What would an Integrative Psychiatric Treatment Plan look like for me?

A holistic and integrative treatment plan may look like the example below if you came into the office with symptoms of depression (low mood, poor sleep, lack of energy, little enjoyment of things you used to enjoy, periods of crying, decreased appetite).

On our first visit, we would discuss, in depth, the following (all of which is a standard diagnostic psychiatric interview):

• Current concerns, stressors, what has been happening in your life recently, your support system, your coping strategies, your activity level and patterns, diet and appetite, sleep pattern and hygiene, sex drive and function, recent changes to memory, attention, and focus, level of irritability, mood variability, and anxiety level.

• Developmental history, from birth, through childhood and into adulthood up until the recent past, including academic performance and difficulties, social history in younger years, formative experiences, including trauma, and family history of psychiatric or significant medical conditions.

• Treatment history for mental health, including hospitalizations, outpatient medication management, previous medications trialed and/or utilized, and work with therapists.

• Screening for other mental health conditions (bipolar, schizophrenia, anxiety disorders, personality disorders, other mood disorders, trauma associated disorders, and neurodevelopmental disorders (though this may require an additional appointment for further testing).

• Review of your medical history, including other chronic conditions, any known familial genetic conditions, recent changes to your physical health, what other medications you are taking, including supplements and over the counter medications, surgical history, and for those with uteri and ovaries, history of menstruation, pregnancy, birth, and associated complications.

Following a thorough history, labs will be ordered, and, if warranted or requested, genetic psychotropic medication testing may be performed (as these tests will also screen for certain genetic variants that can increase risks of depression or anxiety).

If necessary, a medication may be prescribed on the first visit, particularly if symptoms are interfering with daily functioning.

Once labs are received and reviewed, I may learn if there are any physical causes to low mood, low energy, lack of enjoyment in life (thyroid dysfunction, low vitamin levels, other nutritional deficiencies, inflammation or the presence of blood markers that indicates possible auto-immune or hormone involvement). If needed, you will be referred to specialists to follow up and manage these conditions, as many conditions can worsen depression, anxiety, and associated symptoms.

Depending on findings of our initial appointment and the labs, a sample treatment regimen may be as follows:

• Utilization of vitamin D3 2000 units, vitamin B12 1,000 mcg, zinc 50 mg, and St. John’s Wort 300 mg three times daily.

• Development of a structured sleep routine, with limits imposed on screen time in the evening and avoidance of news and social media outside of 1 hour per day.

• Beginning each morning with a positive affirmation.

• 10 minutes of mindfulness or meditation practice per day.

• 30 minutes of moderate intensity exercise, 3 times per week.

• Social engagement, outside of work and family, for 45 minutes once per week (visiting friends, volunteering, joining a hobby).

• A diet low in high-histamine foods.

• Referral for weekly therapy sessions.