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The Numbers Behind the Frustration
In a 2023 mystery-shopper study published in General Hospital Psychiatry, researchers called 948 psychiatrists across five states posing as new patients. Fewer than one in five — 18.5% — were available to see a new patient at all. The most common reason was the simplest one: the practice was not taking new patients, full stop. For callers who did find an open door, the median wait was 67 days for an in-person appointment and 43 days for telepsychiatry.¹
For context, the average wait for a new-patient appointment across other medical specialties is 26 days.² Psychiatry is not a little slower than the rest of medicine. It is two and a half times slower — for conditions where motivation itself is a symptom.
What the Gap Actually Costs
- Readiness decays. The client who said yes in your office was at a motivational peak. Ambivalence reasserts itself within weeks — especially in the avoidant, the anxious, and the executively challenged, which is to say, the clients who most needed the referral.
- Symptoms compound. Two months of untreated escalation can mean a lost semester, a job in jeopardy, a marriage further eroded — outcomes a timely evaluation existed to prevent.
- The therapy stalls with them. You spend sessions managing the holding pattern instead of doing the work. The treatment plan is hostage to someone else’s calendar.
- Trust takes the hit. You recommended this. When the system fails to deliver it, some of that failure lands — unfairly but inevitably — on the recommendation, and on you.
What to Tell Clients While They Wait — and How to Shorten It
“The wait you’ve heard about is real, but it’s not universal. Practices differ enormously in how fast they can see you. Before we accept a two-month timeline, let me point you to options that can move within days — because the version of you that’s ready today is the one I want in that first appointment.”
— Sample language for the client staring down a waitlist
Practically, the levers are: prefer telepsychiatry, where median waits run weeks shorter¹; call promptly while motivation is high rather than “sometime this month”; and know, before you need it, which practices in your referral network can actually move. The last one is the difference between a referral that happens and one that evaporates.
The Ascent Answer to the Two-Month Wait
Ascent Psychiatry was built specifically to close this gap. Referred clients speak with a dedicated Care Navigator who handles scheduling, paperwork, and records, and the first appointment — extended, unhurried, with a physician who has more than twenty years of experience — happens within a week. Statewide, via telehealth, anywhere in Pennsylvania. The moment your client says yes is the moment we are designed for.
Referring Is Simple
Have your client call (215) 876-5015 or email [email protected] and mention your name. Their Care Navigator takes it from there. If you would like to talk with Dr. Modan first — about a specific client or just to know who you are referring to — we are glad to set up a brief introduction call.
Sources
- Sun CF, Correll CU, Trestman RL, et al. Low availability, long wait times, and high geographic disparity of psychiatric outpatient care in the US. General Hospital Psychiatry. 2023;84:12–17. Mystery-shopper study of 948 psychiatrists in five states: 18.5% available to see new patients; median wait 67.0 days in person vs. 43.0 days telepsychiatry; most frequent reason for unavailability was not taking new patients (53.9%).
- AMN Healthcare / Merritt Hawkins. 2022 Survey of Physician Appointment Wait Times and Medicare and Medicaid Acceptance Rates. Average of 26.0 days to schedule a new-patient physician appointment across 1,034 physician offices in 15 major U.S. metro areas.
Ascent Psychiatry provides personalized, accessible, compassionate psychiatric care across Pennsylvania, with first appointments within a week.
Integrative Psychiatric Care at Ascent Psychiatry
Dr. Modan takes a whole-person approach, combining evidence-based psychiatry with informed discussion of nutritional and integrative options. Schedule a consultation to discuss your care.
The post The Two-Month Wait: What Psychiatric Referral Delays Cost Your Clients appeared first on Ascent Psychiatry.
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Why the Two Get Tangled
Both conditions produce inattention, but by different routes. Anxiety hijacks attention: the client cannot concentrate because their cognitive bandwidth is consumed by worry, threat-scanning, and rehearsal. ADHD fails to deploy attention: the client cannot concentrate because the regulation system itself is inconsistent — including when they are calm, including for things they care about. The downstream behavior looks identical in a fifty-minute session. The history rarely does.
And frequently the question is not either/or. In the National Comorbidity Survey Replication, nearly half of adults with ADHD also met criteria for an anxiety disorder.¹ Some of that anxiety is independent. Some of it is secondary — the accumulated dread of a life spent missing deadlines, losing keys, and disappointing people for reasons the client could never quite name. Treat only the anxiety in those clients and you are bailing water without patching the hull.
Questions That Sharpen the Differential
- Timeline. “Tell me about fourth grade.” ADHD is neurodevelopmental; the trail runs back to childhood, even when it was never named. Anxiety more often has an onset, a context, a before-and-after.
- Attention in calm waters. “When you’re relaxed and reading something you chose — what happens?” The anxious client can often sink in; the ADHD client drifts even on vacation.
- The flavor of restlessness. Anxious restlessness is driven by dread and quiets when the threat resolves. ADHD restlessness is constitutional — it is there on good days too.
- What worry is doing. Anxious clients worry ahead of events; ADHD clients are more often ambushed by them. “I knew it was due and couldn’t make myself start” is a different sentence from “I couldn’t stop thinking about it going wrong.”
- Response to structure. External scaffolding, like deadlines, body-doubling, accountability, often transforms ADHD performance. It soothes anxiety much less.
Raising the Possibility With a Client
“Some of what we’ve been calling anxiety might have a second layer underneath it. The way you describe your attention — even on calm days, even for things you love — makes me want a proper evaluation, because if there’s an attention piece, treating it could make everything else we’re doing easier.”
— Sample framing when ADHD may be hiding under an anxiety presentation
Self-report screeners and a strong clinical hunch are a starting point, not an answer. A thorough psychiatric evaluation takes the developmental history, rules out mimics — thyroid disease, sleep disorders, substance effects, trauma — and sequences treatment when both conditions are present. That sequencing is where expertise earns its keep: stimulants started in an untreated panic disorder can pour fuel on it, while SSRIs alone in an unrecognized ADHD picture treat half the problem and get half the credit.
This differential is the daily work of Dr. Modan’s practice. With fellowship training in child and adolescent psychiatry — where ADHD assessment is core curriculum — and more than twenty years of clinical experience across the lifespan, he evaluates the whole picture rather than the loudest symptom. Appointments are long enough to take a real history, because this particular question cannot be answered in fifteen minutes.
Referring Is Simple
Have your client call (215) 876-5015 or email [email protected] and mention your name. Their Care Navigator takes it from there. If you would like to talk with Dr. Modan first — about a specific client or just to know who you are referring to — we are glad to set up a brief introduction call.
Integrative Psychiatric Care at Ascent Psychiatry
Dr. Modan takes a whole-person approach, combining evidence-based psychiatry with informed discussion of nutritional and integrative options. Schedule a consultation to discuss your care.
The post Adult ADHD or Anxiety? Untangling Overlapping Symptoms in Your Clients appeared first on Ascent Psychiatry.
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The frustrating part is that we know coordination works. This post lays out what the evidence shows, what real collaboration looks like in practice, and the questions worth asking any psychiatrist before you send them your clients.
The Evidence: Teams Beat Silos
The best-studied model is collaborative care for depression in primary care. In the IMPACT randomized trial — 1,801 patients across 18 clinics — team-based care, in which a psychiatrist, care manager, and treating clinician actually communicated about shared patients, produced a response rate of roughly 45% at twelve months. Usual care produced 19%.¹ Same patients, same medications available, same evidence base. The difference was the structure: someone owned the follow-up, and the clinicians talked to each other.
Therapy-psychiatry collaboration is a different setting, but the mechanism transfers: shared patients do better when their clinicians operate as a team rather than as two strangers who happen to bill the same person.
What Real Collaboration Looks Like
- A closed loop after the first visit. With the client’s consent, you should hear that the appointment happened, what the working impression is, and what was started or changed. Silence after a referral is not neutrality; it is a coordination failure.
- Medication changes you hear about from the psychiatrist, not the client. You are watching the client weekly. If a dose changed, you are the early-warning system for both benefit and side effects — but only if you know.
- A reachable human. When you observe something concerning — activation, sedation, a mood shift — you need a channel that answers within a day or two, not a portal message into the dark.
- Respect for role boundaries in both directions. The psychiatrist does not restructure the therapy; you do not adjust the medication. Each of you knows what the other is doing and why.
Questions to Ask Before You Refer
“After my client’s first appointment, what will I receive from you, and when? If I notice a concerning change between their visits, how do I reach you — and how fast do you respond?”
— The two questions that separate real collaborators from websites that say “collaborative”
A psychiatrist who welcomes those questions is one you can work with. A practice that cannot answer them concretely is telling you, politely, that you will be coordinating by carrier pigeon. Given that only 18.5% of psychiatrists are reachable and available for new patients in the first place,² it is worth being selective about the ones who are.
How Ascent Closes the Loop
Collaboration is built into Ascent’s model rather than bolted on. Every referred client has a dedicated Care Navigator who knows who referred them and keeps that channel open. With the client’s consent, you receive an update after the first visit — they were seen, here is the plan, here is how to reach us — and you hear about medication changes from us, not from your client’s best recollection. Dr. Modan’s appointments are longer by design, which means there is time to actually read what you send and incorporate it. Your client stays your client. We are the medication arm of a team you are already leading.
Referring Is Simple
Have your client call (215) 876-5015 or email [email protected] and mention your name. Their Care Navigator takes it from there. If you would like to talk with Dr. Modan first — about a specific client or just to know who you are referring to — we are glad to set up a brief introduction call.
Integrative Psychiatric Care at Ascent Psychiatry
Dr. Modan takes a whole-person approach, combining evidence-based psychiatry with informed discussion of nutritional and integrative options. Schedule a consultation to discuss your care.
The post What Collaborative Care Should Actually Look Like Between Therapist and Psychiatrist appeared first on Ascent Psychiatry.
]]>The post How to Raise the Medication Conversation Without Undermining the Therapy appeared first on Ascent Psychiatry.
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This post offers language that works, language that backfires, and a way to handle the most common objections without turning the session into a debate.
Why the Framing Matters More Than the Facts
Clients rarely object to medication on the evidence. They object to what they believe a referral means about them: that they are broken, that their effort did not count, that their therapist is giving up on them. If the framing does not address those meanings directly, no amount of outcome data will move the conversation. Three frames consistently keep the therapy central:
- Information, not commitment. An evaluation is a conversation with a physician — an hour of expert input on a question you and your client have been circling for months. The client decides nothing today except whether they want more information.
- Augmentation, not replacement. The evidence backs this framing literally. In the NIMH MTA study, combined treatment doubled the success rate of behavioral treatment alone — 68% versus 34%.¹ Medication did not replace the behavioral work; it made the behavioral work land.
- Team, not handoff. The single most reassuring sentence you can say is some version of: “I am not going anywhere.” Clients fear losing you more than they fear the appointment.
Language That Works
“You’ve been doing real work in here, and I want to be honest with you about what I’m seeing. Your symptoms are working against you harder than skills alone can fix right now. I’d like a physician’s eyes on this — not instead of what we’re doing, but in support of it. Would you be open to one conversation?”
— Sample framing for the referral conversation
Notice what the framing does: it credits the client’s effort first, names the observation without judgment, positions the evaluation as serving the shared goal, and ends with a small, reversible ask. One conversation. Not a diagnosis, not a prescription, not a new identity.
Language That Backfires
- “I think you need medication.” Too conclusive. It does the psychiatrist’s job in advance and gives the client a verdict to resist rather than a question to consider.
- “There’s nothing more I can do for you.” Even when meant humbly, this reads as abandonment — and makes the referral feel like a discharge.
- “It’s just a chemical imbalance.” Oversimplified, increasingly contested, and it strips the client of agency. You do not need a mechanism story to justify a consultation.
Handling the Common Objections
- “Medication will change who I am.” Acknowledge the fear, then reframe what change means: untreated symptoms are already changing who they get to be. The goal of treatment is more access to themselves, not less.
- “If I take medication, it means therapy didn’t work.” Point gently at the evidence: combined treatment outperforms either alone in the conditions you most often refer for.¹ Two tools beat one tool. Nobody concludes a carpenter failed because they picked up a second tool.
- “I’ll think about it.” Take yes for an answer — and reduce friction. This is where the practical barrier matters: nationally, the median wait for an in-person psychiatric appointment is 67 days, and fewer than one in five psychiatrists are taking new patients at all.³ A client who agrees in March and is seen in June often is not a client who is seen at all. If you refer to a practice that can move within a week, the window of willingness stays open.
How Ascent Helps the Conversation Land
When you refer to Ascent Psychiatry, the path you describe to your client is short and concrete: they call, a dedicated Care Navigator handles all the logistics, and their first appointment — an extended one, with a physician who has more than twenty years of experience — happens within a week. With your client’s consent, you hear back after the visit. The frame you offered in session — information, augmentation, team — turns out to be exactly how the process feels.
Referring Is Simple
Have your client call (215) 876-5015 or email [email protected] and mention your name. Their Care Navigator takes it from there. If you would like to talk with Dr. Modan first, about a specific client or just to know who you are referring to, we are glad to set up a brief introduction call.
Integrative Psychiatric Care at Ascent Psychiatry
Dr. Modan takes a whole-person approach, combining evidence-based psychiatry with informed discussion of nutritional and integrative options. Schedule a consultation to discuss your care.
The post How to Raise the Medication Conversation Without Undermining the Therapy appeared first on Ascent Psychiatry.
]]>The post When Therapy Isn’t Enough: Knowing When Your Client May Benefit from a Psychiatric Evaluation appeared first on Ascent Psychiatry.
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Deciding when to raise a psychiatric referral is one of the harder judgment calls in outpatient practice. Refer too quickly and you risk medicalizing a problem the client could work through. Wait too long and your client spends months white-knuckling symptoms that a thoughtful medication evaluation might have eased. This post offers a practical framework for spotting the signals, raising the conversation, and choosing a psychiatric partner who will support your work rather than complicate it.
Signals That Stalled Progress May Have a Biological Component
No single sign is decisive, but when several of these cluster together, a psychiatric evaluation is worth considering:
- Skills that won’t deploy. Your client can describe their coping strategies perfectly in session but cannot access them in the moment. When baseline anxiety is high enough, the physiological alarm overrides everything you have built together. Medication can lower that floor so the skills finally have room to work.
- Attention symptoms interfering with the therapy itself. The client loses the thread mid-session, forgets homework not from avoidance but from genuine working-memory failure, or has a lifelong pattern of starting strong and trailing off — in jobs, relationships, and now in treatment. With roughly 4.4% of adults meeting criteria for ADHD and most cases going untreated,³ ADHD quietly undermines therapy more often than it gets credit for.
- Vegetative symptoms. Persistent sleep disruption, appetite change, or a fatigue that rest does not touch. These respond unevenly to psychological intervention alone.
- A true plateau despite a strong alliance. Good rapport, good adherence, an approach that fits the presentation — and yet the symptom severity has not budged in months. That pattern deserves a second set of eyes.
- Family history. A first-degree relative who responded well to medication raises the likelihood your client will too.
Raising It Without Undermining the Work
Many clients hear “maybe you should see a psychiatrist” as “therapy failed” or, worse, “you failed.” The framing that works best positions medication as something that serves the therapy, not something that replaces it:
Key distinction: “You’ve been working hard, and I can see it. I’m wondering if your anxiety is sitting at a level where it’s hard for any of this to stick. An evaluation wouldn’t change what we’re doing — it might just make what we’re doing work better.”
— Sample framing for the referral conversation
Two points tend to land well. First, an evaluation is information, not a commitment — the client is agreeing to a conversation with a physician, nothing more. Second, the evidence supports the team approach. In the landmark NIMH MTA study of childhood ADHD, 68% of children receiving combined treatment were rated as successfully treated at the end of the 14-month trial, versus 34% with behavioral treatment alone.⁴ In anxiety disorders, the evidence varies by diagnosis, but when physiological arousal is high enough to block exposure-based work, reducing it pharmacologically is often what lets the therapy succeed. A referral is not a handoff. You remain the anchor of their care.
What to Expect from a Good Psychiatric Partner
Every therapist in Pennsylvania has lived the frustrating version of this story: you make the referral, and your client joins a months-long queue. In a 2023 mystery-shopper study that called 948 psychiatrists posing as new patients, fewer than one in five were available to see a new patient, and the median wait for an in-person appointment was 67 days¹ — more than double the 26-day average for new-patient appointments across other medical specialties.² Momentum dies in that gap, and some clients never go at all.
If that has made you hesitant to refer at all, the bar you should hold a psychiatric practice to is simple:
- Fast access. A referral made at the moment of readiness should be seen within days, not months. Readiness is perishable.
- Real appointments. Long enough to take a genuine history — not a fifteen-minute medication check with a stranger.
- Communication back to you. With the client’s consent, you should know the patient was seen, what the plan is, and how to coordinate. You should never have to chase a psychiatrist for an update.
- Respect for the therapy. A psychiatrist who tells your client they can stop therapy because the medication is working does not understand the evidence — or your role.
How Ascent Works with Referring Therapists
Ascent Psychiatry was built around exactly these frustrations. When you refer a client to us, they speak with a dedicated Care Navigator who handles every piece of logistics — scheduling, paperwork, testing, follow-up — and their first appointment happens within a week. Appointments are longer by design, because people are much more than a diagnosis, and a treatment plan should be built around a person’s life, values, and priorities.
Dr. Modan brings more than twenty years of clinical experience, with fellowship training in child and adolescent psychiatry at Dartmouth and addiction psychiatry training at NYU. We treat children, adolescents, and adults across Pennsylvania via telehealth, with particular depth in ADHD and anxiety — the two presentations most likely to be sitting, partially hidden, in a therapy caseload.
And we close the loop. With your client’s consent, you will hear from us after the first visit: they were seen, here is the plan, here is how to reach us. Your client stays your client. We are simply the medication arm of a team you are already leading.
Referring Is Simple
Have your client call (215) 876-5015 or email [email protected] and mention your name. Their Care Navigator takes it from there. If you would like to talk with Dr. Modan first — about a specific client or just to know who you are referring to — we are glad to set up a brief introduction call.
Integrative Psychiatric Care at Ascent Psychiatry
Dr. Modan takes a whole-person approach, combining evidence-based psychiatry with informed discussion of nutritional and integrative options. Schedule a consultation to discuss your care.
The post When Therapy Isn’t Enough: Knowing When Your Client May Benefit from a Psychiatric Evaluation appeared first on Ascent Psychiatry.
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]]>Medical Disclaimer: This article is for educational purposes only and does not constitute medical advice. Please consult a licensed healthcare provider for diagnosis and treatment. In a mental health crisis, call or text 988.
It’s Not Just a Childhood Condition
For decades, ADHD was considered something children outgrow. Research has definitively disproven that. ADHD is a lifelong neurodevelopmental condition — and for more than half of diagnosed adults, the diagnosis didn’t come until adulthood. Many spent years struggling with focus, organization, and emotional regulation without ever understanding why.
The gap between prevalence and care is striking: over one in three adults with ADHD receives no treatment at all — not medication, not therapy, nothing. Understanding the condition is the first step toward closing that gap.
What Is Adult ADHD?
Attention-Deficit/Hyperactivity Disorder (ADHD) is characterized by persistent patterns of inattention, hyperactivity, and impulsivity that interfere with functioning. The DSM-5-TR recognizes three presentations:
- Predominantly Inattentive — difficulty sustaining focus, organizing tasks, and following through; often mistaken for laziness or apathy
- Predominantly Hyperactive-Impulsive — restlessness, acting without thinking, talking excessively; less common as a standalone type in adults
- Combined Presentation — meets criteria for both; the most commonly diagnosed in adults
In adults, ADHD looks different than the stereotype of a hyperactive child. Adults are more likely to experience internal restlessness — chronic disorganization, emotional reactivity, difficulty with time management, and an inability to complete tasks despite genuine effort and intelligence.
Why ADHD Gets Missed in Adults
Several factors contribute to delayed or missed diagnosis in adults. Girls and women are significantly underdiagnosed — their symptoms tend to present as inattentiveness rather than disruptive hyperactivity, making them easier to overlook. High-functioning individuals often develop compensatory strategies that mask impairment until demands become overwhelming — a new job, parenthood, or major life stress can unmask ADHD that was previously managed.
Co-occurring conditions further complicate the picture. Anxiety, depression, and substance use disorders are highly prevalent in adults with ADHD, and their symptoms can overshadow the underlying attention issues, leading to misdiagnosis and ineffective treatment.
Key distinction: ADHD is not a deficit of attention — it’s inconsistent regulation of attention. People with ADHD can hyperfocus intensely on highly engaging topics while struggling to sustain attention on tasks they find routine or low-stimulation.
Key distinction: ADHD is not a deficit of attention — it's inconsistent regulation of attention. People with ADHD can hyperfocus intensely on highly engaging topics while struggling to sustain attention on tasks they find routine or low-stimulation.
Evidence-Based Treatment
Medication
- Stimulants (amphetamine, methylphenidate) — first-line, 70–80% response rate
- Non-stimulants (atomoxetine, viloxazine, guanfacine) — useful when stimulants are contraindicated
- Dose titration is individualized; response varies
Behavioral & Psychological
- Cognitive Behavioral Therapy (CBT) tailored for ADHD
- Executive function coaching
- Organizational skills training
- Mindfulness-based interventions
Medication and therapy together produce the best outcomes. Medication manages core symptoms; behavioral strategies address the habits, patterns, and secondary emotional consequences that develop over years of unmanaged ADHD.
Integrative Psychiatric Care at Ascent Psychiatry
Dr. Modan takes a whole-person approach, combining evidence-based psychiatry with informed discussion of nutritional and integrative options. Schedule a consultation to discuss your care.
The post Understanding Adult ADHD: It’s Not Just a Childhood Condition appeared first on Ascent Psychiatry.
]]>The post Autism in Children: Recognizing the Signs & Getting the Right Support appeared first on Ascent Psychiatry.
]]>Medical Disclaimer: This article is for educational purposes only. If you have concerns about your child’s development, please consult a qualified developmental or psychiatric specialist. Do not delay seeking evaluation based on this content alone.
What Is Autism Spectrum Disorder?
Autism Spectrum Disorder (ASD) is a neurodevelopmental condition that affects how a child communicates, interacts with others, and experiences the world. Defined by the DSM-5-TR, ASD is characterized by persistent differences in social communication and interaction, paired with restricted or repetitive patterns of behavior, interests, or activities.
The latest CDC data (April 2025) identifies ASD in 1 in 31 eight-year-olds in the United States — up from 1 in 150 roughly two decades ago. This increase reflects broader diagnostic criteria, improved screening, and greater awareness, not a true epidemic. Diagnosis rates among Black, Hispanic, and Asian children now approach those of white children for the first time — a meaningful step toward equity.
Early Signs: What to Watch For
Signs of autism can be visible as early as 12 months, and reliable diagnosis is possible by 18–24 months. Yet the average age of first diagnosis remains around 4 years — a gap that represents missed early intervention. Common early signs include:
- Limited or inconsistent eye contact
- No response to name by 12 months
- Limited joint attention — pointing, showing, sharing interest
- Delayed or absent speech and language milestones
- Repetitive movements (hand-flapping, rocking, spinning objects)
- Rigid adherence to routines; strong distress with change
- Unusual or intense sensory sensitivities
- Highly focused, narrow interests
How Autism Is Diagnosed
There is no blood test or imaging study for autism. Diagnosis is clinical, based on a comprehensive developmental history, structured behavioral observation, and standardized assessment tools (such as the ADOS-2). A multidisciplinary team — including a developmental pediatrician, psychologist, and/or child psychiatrist — provides the most thorough evaluation.
Co-occurring conditions are the rule, not the exception. ADHD, anxiety, sleep disorders, gastrointestinal problems, and sensory processing differences are all common and require their own assessment and management.
Important: Not every child with ASD shows all of these signs, and presentation varies widely. If you notice several of these patterns persisting over time, request a formal developmental evaluation — do not wait for a "watch and see" approach.
Evidence-Based Supports and Interventions
Behavioral & Developmental
- Applied Behavior Analysis (ABA)
- Early Intensive Behavioral Intervention (EIBI)
- Naturalistic Developmental Behavioral Interventions (NDBIs)
- Social communication therapy
Therapeutic & Medical
- Speech-language therapy
- Occupational therapy (sensory, motor)
- Medication for co-occurring ADHD, anxiety, or irritability
- Parent-mediated programs (Hanen, PECS)
No single treatment fits every child. The best approach is individualized, strengths-based, and developed in partnership with the family. Be wary of interventions marketed as a “cure” — the goal of evidence-based care is to support development, reduce distress, and improve quality of life.
When to Involve a Child Psychiatrist
A child psychiatrist plays a critical role when co-occurring psychiatric conditions — anxiety, ADHD, mood dysregulation, OCD — are present alongside ASD. These conditions often require targeted treatment and, if untreated, significantly impact a child’s functioning and quality of life. Early psychiatric involvement ensures the full clinical picture is addressed.
Resources: Autism Society of America — autism-society.org | SPARK — sparkforautism.org | CDC “Learn the Signs” — cdc.gov/ncbddd/autism
Specialized Pediatric ASD Evaluation
Dr. Modan has over 10 years of specialized experience with autism in children and adolescents. Serving Pennsylvania via secure telehealth and in-person in Doylestown.
The post Autism in Children: Recognizing the Signs & Getting the Right Support appeared first on Ascent Psychiatry.
]]>The post Genetic Testing in Psychiatry: Facts, Myths & What It Can Actually Tell You appeared first on Ascent Psychiatry.
]]>Medical Disclaimer: This article is for educational purposes only and does not constitute medical advice or a recommendation for any specific genetic test. Discuss whether pharmacogenomic or other genetic testing is appropriate for your care with a qualified psychiatric provider.
What Is Psychiatric Genetic Testing?
Genetic testing in psychiatry refers to laboratory-based analysis of a patient’s DNA to inform clinical decision-making. The most clinically utilized form today is pharmacogenomics (PGx) — testing that examines how genetic variants affect the way a person metabolizes, responds to, or tolerates psychiatric medications. A growing but still-emerging application is neuropsychiatric genetic panels, which screen for variants associated with conditions like ASD, ADHD, intellectual disability, and epilepsy.
This is one of the fastest-evolving areas in all of medicine. Understanding what these tests can — and cannot — do is essential for patients and families navigating psychiatric care.
How Pharmacogenomics Works
Most psychiatric medications are metabolized by enzymes in the liver, primarily from the cytochrome P450 (CYP450) family — including CYP2D6, CYP2C19, CYP3A4, and others. Genetic variants in these enzymes determine whether a person is a:
- Poor metabolizer — the enzyme functions slowly or not at all; standard doses may accumulate to toxic levels
- Intermediate metabolizer — reduced enzyme activity; may need lower doses
- Normal (extensive) metabolizer — expected response to standard doses
- Ultrarapid metabolizer — enzyme works faster than normal; standard doses may be ineffective as the drug is cleared too quickly
Commonly tested genes include CYP2D6 (affects metabolism of many antidepressants and antipsychotics), CYP2C19 (SSRIs like citalopram and escitalopram), and SLC6A4 (serotonin transporter gene, linked to SSRI response). The MTHFR gene variant — which affects folate metabolism and neurotransmitter synthesis — is also frequently included and has implications for treatment-resistant depression.
Clinically Recognized Applications
Medication Selection
When multiple medications are options, PGx results can help prioritize those likely to be metabolized normally and flag those with elevated risk of toxicity or subtherapeutic levels due to your metabolizer status.
Dose Optimization
Poor and ultrarapid metabolizers may require significantly different doses than standard guidelines suggest. PGx can guide dose adjustments before — not after — a trial-and-error period.
Treatment-Resistant Cases
When patients have failed multiple adequate medication trials, genetic testing may uncover metabolic explanations — such as ultrarapid CYP2D6 status — that were never previously considered.
Neurodevelopmental Evaluation
Chromosomal microarray and targeted gene panels are a standard part of evaluation for children with ASD, intellectual disability, or developmental delay — identifying clinically actionable variants in roughly 15–20% of cases.
Important context: Pharmacogenomic testing tells you about metabolism — how your body processes a drug. It does not predict whether a medication will work for your diagnosis, or whether you will experience every possible side effect. It is one clinical input among many.
Facts & Myths
Genetic testing in psychiatry is surrounded by both hype and misunderstanding. Here is a direct comparison of common claims versus the clinical reality:
| ✘ Myth |  Fact |
|---|---|
| Myth: A genetic test can tell you exactly which psychiatric medication will work best for you. | Fact: PGx identifies how you metabolize medications — not whether they will be therapeutically effective for your condition. No test currently predicts antidepressant or antipsychotic efficacy with reliability. |
| Myth: If a test says a medication is “green” (normal metabolism), it will definitely work and be well-tolerated. | Fact: “Green” means expected metabolism — not guaranteed efficacy or freedom from side effects. Pharmacodynamic factors (receptor sensitivity, brain chemistry) are not captured by current PGx panels. |
| Myth: Genetic testing can diagnose ADHD, depression, or autism. | Fact: No genetic test diagnoses psychiatric conditions. Psychiatric diagnoses are clinical — based on history, symptoms, and functional impairment — not genetic markers. Genetic panels support evaluation but do not replace it. |
| Myth: MTHFR gene variants are a major psychiatric condition requiring treatment in everyone who carries them. | Fact: MTHFR variants (C677T, A1298C) are extremely common — present in 30–60% of the population. Most carriers have no clinical problem. MTHFR is clinically relevant primarily in treatment-resistant depression, where L-methylfolate supplementation may help. |
| Myth: Genetic results don’t change with time, so one test is enough forever. | Fact: Your underlying DNA does not change, but the clinical interpretation of variants evolves as research advances. A result from five years ago may be reinterpreted in light of new evidence. Panels themselves also expand over time. |
| Myth: Consumer direct-to-consumer (DTC) genetic tests like 23andMe are equivalent to clinical pharmacogenomic testing. | Fact: DTC tests are not validated for clinical decision-making in psychiatry. They cover different variants, use different methodologies, and lack the clinical interpretation and provider oversight required for safe medication management. |
| Myth: Insurance never covers psychiatric genetic testing. | Fact: Coverage has expanded significantly. Many major insurers cover PGx testing for patients with documented treatment-resistant depression or other qualifying criteria. Medicare has specific coverage provisions. Prior authorization requirements vary widely. |
What to Expect From Testing
Clinical PGx testing typically involves a cheek swab or blood sample and returns results in 5–10 business days. Results are provided in a clinical report categorizing relevant genes and medications by metabolizer status, with prescribing guidance. The most widely used panels in psychiatry include tests from GeneSight (Myriad), Genomind, and OneOme RightMed — each covering overlapping but distinct gene sets.
Testing is most useful when ordered and interpreted by a clinician who understands both the possibilities and limitations of the results. Raw genetic data without clinical interpretation is of limited — and potentially misleading — value.
Privacy Protections
Patients often worry about genetic data privacy. The Genetic Information Nondiscrimination Act (GINA) prohibits health insurers and employers from discriminating based on genetic information. However, GINA does not cover life, disability, or long-term care insurance. Clinical genetic test results ordered by a provider are part of your protected health record under HIPAA and are not shared with insurers without your authorization.
Crisis Resources: Call or text 988 | Text HOME to 741741 | Call 911 for emergencies.
Further reading: CPIC Guidelines — cpicpgx.org | PharmGKB — pharmgkb.org | ACMG Genetic Testing Resources — acmg.net
Pharmacogenomic Testing at Ascent Psychiatry
Dr. Modan incorporates genetic testing into complex medication evaluations when clinically indicated — interpreting results in the full context of your history, diagnosis, and treatment goals.
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]]>Medical Disclaimer: This article is for educational purposes only and does not constitute medical advice. It does not replace a consultation with a licensed healthcare provider. If you are experiencing a mental health crisis, call or text 988 (Suicide & Crisis Lifeline) or go to your nearest emergency room.
The Magnesium–Mental Health Connection
Most people think of magnesium as a supplement for sleep or muscle cramps. But researchers and clinicians increasingly recognize its role in brain chemistry, stress regulation, and mood. Magnesium is involved in over 300 enzymatic reactions in the body — many of them directly tied to how we think, feel, and respond to stress.
Despite its importance, studies suggest that a significant portion of Americans do not get adequate magnesium from diet alone. Low magnesium levels have been associated with elevated anxiety, depressive symptoms, poor sleep, and even heightened sensitivity to stress. Understanding this connection can be a powerful complement to a comprehensive mental health care plan.
How Magnesium Affects the Brain
Magnesium regulates the activity of NMDA receptors — a type of glutamate receptor central to learning, memory, and mood. It acts like a natural “gatekeeper,” preventing excessive neuronal excitation that can contribute to anxiety and depression. When magnesium levels are low, this gating function weakens, and the nervous system can become overactive and dysregulated.
Magnesium also plays a role in:
- HPA axis regulation — the body’s stress response system. Low magnesium is linked to heightened cortisol release.
- Serotonin synthesis — the neurotransmitter associated with mood stability and well-being.
- Sleep architecture — supporting deeper, more restorative sleep through its calming effect on the nervous system.
- Inflammation — chronic low-grade inflammation is increasingly tied to depression, and magnesium has anti-inflammatory properties.
Magnesium and Depression
Several clinical studies have found associations between low dietary magnesium and higher rates of depression. A 2017 randomized controlled trial published in PLOS ONE found that supplementation with magnesium chloride led to significant improvements in depression and anxiety symptoms in adults with mild to moderate depression — with benefits appearing in as few as two weeks.
While magnesium is not a replacement for antidepressants or psychotherapy, it may serve as a meaningful adjunct — particularly for individuals who are deficient or whose diets are low in magnesium-rich foods like leafy greens, nuts, seeds, and whole grains.
Did you know? Chronic stress, alcohol use, high caffeine intake, and certain medications (including some diuretics and PPIs) can deplete magnesium levels — creating a feedback loop where stress causes deficiency, and deficiency worsens stress reactivity.
Magnesium and Anxiety
Anxiety is one of the most commonly reported mental health concerns in clinical practice. Magnesium’s calming effect on the NMDA receptor system and its ability to modulate cortisol make it a subject of growing interest in integrative psychiatry. Animal and human studies suggest that low magnesium correlates with increased anxiety-like behavior, and that supplementation may reduce subjective anxiety in some populations.
It is important to note that anxiety disorders are complex and influenced by genetics, environment, and life experience. Magnesium is not a cure — but for some individuals, addressing nutritional deficiencies may contribute meaningfully to overall treatment response.
Forms of Magnesium: Not All Are Equal
Better Tolerated
- Magnesium Glycinate — calming, gentle on digestion, well-absorbed
- Magnesium Threonate — may cross the blood-brain barrier more effectively
- Magnesium Taurate — cardiovascular + calming benefits
Use With Caution
- Magnesium Oxide — low absorption, often causes GI upset
- Magnesium Citrate — good absorption but laxative effects at higher doses
- Magnesium Sulfate — primarily IV/clinical use, not for daily oral supplementation
What to Discuss With Your Prescriber
Before starting any supplement, it is important to consult with a qualified provider. Magnesium can interact with certain medications, including antibiotics, diuretics, and some psychiatric medications. It can also affect kidney function in individuals with renal disease. Typical supplemental doses range from 200–400 mg of elemental magnesium daily, though individual needs vary.
A prescriber can help determine whether you are deficient, which form is most appropriate, and how supplementation fits within your broader treatment plan.
Crisis Resources: If you or someone you know is in crisis, please call or text 988, text HOME to 741741 (Crisis Text Line), or call 911 / go to your nearest ER.
Questions About Integrative Psychiatric Care?
Dr. Modan combines evidence-based psychiatry with a whole-person approach. Schedule a consultation to discuss your mental health goals.
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]]>Medical Disclaimer: This article is for educational purposes only. Supplements are not FDA-regulated medications and are not substitutes for evidence-based psychiatric treatment. Always discuss supplements with your prescriber before starting — interactions with psychiatric medications can occur.
Why Supplements Come Up in Psychiatry
More patients ask about supplements than ever before — for mood, focus, sleep, and anxiety. The honest answer: some have meaningful evidence behind them, others have very little, and almost none should replace established treatments. What they can do, in the right context, is complement standard care. Here is an evidence-informed look at the most commonly discussed supplements in psychiatric practice.
Supplements at a Glance
Omega-3 Fatty Acids (EPA & DHA) — Strong Evidence
EPA-predominant formulations (≥60% EPA, 1–2 g/day) have shown consistent benefit as adjuncts to antidepressants across multiple meta-analyses. Preliminary evidence also supports benefits in bipolar depression and ADHD. Fish oil is the most common form; algal oil provides DHA but less EPA. GI side effects are the main complaint.
Best studied for: Depression (adjunct), ADHD
Vitamin D — Moderate Evidence
Vitamin D receptors are found throughout the brain, and deficiency is extremely common — particularly in northern latitudes, older adults, and people with darker skin. Correcting a documented deficiency often improves energy and mood. Evidence for benefit in non-deficient individuals is mixed. Check a 25-OH vitamin D level; supplement with D3 if below 30 ng/mL (typical dose: 1,000–5,000 IU/day).
Best studied for: SAD, deficiency-related mood changes
Magnesium — Moderate Evidence
Magnesium is involved in over 300 enzymatic reactions including NMDA receptor regulation, cortisol modulation, and serotonin synthesis. Low levels are associated with anxiety, depression, and poor sleep. A 2017 RCT found significant improvement in depression and anxiety with magnesium chloride supplementation. Glycinate and threonate are better-tolerated forms. Typical dose: 200–400 mg elemental magnesium daily.
Best studied for: Anxiety, depression (adjunct), sleep
Probiotics & the Gut–Brain Axis — Emerging Evidence
Approximately 90% of serotonin is produced in the gut, and the gut microbiome communicates directly with the brain via the vagus nerve. Several RCTs suggest multi-strain probiotics may reduce anxiety and depressive symptoms. This is one of the most actively researched areas in psychiatry. Results are promising but not yet sufficient to recommend as a primary treatment.
Best studied for: Anxiety reduction, IBS-related mood symptoms
L-Methylfolate — Strong Evidence
L-methylfolate is the bioavailable form of folate that crosses the blood-brain barrier. It is involved in neurotransmitter synthesis (serotonin, dopamine, norepinephrine). In patients with the MTHFR gene variant who metabolize folate poorly, standard antidepressants may underperform. L-methylfolate (7.5–15 mg/day) is FDA-cleared as a medical food adjunct for depression. This is one of the most clinically useful nutraceuticals in psychiatry.
Best studied for: Treatment-resistant depression (adjunct)
NAC (N-Acetylcysteine) — Moderate Evidence
NAC is a precursor to glutathione, the brain’s primary antioxidant. It modulates glutamate and dopamine systems implicated in OCD, addiction, and bipolar disorder. RCTs have shown benefit for OCD compulsions, cannabis use disorder, and bipolar depression. Typical dose: 1,200–2,400 mg/day. Generally well-tolerated; GI upset is the main side effect.
Best studied for: OCD (adjunct), addiction, bipolar depression
What to Discuss With Your Provider - Before starting any supplement, review it with your prescriber. Supplements interact with psychiatric medications — St. John's Wort, for example, significantly reduces blood levels of many drugs including SSRIs and birth control. Quality and dosing vary widely between brands. And unlike medications, supplements are not pre-approved for safety and efficacy by the FDA.
A good prescriber will take your interest in supplements seriously, evaluate the evidence, check for interactions, and help you integrate them appropriately into your overall treatment plan — not dismiss them outright or recommend them uncritically.
Crisis Resources: Call or text 988 · Text HOME to 741741 · Call 911 for emergencies.
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