psychotherapy chevy chase maryland

Psychopharmacology

Our philosophy regarding psychopharmacology is “less is better.” Our conservative approach prioritizes behavioral interventions and therapy; lifestyle changes such as sleep hygiene, exercise, diet and supplements; and brain modulation methods that have little to no side-effects. However, when disruptive behaviors and symptoms persist or their severity is such that we have safety concerns, we’ll recommend, prescribe and monitor an adequate medication regimen. We always discuss the risks and benefits together with potential side-effects and alternatives. 

 

We have extensive experience in pharmacogenetics (using your genetic information to predict medication efficacy and side-effects). We have contributed dozens of peer-reviewed scientific articles and lectured around the world on this topic. Additionally, Dr. Laje has co-invented two pharmacogenetic tests. 

 

Traditional treatment regimens help ameliorate symptoms in a majority of patients, however, some cases may require a more complex pharmacological approach. We are experienced with medications that require registries or special management. These include esketamine (intranasal ketamine), suboxone and clozapine among others.

Esketamine 

SPRAVATO® (esketamine) CIII Nasal Spray is indicated, in conjunction with an oral antidepressant, for Treatment-Resistant Depression (TRD) and suicidality in adults.  Esketamine, approved by the FDA in 2019 to treat TRD, is not like other antidepressants, which often take four to six weeks to take effect - esketamine is effective within hours.  Preventing suicide or reducing suicidal ideation or behavior has also not been demonstrated with esketamine. We cannot send a pharmacy an esketamine prescription, patients must come to the office and be monitored for a minimum of 2 hours following each session. For more information read here.

Suboxone

SUBOXONE® (buprenorphine and naloxone) Sublingual Film (CIII) is a controlled prescription drug used to treat adults who are overly dependent on opioids (either prescription or illegal) as part of a complete treatment program that may include counseling and/or behavioral therapy.

Vivitrol

VIVITROL (naltrexone extended release). Vivitrol is an opioid blocker that is required to be administered by a healthcare provider. It is a once monthly injection, that together with with counseling helps prevent substance and alcohol abuse relapse and helps with craving reduction. It is non-addictive and it’s not a narcotic. The use of VIVITROL requires detoxification, especially opioiods, to avoid sudden withdrawal.

Clozapine

Clozapine is an antipsychotic medication that is used to treat severe symptoms of schizophrenia, bipolar and other disorders in people who have failed other treatment, have tried to harm themselves and are looking to reduce suicidal behavior. Clozapine comes as a pill, an orally disintegrating tablet, and an oral suspension (liquid) taken by mouth. While clozapine can cause a serious blood condition (reduction in neutrophil count), we monitor it by running frequent required blood tests before, during and after treatment. 

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