What is Functional Medicine?

Functional Medicine is a specialized approach to medicine that incorporates a person’s antecedents, triggers, and mediators and considers this history within a matrix of body systems and their functions to tailor treatment toward root causes. It frequently incorporates lifestyle and dietary approaches to care, as well as the use of objective testing such as blood/saliva/urine laboratory analyses. Some FM practitioners are “generalists” (i.e. Family Medicine, Internal Medicine) and others are specialists (i.e. Cardiologists, Neurologists, Psychiatrists), but all practitioners consider all systems in their approach to treatment, even if they are targeting what appears to be a kidney, brain, or knee problem.

What kinds of problems do you work with?

We offer treatment for most mental health conditions, whether they are new or longstanding. However, the personalized, integrative approach that Optimize Psychiatry takes to mental health is especially well-suited to individuals who know they are not functioning as well as they could be and who are willing to at least consider making changes in their lives to aim for improvements. Some patients seeking care are at the next stage and they are functioning fine in their lives as they are, but would like to optimize their function across one or multiple domains of life. We work with anyone who wants more from life. (However, if you have recently self-harmed or are seriously contemplating doing so, this would not be appropriate treatment for you at this time. Please see FAQ #3 for more details.)

Who is appropriate for treatment through telepsychiatry and Optimize Psychiatry?

Telemedicine has made the process of receiving medical care extremely easy and efficient and has allowed people to access specialty providers that would be otherwise inaccessible in a purely physical world. However, given that all treatment is conducted virtually, it is not appropriate for us to treat acute conditions where the patient is a danger to themself to to others. Hence, recent suicidal or homicidal attempts or current intent or planning, new psychosis with development of significant hallucinations or paranoia which render a person unable to interact meaningfully with another person at this time, or anyone who may require a local in-person psychiatrists are not a good fit for Optimize Psychiatry’s treatment approach.

Will I need lots of laboratory testing or imaging exams?

Functional Medicine is known for an approach that often involves more in-depth and expansive use of laboratory testing than conventional medicine. That being said, not all FM practitioners prefer to order many tests, nor is it always necessary to have many (or at times, any) lab tests. Optimize Psychiatry takes a tailored approach to laboratory testing—-we (you and I) will discuss what might be useful to have concrete data on and hence, what labs could be helpful and for what reasons. You will ultimately make a choice on how you would like to proceed and will be given all the information to make that decision. Some testing is very inexpensive (i.e. lipids, electrolytes, glucose) and some are fairly expensive (i.e. esoteric comprehensive tests for certain mold and pathogens or specialized brain imaging). **We do not recommend a shotgun approach to testing and prefer to take a more nuanced and cognitive approach using your history and clinical clues to direct our labs, rather than using labs as our primary indicators of underlying causes of your concerns.

Do you prescribe conventional medications (i.e. antidepressants, antipsychotics, mood stabilizers)?

When they are indicated, absolutely. We believe in taking a personalized approach to every stage of treatment and prescriptions are no different. If medications seem appropriate for your circumstances and are compatible with your goals and personal values, we will prescribe conventional medications. We also may as a team decide that therapy is better suited to you, or that a combination of pharmaceuticals, lifestyle changes, herbs or other supplements are a better match for your unique situation. The goal is to use scientific evidence to guide treatments that are specific to your personal genetics, history, life circumstances, values, and goals.

How will I get any medications that are prescribed?

Any prescriptions (medications, certain supplements) will be sent electronically to a pharmacy of your choosing.

Where can I go to get lab testing?

An electronic order will be sent directly to a testing site near you for basic tests. For more in-depth testing panels, we will order a test kit to be mailed to you which can involve a blood draw at a local site, or at-home testing with certain kits.

Do you accept insurance?

We are able to work with contracted insurers indirectly via Headway.co (Aetna, Cigna, UHS, Oscar; please visit Headway.co for more information or to see if this is an option for you). Otherwise, at this time, Optimize Psychiatry does not accept insurance. Payments are made directly online with credit, debit, or PayPal. We do not communicate with insurance companies, but you are welcome to submit any claims to your health insurance provider to seek reimbursement for labs, prescriptions, or appointments if you so choose.

How many visits will I need?

That depends on where you are now, where you want to land, and what tools we have collectively to get you there. In some cases, the problems you are facing are relatively simple—they cause you issues in one or two domains of your life and you have pretty good insight and motivation. Such cases should only require a handful of visits and then we can touch base as often as you would like thereafter to check in (or never again, if you so choose!). Understandably, more complex, long-standing issues with more areas of compromised function will take longer to work through.

Do you have any in-person availability?

At this time Optimize Psychiatry is only operating virtually.

Do you offer therapy?

Yes! Optimize Psychiatry’s philosophy is to incorporate therapy into every stage of treatment. The beautiful thing about therapy is that it offers an opportunity to discover aspects of a person’s history that may be affecting their present circumstances and to actually try to work through that history in real time, in addition to providing lasting change that is a person’s own to keep for their lifetime. Lasting change is what we are really working for and understanding what makes you You helps to clarify where you’ve been, where you are now, and the most effective approaches to getting you where you want to go. Our foundational therapeutic style is psychodynamic, meaning that we consider your early development, first relationships, attachment styles, unconscious drives, motivations, and fears, underlying defensive styles, and current function across multiple domains (i.e. self, work, play, relationships, cognition) and use this information to guide treatment and to develop your own insights. That being said, we do not believe that one type of therapy is effective for every single person or problem and frequently make use of Acceptance and Commitment Therapy (ACT) or Cognitive Behavioral Therapy (CBT) and find certain principles and tools from Dialectical Behavioral Therapy (DBT), Mentalization-Based Therapy (MBT), Internal Family Systems (IFS) and Attachment Theory to be useful in many cases.

What is the difference between O.P. and conventional psychiatry?

Conventional psychiatry in its modern incarnation has morphed into a domain where psychiatrists function primarily as “prescribers”, namely of pharmaceutical medications such as SSRIs (i.e. Lexapro, Prozac, Zoloft and their generic equivalents), antipsychotics (i.e. Haldol, Abilify, Zyprexa), mood stabilizers (i.e. Lamictal, Depakote, Lithium). Conventional psychiatry visits tend to be 10-20 minutes long and therapy is minimized. Typically, depression is treated as one broad illness, rather than an outcome of any number or combination of specific causes and hence, antidepressants are the primary treatment of choice. Our approach differs in that we believe that psychological distress and psychiatric problems result from specific causes and therefore, we prefer to take the time that is necessary to understand what those specific causes may be in each unique patient and as the Hippocratic Oath requires, to “First do no harm”—whenever possible, we work with you to find treatments that yield the highest benefit with the least amount of harm. That almost always means lifestyle approaches, frequently involves testing to rule out medical drivers of illness, as well as supplement (nutriceuticals, herbs, botanicals) and food-as-medicine prescriptions and occasional incorporates the use of pharmaceutical medications. We take the Hippocratic Oath seriously and it informs our practice. Unlike the standard or conventional practice of psychiatry, we do not believe in prescribing medications or methods that we personally would not be willing to take up.

What are the benefits and drawbacks of Optimize Psychiatry’s approach?

The benefits and drawbacks of Optimize Psychiatry are two sides of the same coin:

Personalized approach: We take a personalized approach to medicine, which means that we do not have a one-size-fits-all treatment strategy, which means that diagnosis and treatment requires a more in-depth analysis and therefore more time and more input on your part to provide the needed input to inform treatment.

Expense: We don’t take insurance, which means that treatment expenses are out-of-pocket for patients and unfortunately, the costs can be a significant barrier for some people.

Motivation: Our treatment depends on what you bring to the table. Motivated patients who are ready and willing to make changes are much better suited to Optimize Psychiatry’s practice style since it is so dependent on what you do at home. We don’t usually just give you a medication for your troubles and send you on your way. Treatment with Optimize Psychiatry is hard work—it involves building insight, exploring past and present drivers of circumstances, and often, making big changes to habits in one’s life. It is not a passive treatment process and it’s not suited for every person or every problem.

Patient characteristics: People who would benefit most from Optimize Psychiatry’s approach are struggling with new or longstanding issues and have dreams of living better. Optimize Psychiatry patients generally come to treatment with some insight into their problems, good reality testing, motivation to make changes, and are seeking a personalized approach to mental health care. People who are undergoing acute psychosis or have recently attempted suicide, frequently self-harm, have very poor insight, or who are not motivated to make changes are not a good fit for this treatment approach.

What are the costs associated with treatment through Optimize Psychiatry?

An initial intake is approximately 75 minutes and credit/debit payment of $450. Follow-up visits are 60 minutes for therapy and/or establishment of an effective treatment plan ($370) or 30 minutes for brief follow-ups to review laboratory testing or to check in with a plan that has been established and is going fairly smoothly ($210). (Length of appointments are dependent on patient preferences, circumstances, and proposed treatment plan.) The cost of psychotherapy and functional medicine can be a barrier for many people and understandly, when possible, most people seek a physician who is able to take their insurance. Unfortunately, there's a significant incompatability with this form of treatment and most insurance providers, who with their reimbursement strategies, practically ensure that most psychiatrists stick with 15 minute medication management visits. The details of this insurance reimbursement issue are too complex (both logistically and ethically) to attempt to explain in this format, however, we have carefully considered the options available to us and a cash-based practice is what allows us to offer the comprehensive and personalized type of practice that resonates with our values.