics. What began as a welcome glimmer of hope for new ways to treat mental illness has perhaps morphed into actual misinformation. In this next article, I will discuss the more challenging issues facing psychedelics and what needs to happen to keep their potential promise on track.

2023 marked a first in my 30-year career… I had to hospitalize someone who was severely overwhelmed from viewing the news. The news is no longer delivered in the way it used to be and our central nervous systems were not designed to take in today’s 24/7 news cycle in all its forms -- whether it be from reading a newspaper, social media, videos, or audio clips. In this article, I will explore the relationship between the news and mental health, and then suggest ways to take care of yourself.

While traditional individual therapy has focused on unhealed personal trauma, in recent years there has been an increasing movement to incorporate the healing of collective trauma into an individual’s treatment. This next article will discuss this expanded map of trauma healing and what it means for reclaiming one’s natural, balanced state of being.

While you may be unfamiliar with the term, dissociation is more common than you might think. Perhaps you have a brief moment where you are out with friends enjoying lunch or sitting in a meeting at work, and you begin to feel out of touch with what’s happening around you. You may even draw a blank an hour later when trying to remember what was discussed at the meeting or maybe you drove home but don’t remember taking the route. Occurrences such as these are a mild and common form of dissociation experienced by most people but in the case of psychological dissociation, it’s not just a matter of daydreaming or getting lost in your thoughts, but rather a severe and chronic medical condition where the individual is detached from reality. In this next article, I will highlight our current understanding of dissociation and how it manifests in everyday life.

I believe there is an important role for MAOIs especially when nothing else seems to work for depression, social phobia, or panic disorder.  In this next article, I will highlight 3 patients over the past year who I have treated successfully with MAOIs.

In this article, I will discuss how the treatment of this MTHFR gene with L-methylfolate can change a treatment resistant depression into a responsive one or even eliminate the need for an antidepressant entirely.

One factor often overlooked in psychiatry is the quality of a person’s breathing especially those with a history of trauma, anxiety, panic symptoms or chronic stress. When stressed or anxious, there is a tendency to breathe more quickly and through the mouth. People often assume that breathing through the mouth is normal. It is not. We are designed and have evolved to breathe through the nose. In this next article, I will offer a few tweaks that may help the reader start to make corrections towards a healthier breath.

When I first heard that the psychedelic, MDMA, was part of a clinical trial for the treatment of Post Traumatic Stress Disorder (PTSD) 4 years ago, I was very surprised and a bit confused. MDMA (aka Ecstasy) had been demonized as a party drug for several decades associated with a lot of negative consequences. But in 2021, Science magazine published a study on MDMA assisted therapy for PTSD. So what is the truth about MDMA? In this article, I will unravel this paradox about MDMA and its implications for treating psychiatric problems.

I had the opportunity to recently attend a “Psychedelics and Psychiatry” conference and was struck by so many new developments over the past year. Some lingering questions from recent years now have some answers but there are always new questions since the research into psychedelics is still in its infancy. In this article, I will share the top 5 take home messages about psychedelics that are relevant to the practice of psychiatry.

While most people think of lithium as a medication for severe mental health problems, research since the 1970s has strongly suggested that low levels of lithium also function as a nutrient. The World Health Organization considers lithium a nutritionally essential trace element, alongside zinc, iodine, and others. In this next article, I will discuss these other uses of lithium that may not even require a doctor’s prescription.

Many believe that people with Borderline Personality Disorder (BPD) can never really get better. However, we now know the perception of BPD as having a bad prognosis over time is incorrect. Multiple studies have confirmed that substantial improvement occurs and that, in fact, BPD has the best prognosis of all major psychiatric disorders. In this next article, I will present an overview of BPD and the keys to a good outcome.

There has been a recent online storm about a review article that announced the death of the serotonin “chemical imbalance” theory of depression. In this next article, I will highlight the evolution of our updated understanding about the cause of depression.

Oftentimes when looking to improve mental health, the first ideas to come to mind are things like beginning therapy, exercise or meditation. One of the most overlooked steps is to simply remain properly hydrated. In this next article, I will discuss the mental health benefits of water and a simple experiment you can do for yourself to see what you notice when you are properly hydrated.

Did you know that there is a “hidden lobe” in the brain that is not well known by many mental health professionals, yet serves one of the most critical functions in the experiencing of one’s own emotional state of being? In this next article, I will highlight how the insula went from relative obscurity to a starring role in what it feels like to be human and what that may mean for psychiatric treatment in the future.

You may recall that last spring I shared an acrylic painting of North America that was based upon a dream I had. This next painting is a companion to that painting but is much simpler in design and was completed in just 4 months. At first glance, it looks like a bunch of animals surrounded by a lot of water but take a really good look at it to see if you can figure what the painting is really about. In this next article, I will highlight what this painting is based upon and discuss some of its details.

Early on in my psychiatry career, I would often lament about the lack of innovative treatments in psychiatry. While it was true new medications were always coming out, it seemed to me most of the time that they very similar to the ones that were already being used. However, in the last decade, that has been changing with the introduction of brain stimulation.

Over the years, I have worked with many patients who are afraid of dying and of death, and with how that fear complicates both the healthy consideration of their own death as well as their grieving process when someone close dies. In this article, I will discuss what I believe is behind these fears as well as a grassroots movement that offers a change in how we prepare for death, personally and collectively.

Grief is not a mental illness, but rather a normal, healthy and pretty rational reaction to extreme loss. Under normal circumstances, grief or bereavement does not require formal treatment with a therapist. In this next article, I will discuss how to distinguish between normal grief and complicated grief and at what point treatment might be useful.

Body Dysmorphic Disorder (BDD) is a disorder marked by an obsessive idea of perceived defects or flaws in one’s appearance. A flaw that to others, is considered minor or not observable. In this next article, I will provide awareness and knowledge of BDD in the hopes of bringing people with BDD out of hiding and increase access to treatment as BDD does not go away on its own.

My last psychedelic update was nearly 2 years ago and at that time there was a sense that FDA approval for psychedelics like psilocybin was inevitable. Here we are in 2021 and there’s still a lot of excitement and astounding interest in using psychedelics to treat mental health conditions.

The first thing I learned when I started my psychiatry training in the early 1990s was how to test for tardive dyskinesia (TD), one of the most important side effects of psychiatric medications. Tardive dyskinesia is an abnormal movement disorder that can develop from long term antipsychotic medication use and can ultimately become disabling. In this article, I will review what to look for in recognizing abnormal movements and the challenges of using telehealth to find and treat TD.

This is a question I’ve asked myself since genetic testing first came available around 2011. I will highlight a few cases in my private practice where genetic testing gave surprisingly helpful results that I otherwise would have never known and using that information has led to improved quality of life for patients as well as new lessons for me.

In the aftermath of recent police brutality incidents, there has been much discussion and protesting over the past year about achieving racial justice in the external world. But there has not been as much discussion about racial healing with each other and within oneself. In my own work with patients, this issue has come up in new ways this past year. In this article, I will highlight the case of a 17-year-old white male who sought my help with feeling emotionally overwhelmed about his “white privilege,” which was triggered by what he had been learning about Critical Race Theory at school.

At a recent mental health conference, I had the opportunity to hear Ben Nemtin, a 37 year-old Canadian writer, give the keynote address Making the Impossible, Possible. As we start to reengage the world from the pandemic, Ben’s message about figuring out what’s important to you so it doesn’t become buried is timely and inspirational. In this next article, I will outline 5 Steps on how you can make the impossible, possible in your own life.

In my private practice, I continue to work with patients who are recovering from addiction as well as a mental health challenge. While many will remain abstinent the rest of their lives, every now and then someone will relapse and our work then becomes about getting them back on track. In this next article, I will highlight the addictive and recovery process and the common roadblocks to recovery.

And now for something completely different. I would like to share a painting that I just completed that has nothing to do with mental health but has a lot to do with creativity and ways to improve your memory which I have previously written about.

There is now compelling scientific evidence that daily lifestyle habits have a much greater impact on your healthy aging than your genes. In this article, I will review the latest research on these lifestyle habits and what researchers call a formula for successful aging that can forestall symptoms of Alzheimer’s disease.

Throughout my career, I have marveled at the preoccupation in our culture with narcissism. Every day, you can find articles about which politician, celebrity, or athlete is “narcissistic” and why. And while that can be interesting to read about, I often wonder if it would be more helpful to look within before we judge others. In this article, I present an overview about narcissism, with particular focus on becoming more self-aware of narcissistic traits in the context of the COVID-19 pandemic.

Over the course of twenty five years in clinical practice, I estimate 60% of the patients I have evaluated have said they have problems with their memory. In this article, I will highlight a few techniques to improve your memory that have been around for thousands of years.

When you think about melatonin what do you think of? Chances are you think of a dietary supplement for sleep that 3 million people in the U.S. take in any given month. In this article, I will highlight some take away points from current research that you should know if you are taking melatonin including very recent studies on how there appears to be an adverse effect of taking melatonin with food.

When I started my psychiatry career in the Navy in the mid-1990’s, I was advised to always tread carefully with patients on three topics: sex, religion, and politics. Twenty-five years later, I find that talking about sex and religion is not so challenging, but politics is a different story.

I attended my first virtual national psychiatric conference and by far my favorite session was called Me2/Classical Music for Mental Health. The session started out with about 12 musicians who were all string players. This was not an ordinary orchestra; in fact, it was quite extraordinary because about half the musicians live with the diagnoses of Bipolar Disorder, Schizophrenia, depression, anxiety or addiction. We all know the power of music to heal for the listeners but it is also healing for the people playing too.

As we enter the sixth month of this pandemic, it’s pretty clear that we’ve all been affected on some level by the quarantine and social distancing.

When it comes to this topic, a part of me is afraid to speak, for fear of saying the wrong thing. My sense is that most people will assume this article does not apply to them, and they would rather not explore the topic too deeply within themselves as it’s uncomfortable. And yet, I really want to share what I hope is a healing message.

Are you wondering how you are going to make it emotionally through this pandemic? In this current article, I will use a case study to illustrate how you can shift negative feelings into positive ones by using a visual “emotional map”.

Even though we’re still in Spring, the year 2020 is already an eventful one—the COVID-19 pandemic, the Senate impeachment trial of the President, and probably a few other surprises. Another “event” that mirrors these headline events is one that is less visible—our feelings about these events, and the potential to feel overwhelmed by them.

In my article from last month, I talked about how the opioid epidemic was 20 years in the making due to opioids being overprescribed during that time period. It turns out the sugar epidemic has been 40 plus years in the making.

19th century philosopher, Karl Marx once said “religion is the opium of the masses” but one could also make the case in the 21st century America that “opium is now the religion of the masses.” 

I’ve gotten this question many times over the last couple years and only recently do I have a complete answer.  Like everyone else, getting trusted information from what’s available online has been a bit frustrating.  Even at psychiatric conferences, I felt some of the answers from my colleagues seem to conflict. There’s still a lot of unanswered questions but I feel it is important to share where things are at in tracking this nationwide trend.

This is a follow up to my January 2019 article, “Are we on the verge of a psychedelic revolution in mainstream psychiatry?” The answer to that question it turns out is not so fast.

As I get closer to releasing my self-help book, I realize the best metaphor for how it came together was like picking berries to make jam.  There were little pieces that came together to form a unique whole over a 15 year period.

In psychiatry, we usually think of energy as a way to describe how we are feeling mentally and/or physically. For example, depression tends to be associated with less energy, while mania is associated with increased energy. However, we can also look at energy in a big picture kind of way. The physical world and our bodies appear through the eye of nuclear physics to be a latticework of energies, in which the body is surrounded and permeated by an energy field which carries information.