Many people suffer from depression
at some point in their lives.
We can help.
At NPA, our recommended treatment plan is individualized to the patient’s needs. Treatment options
may include psychotherapy, psychiatric medication(s), and/or family involvement to achieve an optimal
Some psychiatric problems may benefit from treatment with psychotherapy. Many patients achieve a
better outcome with a combination of medication management and psychotherapy than they would
with either treatment by itself. If psychotherapy is indicated the psychiatrist may either provide this
service or refer the patient to a psychotherapist. For those psychiatrists who do practice psychotherapy,
the decision as to whether to combine psychotherapy with medication management will be a collaborative and joint
decision between the patient and their psychiatrist.
For those patients who see an NPA psychiatrist for psychotherapy, psychiatrist and patient will assess if
the initial problems for which the patient sought help for are resolving. For some patients, there will be
underlying or persistent problems that require longer term or more intensive psychotherapy. The main
types of psychotherapy practices at NPA include problem-focused short term psychotherapy, cognitive-
behavioral psychotherapy (CBT), and psychodynamic psychotherapy.
Problem-focused short term psychotherapy involves looking at specific problems the patient is
confronting at the time and, with the psychiatrist’s help, exploring possible ways to resolve the
problems. Cognitive behavioral psychotherapy looks at the patient’s underlying beliefs about
themselves and their surroundings that are generating their thoughts, feelings, and behaviors, as well as
the responses these behaviors elicit, that usually reinforce the underlying beliefs. Alternative beliefs,
thoughts, and behaviors are explored and practiced to elicit different responses that will be more in line
with what the patient wants or needs. Psychodynamic psychotherapy focuses on patterns of relating
both with oneself and with others. Psychodynamic psychotherapy looks at how these patterns started
in the past, how they maybe repeating in some way in the present, and how they manifest themselves in
the context of the psychotherapeutic relationship. The overall goal is to change unhealthy or
destructive patterns to ones that are more satisfying and effective. This change often begins within the
psychotherapeutic relationship and gradually is applied to other relationships.
In psychotherapy for the child or adolescent, similar approaches as described above are utilized,
depending on the patient’s clinical presentation, as well as their cognitive and developmental level.
There are several types of psychotherapy that involve different approaches, techniques, and
interventions, all designed to help children and families resolve problems, modify behavior, and make
positive changes in their lives. At times, a combination of different psychotherapy approaches may be
helpful along with medication interventions. The child psychiatrist will work with you and your
child/adolescent to define the best therapeutic approach for treatment.
Psychiatric Medication Management
Exciting advances in the understanding of the brain and mental illness have led to the development of
many safe and effective psychoactive medication interventions. We now know that chronic, recurring
problems with anxiety, ADHD, depression, psychosis, and other debilitating mental symptoms are the
result of brain dysfunction. Many factors may contribute, including family genetics, stress, medical
illnesses, and drug or alcohol abuse. These are common illnesses, not signs of weakness, character
flaws, or moral failing. These common illnesses require complex treatments, and medication
management has become a safe and effective part of treatment for most patients with these conditions.
Treatment with medication begins with a thorough psychiatric evaluation which may require one or
more sessions. As part of the evaluation process, your psychiatrist may recommend medical evaluation
or laboratory testing if clinically indicated. The psychiatrist may wish to review records of previous
treatment or interview family members. At the conclusion of the evaluation process, your psychiatrist
will offer a diagnosis and discuss treatment options with you, including medication options appropriate
for your condition. With your input and informed consent, medication decisions can be made and
treatment started. You and your psychiatrist will then meet on a regular basis to monitor your
symptoms and any potential side effects making dosage adjustments and obtaining laboratory tests
when necessary. Medication trials and response may take several weeks, though in many instances you
may experience benefit within a much shorter period of time. If effective, medication will be continued;
if not, you and your psychiatrist will discuss other medication choices. Because treatment is often
complex, many patients require a combination of medications for adequate symptom control, and
arriving at this effective combination is a process you go through with your physician over the treatment
Our ultimate treatment goal is ‘remission’ (complete control of symptoms and normal functioning) and
prevention of relapse in the future. The latter may necessitate remaining on your medication regimen
long term. During this ‘maintenance phase’ of treatment, meetings with your psychiatrist may be
infrequent (every 3-6 months) if you are doing well. In some patients, symptoms may return, despite
treatment, requiring medication adjustments and more frequent appointments. A combined treatment
approach, including medication management, usually provides the most effective outcome. Modern
medications are generally safe and effective, and may be essential to your recovery. Working with a
psychiatrist experienced in the use of these medications will maximize your potential benefit, with
minimum risk and side effects.
Common Psychiatric Disorders
Depression and Mood Disorders
Depression is a serious medical illness that is arguably one of the most debilitating illnesses in today’s
world. It is most commonly characterized by deep feelings of sadness or loss of interest and pleasure in
the activities of daily life. One may experience disruptions in sleep and appetite, loss of energy, feelings
of guilt and hopelessness, loss of concentration and even thoughts of death or suicide. Depression
affects the way one feels, thinks, and acts. There are other mood disturbances that are generally
referred to as cyclical mood disorders. Bipolar disorder, commonly known as manic depression, is one
such illness. It is characterized by shifts in a person’s mood, level or energy, and ability to function.
Bipolar disorder may include periods of depression, but also periods of intense elevation or irritability.
These symptoms may manifest as difficulty concentrating, experiencing racing thoughts, decreased need
for sleep, increased energy, and impulsive or reckless behavior. The causes of depression and other
mood disorders are varied and may involve chemistry of the brain, genetics, the particulars of
personality, and the stress of one’s environment. It is important to obtain experienced help.
Anxiety disorders are common and quite distressing emotional disorders. They affect millions of
Americans. Symptoms may include feelings of constant worry, panic, and fear. They can also include
very physical symptoms such as feeling sick to your stomach, muscle tension, difficulty sleeping, startling
easily, or heart pounding. Anxiety may result in social isolation and can escalate to the point of
difficulties in group settings or being unable to leave one’s home. There are multiple variants of anxiety
disorders including generalized anxiety, panic disorder, phobias, obsessive compulsive disorder, and
posttraumatic stress disorder. Individuals suffering from anxiety disorders are vulnerable to mood
disorders such as depression and substance abuse disorders, including alcohol dependence. Obtaining
experienced help is important.
(Information coming soon)
Disruptive Behavior Disorders
(Information coming soon)
Substance Use, Abuse, and Dependency
Chemical dependency is a condition characterized by compulsive drug seeking and use despite harmful
consequences. Through decades of research, it is now accepted and understood that chemical
dependency is a brain disease. This revolutionary new understanding dispels the myth that individuals
with chemical dependency issues lack willpower or are morally flawed. Instead, these individuals should
and can seek treatment for their medical condition.
Many people first use drugs and alcohol for their perceived positive effects. These chemicals produce
and intense pleasure response in the brain by flooding it with dopamine (a neurotransmitter) up to 10
times more than natural rewards (such as food and sex). This experience makes a person want to repeat
the behavior. With increased chemical use, the brain becomes desensitized to the effect, and the ability
to experience any pleasure becomes reduced. Eventually, the person loses the ability to enjoy the
substance as well as natural rewards. The person only continues the use of the chemical to return to
some sense of normalcy.
Of the millions of substances that we ingest, only a few are capable of producing the characteristic brain
changes that make it essentially impossible for some to stop their use. Neurobiologists believe the
‘need’ to continue using the drug comes from dysregulation in the brain that causes the person to feel
that the drug is ‘correcting’ the brain’s problem. Genetic factors account for 40-60% of a person’s
vulnerability to addiction. The disease is, however, quite complex and affected by multiple psychosocial
and environmental factors.
By the time individuals enter treatment for chemical use and dependency, their disease has disrupted so
many aspects of their lives that treatment should include a number of rehabilitative services. Your
psychiatrist will provide treatment approaches appropriate for an outpatient environment and will
recommend other resources as needed for comprehensive recovery.
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