The So How's Therapy Podcast Cover Art on the Demystifying Psychiatry page

Demystifying Psychiatry vs. Therapy with Dr. Claire Brandon

This week on So, How’s Therapy?, our guest is dual board certified psychiatrist in adult psychiatry and consultation liaison psychiatry, Dr. Claire Brandon. Psychiatrists are often confused with psychologists or therapists, but psychiatry can be an important step on the path to achieving your mental health goals.

When you hear the word “psychiatry”, what comes to mind?

Psychiatry is a medical and mental health practice that lives somewhere between what we think of as medical care and mental health care. This episode aims to dispel the myth that psychiatrists can prescribe a pill to take all your problems away and clear the muddied waters around what psychiatric treatment looks like for patients, whether they’re dealing with anxiety, depression, or managing chronic illness.

A photo of podcast host Karen Conlon on the Demystifying Psychiatry page.

Host Karen Conlon, LCSW CCATP

A photo of special guest Claire Brandon, MD on the Demystifying Psychiatry page.

Special Guest Claire Brandon, MD

What You’ll Learn

  • Psychiatry VS Therapy – which is right for you?
  • Why can’t I talk to my primary care doctor instead of a psychiatrist?
  • How do appointments differ?
  • Insurance and OON benefits
  • What are the top three things you are seeing come in through your practice?
  • How do you decide which medication to prescribe?
  • Are there medications that are specific to mental health that are often abused?
  • Can holistic practices be combined with psychiatric practices? What would you recommend?
  • What is one common misconception about psychiatry/mental health?


Karen Conlon:

Hello again, everyone. And welcome to the So, How’s Therapy? podcast. This is a podcast that demystifies, debunks and destigmatizes what happens in the therapy space. I’m your host, Karen Conlon, and I am so happy to have this guest on today.

This is such an important topic and it’s something that people really need to know more about so that it becomes a much more welcoming and potentially healing place rather than a scary or stigmatizing place to be. And that is psychiatry. So today we are going to be speaking with Dr. Claire Brandon. Dr. Claire Brandon is a dual board certified psychiatrist. She is board certified in both treating adults and consultation, liaison psychiatry.

Claire, you tell me if I got that all right, because you have a bunch of credentials and I want to make sure that I’ve got that right. And you have also your own podcast, which is called The GI Psychiatrist, where you explore brain gut issues and all things GI psychiatry. So tell us a little bit about yourself and your practice, first of all.

Dr. Claire Brandon:

Sure, of course. Thanks so much for having me, Karen. It’s great to be here and to chat with you. Always feel inspired after we talk. So yes, you got that all right. I’m an adult psychiatrist, I’m board-certified in adult general psychiatry, and I also did a fellowship specializing in what’s called consultation-liaison psychiatry.

It’s working with patients that have medical illnesses that either cause psychiatric issues or they just have a co-morbidity with a psychiatric issue. So we need to make sure we’re treating that and being mindful about their medical or chronic illness.

Dr. Claire Brandon:

So I do a ton of work in all different types of medical illnesses, whether it’s neurological, so MS patients, migraine patients, epilepsy, working with gastrointestinal patients, which is, of course, my sort of sub sub specialization is what I say, and that is what my podcast is in. And a lot of the work that I focus on, in gastrointestinal psychiatry with inflammatory bowel, IBS, abdominal pain that’s not clear, the course of it, the etiology of it.

I spread myself across quite a few different places and I have my private practice, but I see those patients in for therapy and medication. I’m excited to talk with you a bit more about medical health and psychiatric health and what that’s all about.

Psychiatry VS Therapy – which is right for you?

Karen Conlon:

First, I’d love to really maybe start with what is the difference between psychiatry and therapy? Because I don’t know if you get this question, but I know that there’s always this confusion about psychiatrist versus psychologists, and who’s a therapist and who’s not a therapist and clinical psychologists.

And I know that depending on states and the laws, what you can do differs. But since we’re in New York State where we’re recording from, let’s talk about New York State and what that looks like and what are the differences.

Dr. Claire Brandon:

So let’s start with what I am. So I’m a psychiatrist. I went to medical school for four years, just like any surgeon, family medicine doctor, the same background, did all the same stuff. I have an MD. So psychiatrists could be an MD or they could be a DO, right? Those are two different types of medical schools. And then I did a residency.

So I trained in adult psychiatry for four years where I was doing inpatient psychiatry in hospitals, consult work in the medical hospitals and doing outpatient psychiatry, learning how to prescribe psychiatric medications and also doing psychotherapy training.

Dr. Claire Brandon:

I’m licensed to practice medicine in New York State. I have a DEA license. I can prescribe medications. And that’s probably one of the most significant differences between psychiatrists and any other type of therapist that we would be talking about in the mental health field, including psychologists who also go by doctor.

They have a PhD or a PsyD, but they can’t prescribe medications. So that would be one of the major impactful differences. They didn’t go to medical school, so they don’t prescribe medication.

Karen Conlon:

You have an MD license as well, right? So here’s something that comes up also. Why can’t I go to my general practitioner to give me a medication for my anxiety?

Why can’t I talk to my primary care doctor instead of a psychiatrist?

Dr. Claire Brandon:

Absolutely, yeah. And actually, we often see and primary care doctors are being tasked more and more these days with more mental health becoming an issue, especially in the context of the pandemic, primary care doctors are often the first people that are prescribing antidepressant medications, anti-anxiety medications.

And what I would say about that is it’s a great starting place. I think it’s super worth talking to somebody that you trust, like your primary care doctor, and they may prescribe you something like a pretty standard antidepressant medication. You guys have probably all heard of Zoloft and Prozac and those types of medications.

But when you start getting into symptoms that are not being targeted by those medications, or you’re feeling like you want more expert guidance on what’s going on or what you should expect from these medications, it can be really, really helpful to see a psychiatrist.

Dr. Claire Brandon:

They can tell you a little bit more about what to expect and how to target the medication. So I often find that the upside is that someone’s been started or have been started to think about a medication because their primary care doctor has told them to think about it, that they might be depressed.

But often, they feel not equipped to sort of help the patient go up on the doses or the patients even want more explanation about what they should expect. And so when someone comes to see me for a consultation, we’re talking about all different kinds of medications we might be able to utilize.

What you should really expect, why would we be using this medication. So I’m just more expert in psychopharmacology in knowing what we’re targeting, how to target it, what you should expect, and actually how to use medications for both their benefits and their side effects.

Dr. Claire Brandon:

I use medications that can be a little sedating to help people both with depression and to go to sleep at night versus sometimes a primary care doctor might not tell you that it’s going to make you sedated or sleepy. And then you’re saying, “I’ve had a bad experience with psychiatric medications. I don’t want to take them.”

So I think it’s helpful to talk with a psychiatrist or at least have a consultation so you know what to expect instead of having a bad experience with somebody telling you, “These don’t work for me. Psychiatric medications don’t work for me. A doctor prescribed it and I didn’t feel well.”

Karen Conlon:

Yeah because that’s a really blanket statement that not only really alienates the possibility of something else that really could work much better for you, but it’s also very rigidly placing psychiatric medications into a bucket where we’re just going to put this here and put this away. You might really be taking away the opportunity for you to actually feel better. And it sounds like in more than one ways, right?

Because I’m hearing, okay, so I’ve got this one medication that is going to help you, not just with your depression, but with your sleep. And I know, and we’ll talk about this too, with GI medications as well, there are some questions sometimes that people have around, “Why did my GI doctor prescribe this particular medication? I’m not depressed.” But we know that there are other reasons and other ways that certain medications are used. Right?

Dr. Claire Brandon:

Yeah. And I think that’s a really great point that you’re making, right? Somebody could feel really taken off guard if they are prescribed a psychiatric medication for a different reason.

A great example of that is that primary care doctors really, really seem to love anti-psychotic medication for sleep. And someone could get really scared if they get put on an anti-psychotic or don’t know the side effects that could potentially come out of that. Not that it’s absolutely wrong all the time that they’re doing that, but it’s sort of something that people can get really thrown off by and confused by.

And they really need to be a little bit more aware of what they’re taking and what’s going on, again, to prevent them from having really bad side effects or prevent them from just not knowing what to expect with the medications and then saying, “I’m done with psychiatry.” You never started psychiatry.

Karen Conlon:

Yeah. And then also the other thing too, that you mentioned was contraindications, right? Sometimes, unless you have the specialty or the focus that you have, we can’t take for granted that a general practitioner will know the difference. They may be very well-meaning and want to continue to try things, but there might be some contraindications, right?

Contraindications, for those of you who haven’t heard that word before, it means things that maybe work against each other or that one medication maybe nullifies the effect of the other, things like that, that can be happening. Really talking to someone who is an expert in their field and especially when it comes to medication management is so important.

Karen Conlon:

The other thing also that comes up often is there is usually a relationship that’s built with the doctor. And especially if it’s your family doctor or your long-term doctor, and there’s a lot hesitancy around authority, right, the authority figure, and not really self-advocating.

Can you maybe provide some guidelines around, okay, when is it time for me to say, “This maybe is not working” or is there some language that you can give people who are listening around how to talk to their providers about it if they feel uncomfortable advocating for themselves?

Dr. Claire Brandon:

People often feel like if I was really doing poorly and my doctor would have told me that already, as if your doctor could mind read you and know that you’re not doing well, or they would be able to see that somehow. And I think the thing that people go into any kind of physician is that they think that the doctor is just going to know the exact questions to ask, and they’re going to know exactly what to do.

And you really have to be part of your own treatment team in order to get the best medical care that you can. So what I would say is, if you do start feeling anxious or depressed, and your doctor is open to having that conversation with you, bringing that up each time you come in, “I am actually not feeling less depressed or I’m still struggling to sleep. Do you think that I need to take a different medication? Do you think that I should see somebody else?”

Dr. Claire Brandon:

And often, primary care doctors, they’re a little nervous to say, “Why don’t you see a psychiatrist?” because I think it goes both ways, that they don’t want to make you feel like something’s going on with you, or that you’re too much for them to take care of.

But the reality is again, if they were looking at your heart for an issue, they would refer you to a cardiologist, no question. And you wouldn’t have any questions about that either. So I think it shouldn’t be a thought that’s different about your mental health and your brain health, and what’s going on with you.

It’s just a matter of, can you speak up to your doctor and say, “I’m not feeling better. What should I do now?” and that you might be open to seeing a psychiatrist or someone else who’s more specialized in mental health instead of hoping that your doctor, every six months, might be able to catch something that’s going on with you. Right?

How do appointments differ?

Dr. Claire Brandon:

That’s the other piece. You have to remember primary care doctors, how often do we get to talk to our primary care doctor more than 15 minutes. Really, that’s the way medicine is now. And you really have to be in and out. And it’s not that the doctors want to do that. They just happen to be on that really strict time restriction.

So that’s worth saying, if you feel like you’re not getting enough time to talk about the antidepressant medication, the anti-anxiety medication, that also might be a trigger in your mind to say, “Could you refer me to a psychiatrist so that I could talk more about this.”

I ended up seeing my patients for 45 minutes and follow up no matter what, even if we’re just doing medication, because it’s important to really discuss that, talk about it, destigmatize taking the medication and I feel like patients have a better outcome when they really understand what they’re putting into their body and what they’re taking.

Karen Conlon:

So 45 minutes, that’s not usual though, for someone seeing a psychiatrist. As a therapist, as an LCSW, I typically see people 50 minutes, right? And sometimes I get people to say, “Oh, I only saw my psychiatrist for 15 minutes and they don’t want to see me more than once a month.”

And there’s this confusion around what the expectation is supposed to be that you’re thinking, well, we’re going to see our psychiatrist for the same amount of time that we see you. And they’re looking at the cost involved and all of this stuff. And so they’re saying, “What’s going on?”

And before they know it, they’re trying to go from psychiatrist to psychiatrist. So can we talk a little bit about what people should expect because 45 minutes is not usual, right?

Insurance and OON benefits

Dr. Claire Brandon:

So we’re in New York, we’re in Manhattan. So it’s a little bit of a bubble as far as mental health goes as well. We’re sort of saturated with psychiatrists here and the coasts have that benefit, whereas in the Midwest or in the South, there’s a lot fewer. And one thing I would say, which is a really serious problem in mental health, is that insurance really does not reimburse mental health services for even psychiatrists.

I’ve see what my bill was and the percentage that the insurance pays back. And it could be really good if they have a good insurance plan, but it could also be 10%. And mental health parody has really not caught up to be seen as something that’s important for your overall wellbeing and health and how to decrease insurance costs long-term, right?

We know depression impacts people’s physical health, we know that it impacts workdays and lost costs of companies and things like that. And yet, people really don’t get reimbursed or benefits it seems, to see a psychiatrist.

Dr. Claire Brandon:

So I think the issue is that in psychiatry, if you are taking insurance, really cost-benefit wise, and this is just the reality of medicine, you can’t see somebody more than 15 minutes because you have to see as many patients as you can, similar to primary care.

If you don’t take insurance, so for my practice, I don’t take insurance, which I know is more of the standard in Manhattan, but it’s also hard for patients and they have to rely on their out of network benefits. But I get to practice the way that I think is the best suited for the patient.

And I guess that’s the benefit that the patient gets as well, that they’re seeing me for 45 minutes, they get 45 minutes of my time, at any interval that we together decide, makes sense. So it could be monthly if they’re really doing well, but it might also be every other week or weekly that I’m seeing somebody, especially if I’m seeing them for psychotherapy as well, to get 45 minutes, it really generally is not an insurance-based practice.

Karen Conlon:

So you mentioned also that you also do psychotherapy, which is why I say that you are a unicorn. Right? So this is the other thing too, that people are expecting, they hear the word psych in psychiatry and they’re expecting therapy. Not all the time, but a lot of times there is this expectation that why was I in an app for 15 minutes?

So thank you for explaining that because there is a huge issue with insurance companies and mental health providers. I think the general public is not really aware of all of the issues that happen with insurance companies, all of the things that we as providers are subjected to.

If you do go and network with an insurance company, things such as clawbacks and audits, and them really being able to say, “Oh, you know what? We’ve decided that this person really didn’t need all this for the last year. You owe us thousands of dollars back.”

Karen Conlon:

These are realities of things that happen and we’re hoping and pushing for insurance companies to be more supportive of mental health. Because at the end of the day, we are the ones who suffer, generally speaking, and our clients, right? Our clients suffer. They’re not getting what they need.

And we as providers are looked at like we’re terrible people because we’re not taking insurance, but there are so many limitations. If I could be on every insurance panel and be able to actually make a living and not have to hire 50 therapists in order to do that, I would be happy to do that.

Dr. Claire Brandon:

It’s not only just the therapist, right? You have to hire billers. Hospital systems have entire departments that go after insurance companies and they only still get percentages of the money back. So to make it as cost-effective as I possibly can, I can’t take insurance.

It’s not a possibility for me because I was trained in medicine and psychiatry. I was not trained in figuring out how to do billing for insurance companies. As confusing as it is to patients, it’s funny, they always ask for my help with navigating and it’s like, I have the same issues with my own insurance, right?

I’m a medical doctor and it’s hard to navigate insurance. So that just tells you how difficult insurance companies really make it for patients to get quality care. I could go on and on of my soap box about insurance companies.

Dr. Claire Brandon:

It’s a huge problem. It’s a huge problem in America to be able to get good insurance, to not break the bank paying for your insurance plan. And I think when people do that, they’re paying potentially on the open market, $2,000 a month for their insurance plan, they don’t want to also pay out of pocket mental health.

And those plans don’t cover mental health, to be frank. I get it. I don’t think people are unreasonable. I think they are reasonable and insurance companies aren’t, but it’s also to get good quality care, unfortunately, it tends to be out of pocket, at least in the East Coast and the West Coast probably.

Karen Conlon:

Yeah. That’s the other thing too that people don’t know. They might be dealing with some issue that if it’s not considered medically necessary, insurance companies will not cover for it.

And speaking of themes and issues that come up, what are the top three things that you’re seeing that come through in your practice? You focus on GI health, you focus on making that connection with medical health. Can you tell me a little bit about what comes through?

What are the top three things you are seeing come in through your practice?

Dr. Claire Brandon:

The three major buckets that are going on in my practice, one is chronic illness, right? So dealing with either the depression and anxiety that inherently come from chronic illness and the medications are used to treat those chronic illnesses. So that could be migraines, migraine medication, how that impacts your life, GI, GI medications, how that impacts your life.

Bucket number two is probably these, I see it as a psychiatrist, the standard anxiety and depression. Obviously, no one’s anxiety and depression is standard, but more straight forward with cognitive behavioral therapy, psychodynamic psychotherapy and using plus or minus medications, in my practice for anxiety, depression symptoms.

A significant amount of obsessional anxiety, I guess, would go into that bucket as well. Often people think they have OCD, but they actually have obsessional anxiety symptoms or ADHD symptoms that we’re uncovering and understanding more.

Dr. Claire Brandon:

And then the third bucket I would say is more of talking about life planning. I see a mix of patients, but a lot of my female patients right now, especially with the pandemic delaying our lives a little bit, thinking about how they’re going back into the dating world, how they’re thinking about getting into relationships, are considering freezing their eggs.

That’s actually been a huge thing that I’ve been talking about with patients right now with the delays in life from the pandemic. So just thinking about making life decisions, assertiveness in your life and you’ve work and making those career type of decisions by using psychotherapy and just coaching through that and thinking about how you want to live your best life, really.

Karen Conlon:

We are also seeing a lot of these three areas. It’s interesting, the obsessional anxiety that you mentioned, that is something that’s come up more. We actually did an episode on OCD recently, and we talked about these different obsessions, but we didn’t talk about medication management and how that can be helpful.

We talked a little bit about neurotransmitters in the brain, but we really didn’t get into this. I’m glad that you’re bringing this up. This is a nice tie in to that episode as well so that people know that you don’t have to have OCD in order to have obsessional anxiety. So this is a great point that you’re bringing up.

Dr. Claire Brandon:

Absolutely. And I think that one of the major differences is that there’s this, you probably talked about this in your OCD episode, the egosyntonic versus ego-dystonic. So egosyntonic means it’s kind of okay with you, like you understand it and you’re with it. Nobody’s super excited to have anxiety, but they’re familiar with their anxiety and they’re familiar with the obsessions that come up with their anxiety.

True OCD is extremely ego-dystonic. So patients are really disturbed by their OCD. It’s not just a, “Oh, I need to check because I feel like it.” They really can’t stop. They really struggle. And often, patients with OCD describe it as a feeling inherently that they get once they have checked something or counted to a certain number.

It finally feels settled to them, but they don’t like that. They’re not happy to wash their hands a thousand times. If I said to them, “If I waved a magic wand and I could get rid of the symptom for you, would you?”, OCD patients and say, “Absolutely. Please get rid of this.”

Dr. Claire Brandon:

Obsessional anxiety patients often have a harder time feeling that buy-in to getting rid of it because their anxiety makes them believe it’s really necessary in a lot of ways. OCD patients can feel some of that necessity to that as well. But I would say that it’s again, more debilitating to them.

They really can’t live their lives with OCD, whereas obsessional anxiety comes across more as, “I’m anxious, but I’m still going to work. I’m still holding down a relationship. I’m still able to do a lot of these things.” Usually patients with significant OCD struggle with a lot of that.

Karen Conlon:

Thank you for describing that because again, it’s one of those topics that I think a lot of people are familiar with generally on a daily basis and going through their lives, but not really understanding the nuances, the differences. Yeah, so I’m glad that you brought that up and you were able to elaborate.

How do you decide which medication to prescribe?

Now that brings me to medications to prescribe, right? Because we’ve talked about chronic illness and we’ve talked about anxiety and depression and life planning. What are some of the more commonly prescribed psychiatric medications? And then also, how do you decide when?

I know that’s a really loaded and general question, but maybe within the realm of those three areas, if you can just give us an example.

Dr. Claire Brandon:

Sure. And I guess to say also this idea of when and why is important because as you were saying before, you hear psych and you think therapy. But when people come to a psychiatrist, an MD, they’re assuming that I’m going to immediately prescribing the medication that’s going to make it go away, right?

So you go to your primary care doctor, you have high blood pressure, you take a medication, you don’t think about it anymore. Your blood pressure’s better. Maybe you make a few lifestyle changes, but generally speaking, medications that target high blood pressure are much more concrete. They’re very black and white, it’s going to either decrease your blood pressure or it’s not.

The tricky part with psychiatric medications is our brain is the most complicated organ in our body, right? We still are figuring out the brain right now. We call psychiatry more of a gray science, more of a gray area.

Dr. Claire Brandon:

And generally, people who are in psychiatry are more able to tolerate that. I usually tell patients, “This may take a couple of tries. We may have to figure out what receptors really makes sense for your brain.” And I say that preemptively because I feel like patients experiencing medicine in general, often get this idea from a doctor that, “Take this, you’ll feel better.”

And that’s really not the case in psychiatry all the time. Of course, that’s my goal, I want you to feel better. But within the realm of expectations that make sense for you that I’m not going to take away the fact that you’re getting a divorce. That’s still going to be stressful, that would be stressful to anybody. Or that you had a major medical diagnosis. These medications don’t wipe your memory and you don’t have to think about that anymore.

Dr. Claire Brandon:

We use medications, the way I describe it to patients is that we’re trying to create a bit more of an armor, right? I want to pull down the intensity of your anxiety. I want to pull down the intensity of your depression so that you can better engage in psychotherapy because that’s really where the long-term work happens.

Usually I don’t keep patients on, especially if they’re dealing with their first episode of anxiety or depression. The studies and the research shows that about a year is what helps to prevent relapse of those symptoms if you’ve gotten full remission of those symptoms. It’s different than bipolar disorder, where you might have to be on medications long-term.

That’s important to keep in mind and schizophrenia or any kind of psychotic disorder, those are very different. But in outpatient psychiatry and these buckets of patients that we’re talking about, we’re really thinking more about how to help you have more resilience, how to help you engage in the work that’s going to help cognitively restructure the patterns and the behaviors that you’re having on a daily basis.

Karen Conlon:

This is such a great explanation for people that you’ve just given because again, it’s one of these areas that we don’t think about that everything might help within its own realm, but not everything is going to be the magic pill, right? Medications have their limitations, right? Medications, maybe in some cases, can help take the edge off, like in some of the things that you described.

But then the long-term work, the psychotherapy work, the cognitive behavioral therapy, the talk therapy, narrative, whatever type of therapy it is that then is going to help you to retrain your brain, reframe and teach you the different coping skills and strategies, medication can’t do that. That’s where you’ve got that bridge where we need to decide, okay, so this is helping and now I’m ready to do more.

Because sometimes if your anxiety is bad enough, if it’s chronic enough, you might be going to therapy on a weekly basis, psychotherapy, and doing all the work and it’s still just not sticking. And if that anxiety is so high that it’s just not allowing you to integrate the work, maybe it’s time for some medication.

Dr. Claire Brandon:

Often I find that all that work that you put in, you start taking a medication and then the work sinks in for you, right? Your brain still held on to it. It was just really difficult to employ until your intensity of your anxiety was down a bit. And to just say the opposite, right?

If you’re experiencing a benefit from the medications and then you say, “Well, I’m going to quit psychotherapy,” that’s also, we don’t want you to do that. The combination is the work. It might feel like an investment, but it’s an investment forever because you can get better from it with this combination of psychotherapy and medications.

And people often say, “Well, I talk to myself about it all the time.” And it’s different when you’re talking to yourself versus having a therapist really reflecting this back to you or saying some of those hard truths that you might not really want to say to yourself or that your mom might not say to you, right?

Dr. Claire Brandon:

So the idea that once you start feeling better, that’s really when you ought to get in there and dig in with the work, because that’s where the long-term benefit is going to come out. So it’s really important to maintain both and to do both things. And probably worth getting an opinion from a psychiatrist earlier, right?

If a medication could help you then you don’t want to be spinning your wheels for two years in psychotherapy when you might get a benefit out of it and be doing both at the same time. So it’s really worth.

At least get a consultation, right? At least get an idea of what you might be able to utilize. You’re not signing over your life. You don’t have to take a medication if you don’t want to. It’s worth understanding what your options are though.

Karen Conlon:

I’m very visual. I’m a very visual thinker. So as you’re talking, I’m thinking about trailheads, right? You’re going on a trail or you’re going hiking, you start off here and then as you go on that trail, you’re not going to know what’s out there or what you’re going to discover until you actually go down the path.

Are there medications that are specific to mental health that are often abused?

And what do we say to people that are afraid of maybe addiction or maybe abusing? Are there medications that are specific to mental health that are abused? And I don’t know if I’m even framing that right, but just wanting to talk a little bit about the fears around abuse and addiction.

Dr. Claire Brandon:

I hear it all the time and it makes me wonder if people think that psychiatrist has some sort of, buy-in, like they want you to be stuck on a medication. But in general, no, I tell my patients, “I would love it if you didn’t need to see me anymore.” That’s the best outcome, you don’t have to see me anymore.

There are some medications that can cause physiological dependence, right? So physiologic dependence versus abuse are different things because physiologic dependence, your body gets used to something. And then you might have withdrawal from it.

Whereas abuse is that you’re using it for a different reason than it’s prescribed. We think about that with opiates, right? Those are theoretically for pain. People take them to self medicate for mood symptoms or to get high or whatever, to feel different than they currently feel.

Dr. Claire Brandon:

Physiological dependence can happen, both can happen in psychiatric medications. And I would say that’s actually even more of a reason to go see a psychiatrist, ideally, who is seeing you for longer than 15 minutes potentially because primary care doctors often are prescribing something that’s going to make you feel better right away.

Again, it’s not a dig on primary care doctors, but something like a benzodiazepine. So that category of drugs would be like Xanax, Klonopin, Ativan, Valium. People take those and they suddenly feel, “Oh, I feel better. That took away my anxiety.”

But unfortunately, those medications actually don’t do anything as far as restructuring your cognitive neuroreceptors. And your brain, it’s not changing. The medication has to be there in order for you to have the effect, which is why it ends up being that people get physiologically dependent on things like Ativan or Xanax.

Dr. Claire Brandon:

Xanax is the worst offender, probably, because people take it, it feels really good right away. And what they often feel is that there’s a rebound anxiety, right? So it’s on in 30 minutes, it’s off in 30 minutes and then suddenly you have even worse anxiety it seems because it comes out of your system like a bullet out of a gun, right? It’s out of your system.

But the idea that, then you have to take more and then you have to take more. And then your body develops this threshold to the medication to keep asking for higher doses. So that is a category of medications that actually I only prescribe for very short amounts of time or for flight anxiety if somebody is taking it once in a while and that’s all they’re taking it for.

Dr. Claire Brandon:

Whereas, SSRI medications, SNRI medications, those are the major classes of antidepressants. That’s like the Zoloft, Prozac or SNRIs, or like the Cymbalta, Effexor or type of medications that often are used in chronic pain as well, or migraine or fibromyalgia. Those medications don’t result in physiologic dependence. You don’t require more and more of the dose. And it’s a daily medication. It’s not causing any kind of addiction properties.

People can feel a withdrawal when it’s coming out of their system because their body’s just adjusting to seeing less of the medication resulting in higher serotonin, higher norepinephrine. So people can feel like they’re withdrawing from it, but it’s not a dangerous withdrawal the way that Valium or Ativan or Xanax could come out of your system and result in you having a serious withdrawal, including seizures and dying.

Karen Conlon:

The lesson here is don’t stop taking anything on your own, right? Because you don’t really know what is going to give you or results in a dangerous withdrawal course versus what’s not.

Dr. Claire Brandon:

Right. And I think being open with your doctor. You are a part of your treatment team, right? So if somebody comes to me and says, “I don’t feel comfortable taking this medication anymore,” it’s not in my best interest to demand that they take this medication.

I don’t have any buy-in to them taking it or not. It’s that I want them to feel better. And if they already cannot feel better because they don’t want to take the medication period, then I’m happy to take them off of the medication.

Dr. Claire Brandon:

That also is an important thing to be seeing a psychiatrist if you’re coming off of a higher dose of an antidepressant, because it’s tough when you’re withdrawing. Sometimes I prescribe a different medication to help aid in that sensation. I might use a compounding pharmacy where I’m doing smaller and smaller doses of the medications than are actually manufactured.

It really requires somebody who knows what those symptoms could be like, instead of just saying, “Yeah, just stop taking it. You’ll feel better.” People can’t tolerate that all the time when it’s worth being able to talk about that and having someone to ping back to, to say, “I’m really struggling with this, coming off this medication.”

Can holistic practices be combined with psychiatric practices? What would you recommend?

Karen Conlon:

And what about holistic? Can we combine holistic practices with medication to help efficacy, just somebody feeling more capable and more in control of their bodies and their symptoms? Are there any holistic practices that you would recommend?

Dr. Claire Brandon:

I think it’s important and probably part of your treatment plan to be doing things that might otherwise seem holistic. But exercise can be a holistic practice that you’re doing, you’re engaging in. Doing yoga has a lot of cognitive therapy in it. If you know cognitive therapy and you listen to yoga instructors, you’re like, “Oh, that’s a CBT technique.”

Doing those things is really important to feel that mind-body connection. That really helps you be grounded, that helps to decrease anxiety and depression symptoms. A lot of my patients, especially with chronic pain, with chronic illness, they’re going to acupuncture, they’re doing massage therapy. They might be doing different techniques like that, which I think are totally great. I totally encourage that.

Dr. Claire Brandon:

The one thing that I want to be transparent with that I’m certainly not against, but taking any kind of supplementation, like over the counter supplements or any kind of herbal medicine, it’s important to be honest with your doctor about what you’re taking. Because unfortunately, A, some of those medications can interact with our medications and B, they’re just not FDA monitored.

So we don’t know. You could be taking a supplemental medication that’s causing you a side effect. And here I am prescribing you Lexapro, you have a bad effect, but it wasn’t the Lexapro. And now you have a bad feeling about psychiatric medication, right?

Dr. Claire Brandon:

And I think the biggest culprit there, which I think people are more and more aware of, but just more saying is that this medication called St. John’s Wort, it’s a medication that often people are taking for anxiety and I think I’m seeing it more in these startup companies that are saying, “Take this to chewable whatever, you’ll feel relaxed.”

It’s called literally just relax and it could be in there. So if you’re taking anything like that, bring the bottles to your first appointment, look it over. It’s not always possible to do drug checks on these because they’re just not in the pharmaceutical registries.

But it’s worth talking about and making sure there’s nothing that’s obviously going to interact with your medications from what we know, and that you don’t end up having a really bad reaction because you were just trying to take a medication that’s going to help you relax on top of whatever else you were getting prescribed.

Karen Conlon:

I’m really glad that you brought that up because I was also thinking about CBD oils and CBD products. That’s the other thing that came up for me now, because that’s really what people are taking, like gummy bears, like literally CBD gummy bears, and things like that. That can be helpful.

But again, we’re talking about really becoming a part of your treatment plan and I want to just bring up what you said before. If you have problems or issues or feel embarrassed or hesitant to talk to your doctor, maybe letting them know that something’s not working, you can maybe reframe that for yourself, right?

And make that doctor human and remember that they cannot read your mind. Your doctors are human beings, they’re not mind readers. They’re going to get it wrong. They’re supposed to get things wrong because they’re humans.

And if you can just help your doctor out by giving them regular feedback, giving them updates on your symptoms, you’re not challenging authority. You’re actually helping them. And if you come across a doctor that is not open to that feedback, then maybe it’s time to consider going somewhere else.

Dr. Claire Brandon:

Absolutely. And I think bringing up things or wondering if something is making an impact and being able to have an open conversation is incredibly important. The one caveat I would say is that if you are demanding something from your doctor, like I’ve had patients say, “I only want Valium.” But I don’t prescribe that.

It’s always, the doctor has to feel comfortable with what they are prescribing. But having an open conversation should always be on the table about why they will or won’t prescribe something or what they think their rationale is. They should be able to explain to you why they think that it would be beneficial for you. And if you’re willing to try it, great. If you’re not, that’s okay too.

Dr. Claire Brandon:

I think it’s just that patients often, they only want a small dose of something. So be open to hearing what the conversation is. If you’re going to take a medication, take it so that it’s therapeutic and effective for you. And if you don’t want to do that, the door is open, right?

You don’t have to decide right then and there. And if the doctor wants you to decide right then and there, I think that’s a good question of, “Well, let me sleep on it.” Feel like you can say, “I’d like to think about it,” and not have to immediately take the medication if you don’t really know if you’re comfortable with it or not.

What is one common misconception about psychiatry/mental health?

Karen Conlon:

Yeah. Absolutely. Just open dialogue and communication is the best way to get the best care for yourself. We’re almost at the end of our time here and I know this, sadly, and so I wanted to ask you. If you can give people here something to think about that they can walk away with, one aspect of psychiatry that you want to debunk, demystify or de-stigmatize, what do you want to say to people? What would you like people to leave with?

Dr. Claire Brandon:

Since I’m in the medically complex world and I’m dealing with a lot of patients that have that, especially in the time right now of COVID and people having chronic issues from that, I guess one thing I would say is to not assume that you need to muster through and to have to deal with it on your own. There are ways to target these symptoms that you’re having.

The expectation if you have a chronic illness is not that you are supposed to have a smile on your face and just walk it off. It’s totally fine and it’s really reasonable and it’s really responsible to get some psychological help for that because no one was born to deal with having a chronic illness, which includes depression and anxiety, by the way.

Dr. Claire Brandon:

No one was going to deal with having a chronic issue and to just deal with that on their own, without any support. We can all benefit from support. If can get it, if you can go to therapy, if you can see a psychiatrist, try it out because it probably isn’t going to be as scary as you think it’s going to be.

And hopefully, just listening to this podcast, hearing me that can help open up that door and make people feel like it is a reasonable next step to take. So don’t feel like you have to do it on your own.

Karen Conlon:

And I actually feel a little warm and fuzzy as I talk to you, not going to lie. So Dr. Claire Brandon, everyone. Can you please tell us how to find you if people want to reach out to you, website, social media, email?

Dr. Claire Brandon:

Absolutely. So my two Instagrams, so one is my name, ClaireBrandonMD And you can look me up on Instagram and reach out there. My podcast is the GI Psychiatrist, as you mentioned. It’s on Apple and Spotify and everybody can listen to podcasts. And I have a corresponding Instagram with that for the GI Psychiatrist.

And you can also go to my website, which is and you can send me a message through that if you’d like a consultation or set up an appointment. That’s an easy way to get in touch with me and definitely look forward to hearing from anybody that has questions.

Karen Conlon:

Wonderful. Thank you so much for being here today. We are so grateful.

Dr. Claire Brandon:

Thank you for having me. This has been so fun. I really enjoyed it.

Karen Conlon:

Good. I’m glad, I’m glad. So many people are going to get so much out of this. Thank you so much.

And as always everyone, if you want to know more about our practice or this podcast, please be sure to head over to to check out the show notes. There, you’ll be able to find resources, links, and how to get in touch and more information on Dr. Claire Brandon.

So I look forward to seeing you next time when I ask again, “So, How’s Therapy?”

About So, How’s Therapy?

In each podcast episode, Karen and her guests work to push through the traditional therapy format to demystify, debunk, and destigmatize therapy.

Whether you’ve been in therapy for years, or are thinking about reaching out, Karen is here to guide you through it all.

She tackles everything from Anxiety, Trauma and PTSD, to Childhood Emotional Neglect, to dealing with chronic illness, and everything in between, through the lens of her private practice in New York City, Cohesive Therapy NYC.

Karen Conlon LCSW | Licensed Clinical Social Worker | Cohesive Therapy NYC

Your Host: Karen Conlon, LCSW CCATP

Owner, Founder, and Clinical Director of Cohesive Therapy NYC

Want to know more, be a guest on the podcast, or are located in New York or New Jersey and interested in therapy? Reach out at We’d love to speak with you.

About the author(s)

Karen is the founder and Clinical Director of Cohesive Therapy NYC. She earned a Masters in Social Work from New York University and has extensive training in Hypnosis, Anxiety, Cognitive Behavioral Therapy, Brainspotting, and DGBI. She is a member of the Institute of Certified Anxiety Treatment Professionals, The Rome Foundation, the National Association of Social Workers, The Crohn's and Colitis Foundation, and the American Social of Clinical Hypnosis.

About Cohesive Therapy NYC

At Cohesive Therapy NYC, we believe that you have an immense amount of inner strength and resilience, even if it is yet to be discovered. Cohesive Therapy NYC is a private group psychotherapy practice in New York City that focuses on treating adults who struggle with Anxiety, Trauma, Chronic Illness, and the adult impact of Childhood Emotional Neglect (CEN). Cohesive Therapy NYC therapists see clients all throughout New York State (Manhattan, Queens, Brooklyn, Bronx, Staten Island, Westchester, and statewide) using online therapy and are also available for in-person visits in their NYC offices, located at 59 East 54th Street, New York, NY 10022. We specialize in helping people who are dealing with anxiety, relationship issues, chronic illness, and digestive and adult trauma related to childhood family dynamics. We all deserve a chance to be well and have support.