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Therapy and medication work on different parts of the same problem. In research on moderate depression, the combination works better than either one alone, and for major depression, panic disorder and obsessive-compulsive disorder, adding therapy to medication works better than medication alone (1, 2). A suggestion to consider medication is not a sign that therapy has failed, and an evaluation does not always end with a prescription. What does the research show? Large analyse

Somewhere along the way, my patients stopped calling me Dr. Cartwright and started calling me Dr. C. Nobody announced it. The name arrived the way nicknames do, one person at a time, until it was simply what I was called in my office. It is a small thing, two letters, and it has come to mean a great deal to me. It carries closeness without losing respect. It sounds like someone you can talk to. The path to that name was not a straight line, and much of it ran through the expe

A psychiatrist is a medical doctor who specializes in mental health. Psychiatrists diagnose psychiatric conditions, look for medical causes of psychological symptoms, prescribe and manage medication, and many also provide psychotherapy. A therapist is a licensed professional whose main work is psychotherapy. In California, therapists and psychologists do not prescribe medication. Who is who? Psychiatrist (MD or DO). A physician who completed medical school and then a residenc

A psychiatric second opinion is a consultation with a psychiatrist who is not your treating clinician, to review your diagnosis and treatment with fresh eyes. It does not replace your current care. Once the consultation is complete, most people continue with their own clinician, with a clearer picture of their situation and their options. What questions does a second opinion answer? A second opinion is built around specific questions rather than ongoing treatment. The most co

Burnout in high-level professionals is rarely a resilience problem. More often it is the cost of sustained misalignment: between how a person thinks and what the role rewards, between real capacity and the system it has to run through. Left long enough, that misalignment can move from exhaustion into depression, and from the inside the two are hard to tell apart. The profile These are not people who have stopped performing. The output is still there. The cost is hidden. An en

Several times a week, someone asks me for help with focus. Sometimes directly. More often in a sentence like: "I know exactly what I have to do. I just cannot get started." That gap, the molasses between thought and action, is not a character flaw. ADHD is real. It affects adults in every walk of life, and treating it is part of my daily work. Stimulant medication has strong evidence for reducing its core symptoms in adults (1). And yet medication rarely solves everything on

Dynamic Integrative Therapy™ (DIT) is a form of psychotherapy I developed over years of clinical work. It starts from a simple premise: distress carries meaning. Anxiety, low mood, exhaustion and the feeling of being pulled apart are treated as signals to understand, not only as symptoms to reduce. Why a different approach? Much of mental health care is now organized around protocols, labels and short appointments. These have their place. What they can miss is the full comple