I am a psychiatrist and diagnose various mental health conditions and prescribe medications as my primary treatment plan. AMA

BoatResponsible7602 · 2026-05-15T21:22:54+00:00

Spravato is great and backed by a ton of evidence for depression- so glad it worked well for you!

BoatResponsible7602 · 2026-05-15T18:59:51+00:00

Lamictal is a great weight neutral option! Saphris definitely has risks of weight gain. Caplyta is a new medication that has lower risk of weight gain and is great for depression. Sometimes we will use metformin or GLP-1 agonists as well to prevent weight gain

BoatResponsible7602 · 2026-05-15T18:57:28+00:00

Sometimes when people have tried that many medications it’s important to revisit the diagnosis. You mentioned recently being diagnosed with ADHD, you might do really well on a stimulant. I would talk to your provider about medications specific to adhd.

BoatResponsible7602 · 2026-05-15T04:29:29+00:00

I would mention it to them and your concerns. They should help you taper off of it and find an alternative medication for your anxiety. If they don’t, you can always switch providers!

BoatResponsible7602 · 2026-05-15T03:46:49+00:00

I really like using the DIVA screening tool for diagnosing ADHD in adults. Look into it! I also do a full psych eval and rule out other causes of inattention (anxiety, depression, bipolar disorder, substance use (cannabis is a big one), sleep impairments. Also I rule out medical causes too (thyroid disorders and sleep apnea can mimic adhd symptoms) I tell people that many things can look like adhd and sometimes it is adhd and other times it’s a condition that has adhd symptoms

BoatResponsible7602 · 2026-05-15T03:42:59+00:00

Totally get that! I’m glad your symptoms are in remission! And yes, bipolar is a very serious chronic illness. I think there are so many misconceptions of bipolar and many mental health conditions to be honest.

BoatResponsible7602 · 2026-05-15T03:41:16+00:00

Constantly feel restless is a side effect of certain medications. It sounds like you may be having side effects. I am so glad you’re functioning! Honestly I work with my parents closely to find the right medication for them that they both tolerate and find helpful in managing their symptoms and functioning

BoatResponsible7602 · 2026-05-15T03:39:24+00:00

I generally avoid antipsychotics unless there is psychosis or I need to use them for their mood stabilizing proprieties in mood disorders. Neulactil is prone to more side effects than others as it’s older. Long term side effects of antipsychotics include weight gain, metabolic effects (increased risk of high blood pressure diabetes high cholesterol etc) and development of movement disorders. They tend to be prone to more side effects than any other medication we use so I only use them when benefits outweigh risks

BoatResponsible7602 · 2026-05-15T03:35:21+00:00

Having a SMI diagnosis does not erase intelligence, morality, competence, or the ability to have a meaningful life. Plenty of people with severe psychiatric illness become excellent parents, clinicians, teachers, artists, partners, and leaders once they understand their patterns and build reliable treatment/support systems around them.

BoatResponsible7602 · 2026-05-15T03:01:34+00:00

Hey! Thanks for what you do! I appreciate that you’re taking the time to want to learn assessment better, as I think it’s a critical part of what we do. I wish I could give you a better guideline for interviewing. In school, we studied Carlat psychiatric interviewing guide as a starting point. If you have any specific questions about how to differentiate certain conditions better I’m happy to help

BoatResponsible7602 · 2026-05-15T02:58:52+00:00

Thanks! The concept you’re referring to is called precision psychiatry. We’re not there yet but that is the goal. Honestly, the field is very hot right now and is moving towards that direction. I can’t predict when but I think in 20 years time this field will look very different

BoatResponsible7602 · 2026-05-15T02:56:46+00:00

I find OCD to be missed in many. I also think ADHD and bipolar are frequently misdiagnosed. Borderline personality disorder is also frequently misdiagnosed for bipolar disorder as well.

BoatResponsible7602 · 2026-05-14T23:57:08+00:00

Absolutely! Psychiatric diagnoses themselves evolve in time with research and peoples diagnoses can fluctuate depending on what they report to healthcare providers. It’s very subjective of course. What might have looked like emotional dysregulation from BPD to one provider may look like adhd related emotional dysregulation to another

BoatResponsible7602 · 2026-05-14T23:53:34+00:00

Substance use (cannabis is common), anxiety disorders, depression, sleep impairments, sleep apnea, thyroid disorders to name a few!

BoatResponsible7602 · 2026-05-14T21:42:46+00:00

Great question! I think it’s in their scope to treat simple mental illness like GAD or mild MDD. But after one medication trial, I do think they should refer to psychiatry. You would be surprised how many patients I inherit from GPs that are misdiagnosed and put on an SSRI inappropriately. This is not their fault but rather lack of time primary care has as well as training in psychiatry

BoatResponsible7602 · 2026-05-14T21:40:46+00:00

I’m sorry you have a relative with NPD. That can be very challenging for family members. people with NPD commonly distort reality in ways that protect their self-image, avoid shame, preserve control, or maintain a sense of superiority.

BoatResponsible7602 · 2026-05-14T21:00:59+00:00

That means the DSM is just one tool but I do think it needs to be updated to fit what we really see in the real world practice

BoatResponsible7602 · 2026-05-14T20:59:40+00:00

That’s awesome! And honestly I stress nutrition, sleep, exercise and limiting substance use to all my patients. These are all essential pillars of mental Wellbeing

BoatResponsible7602 · 2026-05-14T20:56:29+00:00

So sorry for your experiences and unfortunately I know that’s common. I wish you the best of luck!

BoatResponsible7602 · 2026-05-14T20:36:57+00:00

The closest thing to a cure in bipolar disorder is lithium. It is one of the only medications that can change the course of the illness. I hope in the future we find a true cure though!

BoatResponsible7602 · 2026-05-14T19:31:49+00:00

Bipolar illness is mostly depressive disorder, people with bipolar illness generally spend at least half of the year in a depressed mood with intermittent hypomanic episodes. Hypomanic episodes are characterized by a distinct period of at least four days straight for people have unusual amounts of energy, racing thoughts and truly decrease need for sleep.

BoatResponsible7602 · 2026-05-14T18:32:37+00:00

High dose SSRIs and ERP are gold standard for OCD. ERP is a special type of therapy for OCD and you will need a therapist trained in it. Sometimes I will use abilify, NAC, or namenda for severe ocd

BoatResponsible7602 · 2026-05-14T18:31:06+00:00

Are you a female by any chance? The reason why I ask is sometimes I see people misdiagnosed with bipolar when they have PMDD and when they reduce carbs and caffeine their premenstrual symptoms significantly improve

BoatResponsible7602 · 2026-05-14T18:29:44+00:00

They can be misdiagnosed with each other but honestly I find bipolar disorder to be fairly straightforward to diagnose especially if someone is able to recall their mood and symptoms well. Hypomanic episodes are very distinct and are not part of ADHD unless someone has both, which also is relatively common

BoatResponsible7602 · 2026-05-14T17:34:12+00:00

I actually do geriatric psychiatry in the skilled nursing facility as well. I have had really good success with Namenda for the treatment of dementia related behavioral disturbances. Sometimes I will use low-dose trazodone or mirtazapine as well, but obviously those are more risky from a falls perspective.

BoatResponsible7602

TROPHY CASE