The Frontier Psychiatrists

Schizophrenia is a really challenging illness. There's been a lot of progress made recently, I will note. I've already written about novel treatments like Cobenfy, and using accelerated transcranial magnetic stimulation for negative symptoms and positive symptoms in schizophrenia. One of the most bothersome of those “positive symptoms”—things that shouldn't be there, in someone's mind, but are—are auditory hallucinations. If you imagine having invisible AirPods that are playing a terrible podcast that you'd rather not be listening to, and that everyone else can't hear, you get a sense of how distracting it might be to have auditory hallucin...

I wrote an article about this research before, available here. However, I also made a podcast for my audience about the topic! Antisocial Personality Disorder is usually considered untreatable. A new study from the Anna Freud Centre’s MBT program demonstrates a remarkably effective treatment.

At Radial, this is the modality of therapy we specialize in providing. It is also effective in borderline personality disorder and in suicidal adolescents. However, with some riffs, it turns out, it also helps ASPD. I even wrote a book on this a while back, published by Springer Nature (Amazon affiliate link).

This is the podcast version of yesterday’s article. Yes, I Know It Has A Different Title.

Thanks for listening.

And if you are looking for care for yourself or a loved one…join us at Radial—where I work—we focus on next-generation treatments.

They include Spravato, Nightware, eTNS, PRISM Neurofeedback, soon, eCOT-AS by Neurolief, TMS, Accelerated TMS, and fMRI-guided SAINT TMS.

Radial offers the most advanced mental health care, anywhere.

I was invited, thanks to the magnificent and only-ever-positive internet, to give a lecture to colleagues in Nigeria. I’m kidding, a little—the internet can be rough. Ask a comment section of a YouTube video! However, it is also a technology that has brought the world closer together. One of those less absurd corners of the internet is LinkedIn—it’s like the world’s most boring dad and his boss decided to invite you to a global-scale compliance educational module. “So exciting, it’s mandatory!”

I am giving the internet a hard time. Sometimes it’s a special kind o...

One of my great joys as a psychiatrist is the ability to collaborate with excellent colleagues. Irfan Handoo, M.D., of Kansas City Psychiatric Partners, is one such human.

In this interview, we learn about how Dr. Handoo went from psychopharmacologist to interventional psychiatrist, why Kansas City is the best city in the world, and why being South Asian is the ultimate hack to get your patients the best care. It's really easy to think of doctors being completely burned out, and not caring about their patients. Being a physician is a tremendously challenging thing to do...

Every once in a while, science authors will crank out a paper that answers some questions, but asks so many more. I’ve been talking, writing, and podcasting about physician suicide longer than most other topics in my creative life.

I did a whole award-winning series as a Rudin Master Scholar in Ethics and Humanities, which no one noticed. Including podcasts like these:

and this…

and this…

Today’s podcast is instead of a written column. Feel free to listen. The paper it’s about is here:

Causes of Death Amon...

Author’s Note: This writing was adapted from a series of conversations around race in America and edited as audio, recorded in 2020, right after George Floyd was lynched.. The podcast of this writing is the real thing, as it were.  What follows is edited text to clarify the narrators, absent the audio.  Please consider following the podcast associated with this newsletter and leaving a 5-star review on Spotify or Apple Podcasts. Please subscribe to support high-impact content like this.

The author, David Foster Wallace, described the experience of reading his novel Infinite Jest as intended to feel “tornadi...

Owen Muir, M.D. of The Frontier P

Oh my. The irony is thick with this one. Your author, and sometimes scientist, Owen Scott Muir, M.D. has been doing research on Tardive Dyskinesia. And…he might have the disorder. The search function lets you search for other articles on the topic.

If you are interested in treatments for psychiatric disorders that don't cause this adverse effect—a permanent movement disorder—they exist. The care we provide in New York, California, and now, South Carolina works, diligently, to advance the science of safer treatment.

The frontier Psychiatrists breaks down a publication on the topic of immune modulation of TMS response in depression. And Dr. Owen Muir explains what inflammation is for mental health conditions in the process.

I’ve been obsessed with the Peloponnesian War as a historical event for 20 years now. I wrote an article about it recently, and also recorded a song about it many years back.

Enjoy the listen!

If you like the music, there is more of it on Spotify…

The Frontier Psychiatrists is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.

This podcast was edited on a plane ride to Japan, and the intro was recorded in a bathroom while my kids slept off the jet lag. It’s still good. I recently went down with Ben Greenzweig, the Executive Director of the non-profit Living Water Brain Treatment Center in Myrtle Beach, South Carolina. We are—right now—providing TMS treatment and, soon to be more, in a local community in Ben’s beloved home of Horry County. There are 400,000 residents and less than 30 psychiatric inpatient beds in the county. There are not enough services to meet the needs he saw in h...

My readers and listeners know that this project, The Frontier Psychiatrists, is daily. Sometimes, I don't get the thing done till the end of the day. Today is one of those days. I was running on empty when it came to narrative this morning, so I decided to try to make a podcast. One of the tricky things about these more experimental days is that I don't know if the story is going to work. It's like walking a tightrope. I'll choose something— anything— to write about. And today I decide to make it even more difficult for myself, beca...

Today, The Frontier Psychatrists welcomes back my friend Ben Spielberg. He's been a reader for a long time and has contributed to the newsletter in the past. It was on Clinical Trial design, a perennial favorite around these parts.

With only light edits, what follows is his work, narrated by me, for the Audio Version.

I would invite you to the live class today on working as an out-of-network provider, but it sold out last night, so you'll have to wait for the next one.

My prior article on Spravato is available here.<...

The Frontier Psychiatrists is a daily-enough health-themed publication. But sometimes, I just want to make a podcast. Today is one such day.

Enjoy!

The Frontier Psychiatrists is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.

Today is a day of mourning. In broad daylight, in the city I love, Brian Thompson, the CEO of UnitedHealthcare’s insurance subsidiary, was murdered. According to CNN:

Brian Thompson was walking toward the New York Hilton Hotel in Midtown Manhattan, dressed in a suit and tie, to attend UnitedHealthcare’s annual investor conference being held in the ballroom.

A gunman, who investigators tell CNN was masked in the sub-freezing temperatures, waited for about 10 minutes before Thompson’s arrival, before opening fire from 20 feet away shooting multiple times, striking Thompson.

The gunman fled, cuttin...

Synopsis:

Bobby, alone on the side of the road driving back to Manhattan after loading a bear carcass into his Cybertruck, reveals his intention to play the villain. He then pretends to console Donald, the first victim of this villainy. After Donald is led off toward the White House, Bobby greets Elon, who tells him that someone is very ill from an infectious disease. Bobby, once again alone onstage, outlines his plan to have Donald killed by preventable illness and to marry Lady Melania.

—

Act I, Scene I

Bobby:

No...

The path from xanomeline to the brand name treatment named Cobenfy was a long one. Cobenfy is FDA-approved for the treatment of Schizophrenia. Here is the literal label:

COBENFY is a combination of xanomeline, a muscarinic agonist, and trospium chloride, a muscarinic antagonist, indicated for the treatment of schizophrenia in adults.

To people who haven't yet read my book Inessential Pharmacology, (Amazon Affiliate Link), I will highlight that this is approved as a monotherapy. That means it can be prescribed as the only drug for people with Schizophrenia.

It has a completely different...

I was at AACAP and sat down with Dr. Sood, a colleague, and we had a chat about investing, goal setting, venture scaleable businesses, and private equity, and we had some fun at the expense of Red Lobster in the process. I hope my colleagues enjoy the listen!

Prior articles on the topic include What If We Didn’t Blow The Horn, Private Equity Sucks at Running Business of Medicine, and more. Thanks for reading and listening, and Ashwin for joining me!

This Podcast is a recording of departmental grand rounds presented at the Medical University of South Alabama pre-pandemic on burnout. It references a long legal back and forth I’d put up with. That has led to, last year, our legal team filing a defamation lawsuit and, this week, a request for an injunction. It’s more burnout than when I did the talk. I hope it’s still a source of sassy wisdom about what physicians must do to keep their heads in the game, care for patients, and respond with sense and compassion.

The Frontier Psychiatrists is a daily health-themed newsletter. My dear friend Courtny —who recently penned an awesome guest post— reminded me that Fall is here. And with it, seasonal changes in mood for those with Bipolar Disorder. I’ve written about having bipolar disorder before, in a letter to that disorder. I’ve written about how important sleep is to not die. I’ve even written about this specific topic—circadian rhythm changes in bipolar illness, in a prior article here. But who has the time to read anymore? Isn’t there a video or podcast I can view without having...

This newsletter is quite the multi-media shop. It gave me a new tool here on Substack, and I’ll use it less-than-polishedly. I wrote a column earlier this week on infidelity, which seemed to strike a chord. This video experiment was created in response to reader feedback on that piece of writing. It’s a new format for me and far from perfect. Let me know if you dig it anyway.

Remember—I’ve got music on Spotify!

I’m broadly not very talented in a wide range of media.

The Frontier Psychiatri...

My mom and dad left a lot unsaid between them, and after his second stroke, the ability to have the conversation that they had put off? It was like visiting a ski slope in the summer. You can see the runs, you can see where the snow would have been, and imagine the speed, the presence, the thrill, breath taking cold. But none of it is that, at that moment. Many close relationships are actually three relationships happening at once. One relationship is the explicit relationship— what you say to each other. The others live inside each of your he...

Recently, the leadership of all three big health PBMs testified in front of Congress…and…have now been asked to correct the congressional record.

So, I made a podcast instead of an article about it today cause my kids are away, and I love the format. I hope you all enjoy it. The transcript is in the top right if you just want to read, and not listen!

A few prior articles include:

The Frontier Psychiatrists is a reader-supported publication. To receive new posts and support my work, consider becoming a fr...

The Frontier Psychiatrists is a daily enough health-themed publication. It’s also a podcast. Sometimes, I need a break from serious coverage of policy. In those cases, I amuse myself with David Foster Wallace-esque fan fiction about health policy, like this first chapter in my Wizard of Oz-themed parody about health insurance. Dorothy gets strep…then psoriasis…then OCD! Join us for a little health-themed absurdity, and maybe, just maybe, we will all learn something.

The Frontier Psychiatrists is a reader-supported publication. To receive new posts and support my work, consider becoming a free or pai...

I have been writing about PTSD treatments quite a bit in The Frontier Psychiatrists newsletter. One is offered at Fermata, the clinic I co-run in Brooklyn. I recently wrote an article about it. We provide Prism treatment for PTSD at our clinic, much like our colleagues at Homebase in Boston, with Veteran Populations.

Sometimes, you’d rather listen. On that note, here is the podcast version of that article.

Other PTSD-themed writing includes…

Medical Cannabis for PTSD?

Prazosin

The ICU is Traumatic For Everyone

As well as a wh...

I am usually writing these columns from my perch as a psychiatrist, and a distinguished-ish one at that. However, I have been one with an illness. I’m a…patient. Today’s article is very much from that vantage point, to explain to other health professionals how those of us who are patients think. This is not restricted to psychiatric illness, but is more pronounced the more stigmatized the condition.

I’m going to use we here, but it’s the royal we. We are always on the lookout for bigots. We know you judge us. We know you d...

My friend and RAMHT co-founder, Grady Hannah, had a quick and dirty conversation with two friends today about the thrilling 2025 CMS Physician Fee Schedule. Every year, there is an open comment period on these proposed changes, and this year has some crucial changes for physicians who’d love to be able to deploy Digital Theraputics in the context of Behavioral Health Disorders.

Thanks for listening. More coverage of this open comment period is coming soon, but here is a quick overview of the issues at stake.

Yes, this is how nerdy we are at baseline. Ye...

Yesterday’s column was a fine article, but what if you miss my snarky tone while reading it to yourself? Problem? Solved. Dear Readers, here is the podcast version of the aforementioned article!

For those hoping for actual solutions? The AACAP Facts for Families series of guides exist! For example, you can learn how to prepare for your child’s first cell phone. You can also get expert guidance from actual child psychiatry doctors on Internet Use In Children. Or we could follow scaremongering from the Surgeon General? That is also an option.

My ChatGPT prom...

The Frontier Psychiatrists started as a room in on the clubhouse app. One of the enduring pleasures from that era is my friendship with @Psych Fox (Jeremy Fox, P.C.). He’s a licensed professional counselor, EMDR therapist, and a delight to speak with. This week’s podcast features a discussion of a paper Jeremy brought to the table:

Are mental health awareness efforts contributing to the rise in reported mental health problems? A call to test the prevalence inflation hypothesis

The inflation hypothesis posits that more talking about mental health problems leads to more actu...

The Frontier Psychiatrists newsletter and podcast do a lot of cheerleading for brain stimulation—particularly accelerated TMS. However, I’ve recently added many new readers and have not explained my favorite brain stimulation approach. The podcast version and a useful transcript are intended for educational value. Also, here is Garfield:

Prior articles on the topic are myriad, but include:

TMS is better than Drugs

TMS Should be Covered by Medicaid

Depression Can Be Over in 5 Days, Replicated

The Science Behind the Best Outcomes In Mental Health

Your Depr...

The following is a brief explanation of an overarching point of this newsletter: The Frontier Psychiatrists, for new and old readers alike.

It's mostly penned, in the Apple Pencil Pro sense of the word, by Owen Scott Muir, M.D., although I sometimes have guests. We already have a diffusion product: the series of RAMHT events! That's “rapid-acting mental health treatment,” co-created with Grady Hannah.

A crisis is not just a problem.  It’s not just problems—plural.  It’s the admixture of problems with hopelessness.  This newsletter is written to go beyond providing “solutions to problems.”...

The Frontier Psychiatrists is a newsletter and a podcast. Most people assume podcast means “recording a good enough conversation.” Yes, I do those too. I also have a sick fetish for spending way too much time crafting highly produced audio pieces that happen to be podcasts. I think these might need a different name in the future—what happens when species diverge in evolution?

This story is about someone I know—Alan Emamdee, D.O. A man arrested for a crime he didn’t commit. Unlike the A-Team, he didn’t get to go on the run and help peo...

The Frontier Psychiatrists started as a Creator First show on the ill-fated clubhouse app. One of our favorite guests was the remarkable @Psych Fox (Jeremy Fox, LPC), an EMDR therapist with a passion for working with men around their actual problems. One of those is the loss of normative friendships among men—15% of men report no close friendships at all. This corrosion of close relationships is an accelerating problem for both individual men and society.

Today’s episode of the podcast includes both the video above and pushes the audio to the podcast feed!

Prior writ...

The Frontier Psychiatrists is a daily health-themed publication. Your author’s love of podcasting is well established, and today, another from the vaults, dating back to the pandemic. In this episode, which I called “The Wave,” I started getting a little more ambitious in production, and strange in the jagged nature of my storytelling. I interview John Samuels, of WellWorth Advisors, Sonia Patel, of Capsule, and a journalist from the New York Times, as well as folks on my team at the time. Thanks for stepping in the way back machine with me. The pandemic was strange. It shaped us, no...

I know how much my readers love my ongoing coverage of Change Healthcare, and sort of kind of promise to keep dissecting drugs or making fun of myself or whatever it is you find compelling about this newsletter and media empire. Today, however, I will publish a podcast. I had a conversation with @Psych Fox this week, before the ransom was paid, by UHC, about the Change situation. Out of respect to my guest, I’m going to publish it today.

I also take requests on topics for articles and podcasts, so keep them coming. Th...

In this Frontier Psychiatrists Podcast, Jeremy Fox, P.C., And I discuss this remarkable work, as published by Cherian Et. Al. In Nature Medicine. Always love when @Psych Fox can pop in!

We discussed the role of understanding the sample in a research trial and the remarkable potency of Ibogaine, with the additional safety of magnesium to prevent cardiac side effects, in this newly published research.

Thanks for watching and listening, and feel free to share with your friends.

Other excellent psychedelic-themed writers I’d highlight are Mason Marks at Psychedelic Week and Th...

The Frontier Psychiatrists started as a “room” on Clubhouse, and in this podcast, I am joined by one of our favorite contributors @Psych Fox ! He joins me today to discuss how employee assistance programs can create the on-ramp to help and what might improve that process.

A sampling of prior articles about employer-based health care is available here:

The Science Behind The Best In Class Outcomes in Mental Health (with Acacia Clinics)

Lawsuits for Health Plans Have Begun

Alcohol Use Disorder is a Disability

A Conversation About First Responder Heal...

On weekends, I tend to take a break from health policy to focus on personal writing here on The Frontier Psychiatrists. This one is unfortunate, and it is a fair warning to readers who are in no mood for something like that.

My older sister,  Alison, was troubled.   She was also very gifted.   She was trained as the chef at LaVernne, which was a very serious place to do your training as a chef. Parisian chef school doesn't f- around, and she was a gifted teacher of her craft.   She landed a job that she thought would be g...

I checked in with Jeremy Fox, P.C., about a new FDA-cleared device, the PRISM system by GrayMatters Health. This is a treatment modality for Post Traumatic Stress Disorder that doesn't require talking about your trauma! @Psych Fox is one of my favorite trauma therapists, so I called him to discuss.

This is now offered at four sites in the US, and Fermata in Brooklyn, NY, is one of them. I discuss the experience of having PTSD myself and the role of trauma exposure in medical training and practice.

I do the quick version of...