Psychiatry is the practice of medicine as it relates to mental health. It includes diagnosing mental health conditions such as such as anxiety, depression, sleep problems, bi-polar disorder, stress and more, as well as creating comprehensive treatment plans which may include prescribing medications.
The way we approach psychiatry is integrative, meaning that we bring a lifestyle-based focus to your health and wellness, with medicine as a supporting, rather than as a primary agent of healing and change. Part of an integrative consult is exploring how your lifestyle can aid your healing and growth process for specific conditions. We integrate nutrition, mindfulness, exercise, relational and social interaction, physiological considerations such as sleep, stress, and eating patterns, supplements, coordinating with your therapist, and more, to help you with your concerns.
Integrative Psychiatry includes:
- Longer consults to really get to know you and understand your concerns
- An exploration of lifestyle modifications
- Supplement recommendations
- Medication when needed, at the lowest therapeutic dose, for as short a time as possible
- Support for occasional sleep, stress and anxiety issues
- Evaluation of current medications and plan going forward
- Cycling off of medications as soon as it is feasible
Why Integrative Psychiatry?
Many doctors talk to you for 15 minutes, hand you a prescription, and never follow up with you. We believe psychiatry must be practiced expertly and carefully. We take the time to get to know you, prescribing medication only if needed and at the lowest therapeutic dose. We form a plan with you to come off the medication. We follow up with you and stay in touch so we know that the approach we’re taking is addressing your issue. And we discuss natural, supportive components of treatment with you like lifestyle modifications, exercise, nutrition, supplements, meditation and more.
Psychiatry sometimes requires some tinkering over time to discover the right medication and the right dosage. Everyone’s chemistry is unique, and there isn’t exactly a one-size-fits-all approach to depression, anxiety, or other issues. You want to work with a practitioner that will follow up with you, monitor symptoms and progress, and be in that evaluation stage of treatment until you find the approach that works. Our practitioners take the time to find out exactly what helps you, monitoring results and making any needed changes throughout the process.
Do I Really Need Medication?
That’s what a professional consult will help establish. In some cases, lifestyle modifications and supplements may be enough to address an issue. Other times, medication plays an important role. There are many types of mental health medication. Some you take daily and they support your brain slowly over time to balance neurochemicals and other messengers. Some, you take as needed if it’s a tough day, to help you sleep, with stress, or to lower high anxiety.
Here are a few points about medication that are poorly understood:
- If the side-effects or symptoms of your mental health issues are worse than the side-effects of a medication, the medication may be a good choice to support your health
- Depression, stress and anxiety that linger too long are neurotoxic and degrade brain cells and your overall health
- The longer it takes to treat a mental health condition, the more difficult it may be to treat and the longer recovery may take. Medications sometimes speed up the process and at times provide critical interventions
- Medication is not an ‘escape’ from challenges or emotional pain. Generally, medication helps you be more present to process those challenges and allows psychotherapy to work more effectively with your mind
- Medication is often helpful to get you over a stubborn ‘hump’ in a mental health issue, and helps your brain learn how to function in a more healthy manner so you can then taper off the medication once your mind has adjusted back to a healthier normal
- We only recommend medication when it’s needed, and when it’s needed, it can be a life saver
- Some mental health medications have no side effects. Many have been on the market a long time and their side effects are well-understood
- They won’t make you a zombie
- You may be medicating already without realizing it, using pot, alcohol, excessive caffeine or other substances to relieve emotional pain, provide distraction, reduce anxiety and stress, and feel better. Most recreational drugs are globally acting on the body and organ systems, tiring you out while targeting areas you don’t need. The health impact of recreational drugs on your body is often worse than the impact of targeted medications tailored for a specific effect.
I like to Treat Things Naturally. Is that OK?
Sure. We prefer natural approaches as well. The question is, what is the health impact of the issue you’re dealing with? We are experts in the treatment of depression, anxiety, stress, sleep issues, and more, and have seen it all. Trust us–you’re not the only person wondering if a ayahuasca ceremony in the jungle might cure your depression. There are some natural approaches that work well, and these form part of your consult with a professional to determine if that’s the right path for your healing. In some cases, natural methods are enough. Daily exercise and some supplements have been proven to help with anxiety and depression. In other cases, a focus on lifestyle interventions alone can prolong problematic symptoms, allowing mental health issues to progress, making it harder to treat the issue properly later. In some instances, taking a non-medical approach can make an issue worse. We will help you determine the appropriate mix of natural approaches and if medication may be an important part of your healing.
Medication Management–How Long Has it Been?
Part of psychiatry is what we call med-management, checking in on medications you may be taking to evaluate if they are still needed, still effective, or can be slowly tapered out. If you haven’t had a psychiatric visit in over a year and take a mental health medication, or if you originally had a mental health medication prescribed by a primary care provider, we recommend making an appointment for re-evaluation to check what you are taking, at what dose, if it is fully effective, and if it is still the right approach. Primary care physicians are not mental health experts and may mis-diagnose an issue, prescribe a medication when a different one may be better, or not follow up to monitor the effects of the medication over time. Many medications also lose their efficacy over time and need to be rotated or replaced. We will help you check on if you should continue with a medication you are taking, the dose, and if a different medication might be more targeted to your current goals.
In Psychiatry, Expertise Matters
It’s your brain and mind! Don’t entrust them to a non-expert! So many people get prescriptions for depression from a doc-in-a-box who doesn’t specialize in mental health medication. Don’t make that mistake! Our psychiatric team is one of the best. We take the time to get to know you (none of this 15 min ‘pill mill’ stuff!), do longer and more detailed in-depth consults, and take the time to reflect on the best option for you. Then, we stay in touch with you, and are available for follow up contact as you experience the effects of treatment.
Psychiatry can be done well, or not well, and too often, the latter is true due to short consults, knee-jerk prescribing, and little to no follow up regarding your care. PRESENCE has always only worked with the best psychiatrists in Austin, making sure the medication side of care is done right, and now we have our own internal program to better coordinate with the counseling and therapy we provide. You can still come in to just see your prescriber–you don’t have to be in therapy with us to benefit from our expert approach to medication.
Our psychiatric providers are:
Victoria Nettles, MD
Victoria is an integrative psychiatrist who specializes in anxiety, depression, stress, sleep issues, and more. She takes a whole-body, holistic approach and offers both initial consults for evaluation and medication as well as medication management. Victoria’s rates are $350 for the initial intake session and $225 for follow-up appointments. Intakes are 75 minutes and follow ups are 30 minute appointments. She currently accepts Blue Cross Blue Shield PPO, Whole Foods, Inc., Seton and Humana as the only insurance plans. To schedule with Dr. Nettles, please call our main office at 512-469-0535 or email us at admin@presencewellness.co. More information on Dr. Nettles can be found by clicking here to visit her profile page.
Adrienne Feehan, PMHNP
Adrienne is an experienced psychiatric nurse practitioner who helps her clients with sleep issues, depression, stress, anxiety, mood disorders, trauma, substance use, and more. She has extensive experience in the use of supplements to support mental health concerns and in lifestyle modifications to try and address your concerns as naturally as possible. She offers mental health evaluations, can prescribe medication when needed, and will review current medications you may be taking. Adrienne works collaboratively with our head of department and her supervising physician, Dr. Robin May-Davis. Adrienne charges $250 for 75 minute initial appointments and $175 for 30 minute follow ups. She currently accepts Blue Cross Blue Shield PPO, Whole Foods, Inc., Seton and Humana as the only insurance plans. To schedule with Adrienne, please call our main office at 512-469-0535 or email us at admin@presencewellness.co. We can often accommodate same-week or following-week appointments.
When to Consider Psychiatry
Austin is a town that is into health, wellness, nature, and a natural lifestyle. It makes sense, therefore, that many in Austin have aversions to mental health medication. We understand. We aim for a healthy, natural lifestyle as well. In our integrative approach, medication is only recommended when needed and then administered carefully. Keep in mind that the side-effects of many mental and emotional health issues are worse than the side-effects of most medications used in mental health. It’s worse for your health, immune system, and lifespan to try and white-knuckle your way through lifelong anxiety, or through major depressive episodes. Relationships can suffer from untreated ADD, depression, anxiety, mood disorders, and other mental health issues, so there can be negative downstream effects in your partnership life or in parenting of not treating mental health issues properly. Job performance can also be affected by untreated anxiety, depression, and more.
The time to consider psychiatry is when you have a significant concern that is not improving and needs support beyond psychotherapy. A psychiatrist will assess the issue, and discuss with you whether medication could help. One benefit of pairing medication with counseling when it is necessary to do so, is that it helps your mind learn to live free of the issue you are experiencing. Once your mind adjusts to a new way of moving through life, it can often hold those gains even as the medication is phased out. We aim to reduce and taper off of medication whenever possible.
Certain psychological issues can be difficult to overcome without also treating them physiologically and biochemically. The mind and body work together and one can impact the other. Medicines work with the body to support the mind, and therapy works with the mind to support both mind and body. At PRESENCE, we assess your issues physiologically and psychologically, giving you the best chance to fully understand and improve them with the latest science. Supporting the body, which works hand in hand with the mind, is key to the fast and effective treatment of many mental health issues, especially when they become more serious and impact your ability to fully function at work or at home. For many, once your mind learns to live and function without the problem, the medication can be eased out and many of the gains made in counseling remain.
While you may have heard or read some negative things about mental health medication, most negative experiences result from poor or improper treatment–physicians who prescribe after a 15 minute visit, who prescribe and don’t follow up to monitor progress, or who don’t specialize in mental health issues. Engaging in a proper, managed process of taking medication for mental and emotional health and working with an expert alleviates many potential drawbacks and increases positive outcomes. Medication is an imperfect tool like anything else, but done correctly and in the right circumstances as needed, the combination of medication with counseling offers the best and fastest treatment for many mental health issues.
Our expert practitioners will take good care of you in managing any mental health issues that need medical support, getting to know you and your concerns, discussing lifestyle remedies, and prescribing medication as needed. Just reach out by email or call our office to schedule a consult today.
