The anatomy of the human body is well studied and fairly well understood, which makes treating physical ailments and diseases straightforward with the right imaging or lab results in hand. The human mind, however, is a different matter. Some call the study of the brain the final frontier of medicine. Therefore, proper treatment of mental health disorders with medications is complex, and experience and a varied skillset are required to help achieve the best outcomes.
Dr. Matthew Goldenberg has extensive experience helping patients with a wide range of mental health issues, and he understands that there is no one-size-fits-all solution. Each patient has a unique history, a specific set of symptoms, and unique expectations that shape their goals, diagnosis, and prognosis. When it comes to managing mental health disorders through psychopharmacology, Dr. Goldenberg takes a highly individualized and personalized approach. He may recommend medications but rarely relies on them as the sole treatment method.
To better explain how Dr. Goldenberg customizes his diagnosis and treatment approach and how he focuses on the whole patient, not just a medication solution, these are seven of the patient care philosophies that he follows:
1. Extensive Evaluation
Before starting you on any medications, Dr. Goldenberg performs an extensive evaluation of your psychiatric, medical, family, and social histories and discusses your behaviors, lifestyle, and goals. Understanding how a patient is struggling or suffering, and not performing at their best baseline, can help to determine what aspect(s) of a biological, psychological, and social approach will be most likely to be clinically effective.
Oftentimes, there are improvements that patients can make outside of medication, related to their behaviors, interactions with the world around them or in better caring for themselves that can go a long way toward improving mental health without medicine or increasing the likelihood that medications will be effective.
For example, certain behavioral attributes, such as how much you exercise, your sleep habits, your diet, and nutritional intake, and your drug and alcohol use can influence your mental health, your wellness, and the effectiveness of medications if they are to be employed. Dr. Goldenberg works with patients to understand the connection between their lifestyle and behaviors and their mental health and wellness.
In many cases, lifestyle adjustments and/or non-medication interventions like psychotherapy, coaching, or group participation may be the first-line treatment option before medications are needed to be initiated. Dr. Goldenberg is keenly aware that medications are not for every patient and can help you to determine if they are right for you or not.
At the very least, a psychiatric evaluation from Dr. Goldenberg can help you to better understand all of the options that you have available.
2. Just for Now, Not Forever
One of the most important aspects of how Dr. Goldenberg practices psychiatry is that he believes that for many patients, if not most patients, medications are a tool to help patients achieve their goal of improved mental health but they are rarely indicated for life. (There are exceptions for chronic diagnoses).
Medications often help achieve three things:
- Medications can help to reduce an unwanted or negative symptom (i.e. anxiety and/or depression).
- Medications can serve as a safety net, so that those symptoms are not retriggered or worsened.
- Medications can help to decrease negative symptoms so that patients can more easily perform healthy behaviors that will restore and maintain their mental health and wellness long-term (i.e. improved diet, exercise, sleep, and increased engagement in hobbies and interests).
Accordingly, the goal is often to stabilize your symptoms for 4-6 months, during which you can reconnect with interests, hobbies, passions, and life.
These behaviors, possible engagement in psychotherapy or other non-medication treatment modalities, and experiencing increased aspects of mental wellness are what keep you doing well, so that medications can slowly and safely be decreased and removed.
3. Less is Often More
Another important aspect of the care that Dr. Goldenberg provides is to minimize the number of medications. In most cases, he aims to maximize one medication before adding more.
While collecting your history during the initial psychiatric evaluation, Dr. Goldenberg will discuss if you have tried medications before or are currently taking any. Understanding what medications have worked for you (or have not worked) and/or what medications have worked for closely related family members (or have not worked) can help to optimize what medication(s) are most likely to help achieve your goals moving forward. This can also help to cut down unnecessary and unneeded prescribing of multiple medications in many cases.
4. Lowest Effective Doses
Dr. Goldenberg also strives to start low and go up slow. Specifically, he starts with low doses of medications and slowly increases them over time. This allows Dr. Goldenberg to avoid overmedicating his patients and also can avoid unnecessary and avoidable medication side effects.
As you increase the medication dosage, the goal is to reach the lowest effective dose for you.
5. Avoiding Addiction
One thing that we all learned from the unfortunate and well-publicized opioid epidemic is that even prescribed medications can be potentially addictive. There are certain medications, such as benzodiazepines and stimulants, that can be effective when addressing certain mental health concerns, but these medications also have the potential for addiction.
Dr. Goldenberg is board-certified in both general and addiction psychiatry. Therefore, he received additional training that is of benefit to his patients both with and without addiction. This is because he has an increased understanding and extensive experience in how and which medications can be addictive and habit forming and which are not likely to lead to addiction.
In cases where medications with addictive potential are needed and indicated, Dr. Goldenberg is able to help patients safely navigate their use and can provide the needed guidance to help them come off of them safely.
6. Coming Off of Medication(s)
In many cases, patients come to Dr. Goldenberg to get off of medications, and he is able to help patients do this safely and effectively.
Perhaps you’ve been to multiple doctors and each has placed you on a different medication. Or maybe you have been on a medication (or two or three) for years, and your current doctor is unable to help you come off of them.
In these cases, Dr. Goldenberg utilizes the full psychiatric evaluation and his comprehensive and individualized approach to determine the best way to slowly taper and eventually discontinue the medications that may not be helping and may no longer be needed.
7. Understand All of Your Options
Sometimes you just want to hear the options, and you have no idea where to start. If you’re worried from the onset about taking medications for your mental health, rest assured Dr. Goldenberg gets it. It is very common and normal to have reservations about starting medication.
During your initial psychiatric evaluation, Dr. Goldenberg spends time reviewing your options and providing you with the education you need to make an informed decision, which includes alternatives to medications, as well as the pros and cons of using medication as a treatment method.
The bottom line is that medication can certainly play a role in improving your mental health, but it should be viewed as only one tool in an otherwise much larger toolbox.
It is not uncommon for a patient to meet with Dr. Goldenberg and by the end of the psychiatric evaluation, once they are able to better understand all of their options, they choose to take some time to reflect on what the best direction is for them. It could include medication or non-mediation options or a combination of both.
Regardless, the important takeaway is that meeting with Dr. Goldenberg for a psychiatric evaluation does not obligate you to start medication and at the least, you will leave with a much more complete understanding of all of your options.
If you have questions about the use of medications for treating your mental health, we invite you to contact Dr. Goldenberg’s office in Santa Monica, California, by calling or booking an appointment online today. Dr. Goldenberg is also licensed in the state of Alaska and provides his services via secure video all across the states of Alaska and California.