FAQs

Why see a psychiatrist?

A psychiatrist is a medical doctor (MD) or doctor of osteopathy (DO) who, after 4 years of medical school, has completed a residency of at least 4 more years focusing on the causes and the evaluation and treatment of a number of emotional, behavioral or cognitive disorders. A Child and Adolescent Psychiatrist has an additional two years of fellowship training focused on evaluating and treating children and adolescents. 

Some common conditions treated by psychiatrists include mood disorders (depression, dysthymia, bipolar disorder), anxiety disorders (panic disorder, generalized anxiety, obsessive compulsive disorder, post traumatic stress disorder), thought disorders (schizophrenia, schizoaffective disorder), impulse control disorders (attention deficit disorder, substance abuse disorders), eating disorders (anorexia, bulimia), developmental disorders (Autistic spectrum disorders) and many more. In addition, psychiatrists are experts in understanding and treating developmental and adjustment disorders as well as grief reactions. 

A psychiatrist should be consulted if an individual is struggling with problems associated with their mood, thoughts or behavior, particularly if these problems are profoundly affecting their ability to function to their potential or to develop and maintain happy and healthy relationships.

Children and adolescents should be evaluated if they are struggling with conditions or symptoms that are adversely impacting their emotional, social or academic development.

Do you just prescribe medication?

As a trained psychopharmacologist, treatment with medication (psychopharmacology) is a significant part of my practice, and I enjoy the challenges of thoughtful medication management. What I believe is as or more important, however, is developing a comprehensive understanding of what factors may be contributing to an individual’s distress. From that understanding, an effective treatment plan can be developed and implemented. The use of medication may be part of that plan. In addition, I also am trained in treating through psychotherapy.

What happens at the evaluation?

The first appointment, the “evaluation”, gives us an opportunity to identify the presenting concerns, to discuss possible diagnoses, and to establish a treatment plan. I typically make recommendations at the end of that appointment which may include therapy (individual, family or couples therapy or parent guidance), medication management, further assessment (eg, neuropsychological assessment, medical workup, bloodwork), or some combination of these.

When I evaluate children or adolescents, I may review paperwork including rating scales prior to the appointment. The first part of the appointment is typically with the parent(s) or caregiver(s) and the child or adolescent all together. Then I try to spend some time alone with the parent(s) or caregiver(s) (mainly to hear their concerns alone and to get a detailed family history) and then, depending on their comfort level and interest, time alone with the child or adolescent. We all meet together at the end of the appointment to discuss my impressions and recommendations. 

In fact, the evaluation is oftentimes an ongoing process and it typically takes several appointments, or more, before we can have a thorough understanding of all of the factors that may be contributing to an individual’s difficulties or distress. 

How does medication work and is it safe? 

Most psychotropic medications work by effecting levels of molecules called neurotransmitters that are in the brain. For instance, selective serotonin re-uptake inhibitors (SSRIs) such as those with the brand names of Prozac, Zoloft, Lexapro, Paxil, Celexa and Luvox, increase levels of the neurotransmitter serotonin. Low levels of serotonin are known to cause depression or anxiety or both. These medications are used to normalize the serotonin levels and are often very effective in treating many different anxiety and depressive disorders.

Other medications may effect levels of the neurotransmitters norepinephrine, dopamine or GABA and are used to treat many other psychiatric symptoms.  

While any medication has the potential for side effects, when prescribed in the context of a thoughtful evaluation and when taken as prescribed, they are generally very safe and are usually well tolerated. When side effects do occur, it is important to discuss them with your doctor as it may be a simple matter to reduce or eliminate the side effects by adjusting the dose or changing the time the medication is taken.

What do I do if there is an emergency?

If you are a patient of mine and have what you feel is an emergency, you can generally reach me during office hours by calling my office number (603-610-0235) and leaving a message, or, if it is after office hours by calling my office number and by following the directions to page me. (Please leave a message on my office voicemail with your phone number if you are going to page me to help avoid any missed pages.) I will get back to you as quickly as I can. If you feel it cannot wait, then you should go to the nearest emergency room and have me paged from there.

I am not affiliated with any hospitals and do not have admitting privileges but will do what I can to facilitate any hospital admissions and treatment.

Why does the pharmacy say my prescription needs a prior authorization?

Some insurance plans have something known as a “restricted formulary”. You can fill any prescription I write, it just may be that your insurer won’t pay for it without a “prior authorization”. 

Because there are so many different types of insurance plans, and because they are constantly changing, it is impossible for any physician to know which insurers cover which medications. So it may be that the prescription I wrote for you is not covered by your insurer. Typically they do this because they want me to consider an alternative that will cost less for your insurer to pay for.

When I write a prescription, I am trying to provide you with the medication that is going to be the best for your particular situation. That means the medication that is going to work the quickest, the most effectively, and with the fewest side effects. I am always cognizant of health care costs and will keep this in mind when I write your prescription.

A “prior authorization” is simply an additional step your insurer is asking me to take before they will agree to pay for the medication that I prescribed. Typically it takes some amount of time for me or my staff to get the process started, and it includes my efforts to convince your insurer why they should pay for the medication. Oftentimes, my efforts are not successful and your insurer will only pay for a  less expensive alternative. If that is the case, it will be up to you to decide if you want to go with the medication I recommend (and pay for it yourself) or to go with a medication that your insurer will pay for.

When your insurer will not pay for a medication that is available in a generic form without a prior authorization, I may encourage you to explore costs of the medication I prescribed and to consider paying for the medicine yourself. One tool I recommend is GoodRx. By logging on to GoodRx.com, you can find the cost of any medication at all the pharmacies in your area. In addition, GoodRx offers discount coupons for all generic medications. The “out of pocket” cost using GoodRx coupons and paying yourself is often less than the copay cost charged by some insurance companies.

Will my insurance cover the cost of the appointments?

I am not in network with any insurance companies. Every insurance company has different benefits and policies and many do have "out of network" benefits. You should check with your insurer to find out if you might be reimbursed for my services. Once payment is made, I can provide you with a receipt with the procedure and diagnosis codes that can be submitted to your insurer.

How frequent are the follow up appointments and how long are they?

Follow up appointments are as often as necessary. Usually a follow up appointment of about 20 minutes is scheduled in the few weeks following the evaluation, and after that they typically are anywhere from every couple of weeks to every few months.