PTSD and major depression commonly travel together. But here is the clinical point people miss: When someone has both, you have to ask, “Which one is driving the case?” #trauma #PTSD #mentalhealth #psychiatry #PTSDrecovery #medical #doctor

PTSD may be one of the most misunderstood diagnoses in mental health Because PTSD does not start with symptoms It starts with exposure #PTSD #PTSDtreatment #Mentalhealth #PTSDhelp #mentalhealthmatters #mentalhealthishealth

There is a type of patient you have to be very careful with Not because they are bad Because they can make you feel like the hero #psychiatry #psychiatrist #mentalhealth #therapy #patientcare #doctor #doctorlife #medicalstudents #medcialschool

Fear of snakes, fear of public speaking, and fear of being trapped without help are not the same diagnosis #psychiatry #psychiatrist #mentalhealth #doctor #anxiety #phobia

Psychiatry history is wild Before we had panic disorder, people used terms like vapors, neurasthenia, and anxiety neurosis Then in 1980, DSM-III changed the game #psychiatry #mentalhealth #anxiety #panicdisorder #phobia #DSM

#Psychiatry Unfiltered takeaway: Panic disorder is not “being dramatic” It is a real syndrome where the alarm system keeps misfiring But before we call it psychiatric, we still have to respect the body Rule out the dangerous stuff Then treat the pattern #anxiety #panicdisorder #panicattack

Panic disorder is not “being dramatic.” It is a real syndrome where the alarm system keeps misfiring. But before we call it psychiatric, we still have to respect the body. Rule out the dangerous stuff. Then treat the pattern. #psychiatry #MedX #panic #anxiety #panicdisorder #EM

A panic attack is an event, not a full diagnosis. The diagnosis depends on the pattern, the trigger, the aftermath, and the context #PanicAttack #PanicDisorder #Anxiety #MentalHealth #Psychiatry #Psychiatrist #MentalHealthEducation #AnxietyDisorders

Psychiatry’s gold standard has a problem diagnostic interviews may be less reliable That does NOT mean psychiatric illness is fake It means diagnosis is hard A checklist can organize the interview It cannot replace clinical judgment #psychiatry #mentalhealth #doctor #depression #bipolar

I was reading about agoraphobia today as one does and realized something uncomfortable: I don’t love big crowds, but somehow I keep ending up at concerts. Which is either exposure therapy… or poor planning #PanicDisorder #Anxiety #MentalHealth #Psychiatry #CBT #PanicAttacks #MentalHealthAwareness

The Hardest Skill in Psychiatry: Knowing When NOT to Prescribe youtu.be/rdtrmaLaN8s?... via @YouTube Medication can be life-saving when the diagnosis is right #Psychiatry #MentalHealth #Psychopharmacology #mentalhealthmatters #psychiatrist #depression #anxiety

Work can be antidepressant But it can also become avoidance Meaningful absorption helps depression But if your entire treatment plan is “stay busy enough not to collapse,” you are not recovering You are running And eventually, everyone gets tired #psychiatry #psychiatrist #doctor #depression

Why Psychiatry Needs a Smarter DSM #shorts youtu.be/xudp7L46yzA?... via @YouTube #psychiatry #mentalhealth #DSM #depression #anxiety

Street Smarts in Psychopharm: What Every Clinician Needs to Know www.thecarlatreport.com/articles/630... #psychiatry #mentalhealth #doctor #doctor #psychopharm

Men’s mental health needs more than slogans. Many men don’t present saying “I’m depressed.” They show up angry, drinking, reckless, overworking, isolated, physically tense This Thursday at 12 PM I’m speaking to the NJPA on why psychiatry needs better models for men #psychiatry #mentalhealth #PMHNP

One of the most dangerous traps in psychiatry is believing that once someone with bipolar disorder, schizophrenia, or another serious mental illness feels better, the illness is gone #mentalhealth #psychiatry #depression #bipolar #schizophrenia

The exam room has changed Patients are not just arriving with symptoms Some arrive with TikTok and Reddit scripts My new Carlat article is out: Street Smarts in Psychopharm www.thecarlatreport.com/articles/630... #Psychiatry #ADHD #MentalHealth #MedEd #benzos @chrisaikenmd.bsky.social

Not all depression is the same A small JAMA Psychiatry proof-of-concept trial suggests IL-6 blockade may help a subset of difficult-to-treat depression Not ready for routine clinical use Think phenotype, not just diagnosis Psychiatry needs sharper science #psychiatry #depression #inflammation

#Psychiatry is on trial The conversation raises fair concerns But scrutiny is not scapegoating Some patients are overmedicated Many are undertreated The answer is not anti-psychiatry It is better psychiatry. #mentalhealth #antidepressants #publichealth #healthcare #policy

Auvelity was FDA-approved for agitation associated with dementia due to Alzheimer’s disease, the first non-antipsychotic approved for this indication Big unmet need Real-world utility? TBD #Psychiatry #Dementia #Auvelity #mentalhealth #medical #doctor

#Deprescribing is not the answer to America’s mental health crisis It is part of good psychiatric care But it will not create psych beds, shorten waitlists, replace #therapy, fix workforce shortages, or treat serious #mentalillness by itself #psychiatry #mentalhealth youtube.com/shorts/Zqvuc...

There is a dangerous difference between criticizing bad psychiatric practice and stigmatizing psychiatric illness. shrinksinsneakers.com/2026/05/05/p... #psychiatry #psychiatrist #doctor #medicine #medical #RFK #antidepressants #depression #anxiety #medication

Psych meds are not the enemy Bad medicine is Serious mental illness is real Deprescribing matters, but it will not solve the mental health crisis The goal is not fewer meds The goal is better medicine #Psychiatry #MentalHealth #psychiatrist #medicine #mentalilless #medication #doctor

Not all distress is disease That sentence should not be controversial My latest in @PsychTimes on DSM-6, diagnostic validity, biomarkers, hierarchy, and psychiatry’s credibility: www.psychiatrictimes.com/view/psychia... #psychiatry #psychiatrist #doctor #DSM #mentalhealth #medicalschool

The future of psychiatry depends on holding two truths at once: Mental illness is real. And not everything painful is mental illness. shrinksinsneakers.com/2026/04/29/m... #mentalhealth #depression #trauma #mentalillness #blog #psychiatrist #psychiatry

Culture is moving faster than science estimated ~8 million Americans used psilocybin in the past year. Those more likely to use it? People with depression and alcohol use disorder. It’s already in your clinic shrinksinsneakers.com/2026/04/28/w... #psychiatry #mentalhealth #psychedelics #depression

Psychotic depression is not just “severe depression.” It’s a different syndrome with different treatment. Miss it, and you may keep escalating the wrong meds while the patient gets worse ECT remains the gold standard #psychiatry #depression #ECT #psychosis #mentalhealth

Shrinks In Sneakers #Psychedelics may open the door. They do not walk you through it My new piece is about the part of the conversation too many people skip: insight is not integration, and transcendence is not recovery shrinksinsneakers.com/2026/04/26/p... #mentalhealth #psychiatry #therapy

I haven't updated the blog in almost a year, I think it's about time, all this psychedelic talk is getting me excited shrinksinsneakers.com/category/psy... #psychiatry #psychiatrist #doctor #medical #mentalhealth #medicaleducation #psychedelics #psychedelicmedicine #MDMA #psilocybin

Not every depressed patient should automatically get an antidepressant. That’s not anti-medication. It’s pro-diagnosis. Bipolarity, mixed features, trauma, grief, substance use, and psychosis all change the treatment plan. #psychiatry #depression #SSRIs #Mentalhealth #anxiety #antidepressants

www.psychiatrictimes.com/view/psyched... Freedom to experiment with your own consciousness is one argument Claiming a substance treats #depression, cures #PTSD, or prevents #opioid relapse is a completely different one. That is no longer about liberty. That is medicine. #psychiatry #medicine

www.psychiatrictimes.com/view/psyched... Psychedelics may hold real promise in psychiatry. In my new Psychiatric Times piece, I argue for rigorous trials, honest safety discussions not #political hype #psychiatry #FDA #psychedelics #mentalhealth #PTSD #psilocybin #RFK #JoeRogan

Cannabinoids are widely discussed for anxiety and depression The evidence is much weaker no significant benefit for anxiety disorders no RCTs at all for depression Patients are using them Culture has embraced them #Psychiatry #MentalHealth #Cannabis #Depression #Anxiety

High-potency cannabis is not a niche issue anymore. It is a psychiatric one. #Psychiatry #Cannabis #MentalHealth #Psychosis #mentalhealth #addictionmedicine

When I think beyond SSRIs in depression: severe illness psychosis suicidality repeated adequate failed trials need for faster or different intervention ECT, TMS, ketamine, esketamine all have a role. Educational only, not medical advice #psychiatry #depression #mentalhealth #TMS #ECT #doctor

Cannabinoids are being treated like evidence-based options for anxiety and depression They’re not A new Lancet Psychiatry found: no significant benefit for anxiety disorders no RCTs at all for depression Culture moved faster than the science #Psychiatry #MentalHealth #Cannabis #Depression #Anxiety

Not every antidepressant failure is a true med failure. Sometimes it’s: side effects early discontinuation wrong diagnosis wrong subtype substance use trauma psychosocial chaos Slow down before you call it nonresponse. #psychiatry #depression #mentalhealth #medical #doctor #antidepressants

Difficult depression? I’m asking thyroid disease? B12/folate issues? anemia? sleep apnea? substance use? medication-induced symptoms? inflammatory or vascular clues? Not every hard depression needs “another SSRI.” #psychiatry #depression #MedX #medical #doctor #mentalhealth

High-potency cannabis is not a niche issue anymore. It is a psychiatric one I argue that modern cannabis has evolved far beyond the low-potency marijuana many clinicians still picture #psychiatry #psychiatrist #addiction #cannabis #mentalhealth www.psychiatrictimes.com/view/high-po...

Psychotic depression is not always obvious. Watch for: * guardedness * severe indecision * rigid thinking * suspiciousness * delusional guilt * odd sensory experiences patients are ashamed to mention Miss it, and you treat the wrong illness. #psychiatry #depression #ECT #psychosis #mentalhealth

Mixed features red flags in a “depressed” patient: agitation inner tension irritability racing thoughts emotional lability reduced need for sleep antidepressant activation Miss this, and you may keep treating the wrong illness. #psychiatry #depression #mentalhealth #mooddisorders #bipolar

Before I call someone “just depressed,” I screen for bipolar disorder: elevated or irritable mood decreased need for sleep racing thoughts impulsivity episodic course family history Missed bipolar disorder is a huge reason depression treatment fails. #psychiatry #bipolar #depression #psychiatrist

Before you call it treatment-resistant depression, check 5 things: Right diagnosis? Therapeutic dose? Long enough trial? Real adherence? Right treatment for the subtype? A lot of “TRD” is just missed diagnosis or under-treatment. #psychiatry #depression #medical #MentalHealth #doctor

Did ADHD suddenly explode, or did we broaden the diagnosis while making modern life harder to tolerate? A recent JAMA study found ADHD diagnoses accelerated after DSM-5 and again after COVID jamanetwork.com/journals/jam... #ADHD #Psychiatry #MentalHealth #PsychiatryUnfiltered

The biggest lie we tell about bipolar II is that it’s the “mild” version No full mania does not mean low severity. It often means the illness hides inside chronic depression, misdiagnosis, functional decline, and suicide risk Bipolar II is not bipolar lite #psychiatry #bipolar #mentalhealth

Not every psychiatric problem needs another prescription. My new Psychiatric Times article argues that sometimes the most honest move is to put the prescription pad down and build a better plan www.psychiatrictimes.com/view/when-pi... #psychiatry #mentalhealth #medication #MedX #Medtwitter

Inflammatory depression is a useful clinical concept. Fatigue. Brain fog Low motivation Anhedonia Heavy, slowed-down presentation Treat the phenotype, not just the code #psychiatry #depression #inflammation #psychopharm #depressiontreatment #mentalhealth #depressiontypes

This mirtazapine paper on methamphetamine use disorder is worth your attention. For many of us, this isn’t new clinically, it’s validation of what we’ve already been doing. My go-to options: bupropion/naltrexone and mirtazapine. #psychiatry #addiction #addictiontreatment #mentalhealth

Vascular depression is one of the most underrecognized forms of depression. Older patient. Gradual onset. Cognitive slowing. HTN/DM. White matter changes on MRI. That’s not just “regular depression in an older person.” #psychiatry #depression #geriatrics #TMS #ECT #mentalhealth

The wrong diagnosis is not harmless. It becomes the wrong treatment My new @apapsychiatric.bsky.social article is about the real danger of mislabeling We do not owe patients a comfortable label. We owe them the right one www.psychiatrictimes.com/view/when-th... #psychiatry #mentalhealth #ADHD