Psychiatric Second Opinions in Manhattan

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Most people who ask for a second opinion have been in treatment for years, are not much better, and have started to suspect the problem is them.

Usually it isn't.

What I actually find

In rough order of frequency:

The initial evaluation was incomplete. A diagnosis assigned in a 20-minute visit during a crisis, never revisited. Everything downstream inherits that error.

There is an untreated comorbid condition. Depression treated for a decade in someone whose undiagnosed ADHD is generating the failure that generates the depression. Anxiety treated in someone with untreated sleep apnea. OCD treated with supportive therapy that functions as reassurance.

The medication was never adequately titrated. Declared a failure at a starting dose or at four weeks. OCD in particular requires higher doses and 10–12 week trials, and premature abandonment is routine.

The regimen accumulated and was never subtracted from. Four or five medications, each added during a crisis, none stopped. Nobody can say which is working. This is the most common finding in complex cases and the one where careful, staged deprescribing produces the largest improvement.

The diagnosis was right once and isn't now. Bipolar diagnosed off a stimulant-induced activation. Borderline personality disorder assigned to someone with untreated ADHD and trauma. These labels follow people for decades.

What I bring to it

I research psychotropic prescribing. My 2019 JAMA Network Open study — 440+ citations — documented antipsychotics being prescribed to young people with ADHD without appropriate indication. I've published on clozapine underuse and on ADHD medication and functional outcomes in JAMA Psychiatry.

I am also board-certified in both adult and child/adolescent psychiatry, which matters when the question involves a diagnosis originally made in childhood.

And I have no interest in defending a prior clinician's decisions or in reflexively contradicting them. Frequently the previous treatment was reasonable given the information available at the time. The useful question is what the information supports now.

What a second opinion involves

Before the visit. Send records if you have them — prior evaluations, medication history with doses and durations, relevant labs. Not required, but it substantially improves what I can tell you.

The visit (90 minutes). Full independent evaluation. I do not start from the existing diagnosis. Developmental history, treatment history including what was tried at what dose for how long, and systematic differential screening.

The output. A written assessment: what I think the diagnosis is, where I agree and disagree with the current formulation, what I'd change and in what order, and what I'd want to see before changing more.

What happens next is yours. You can take the assessment back to your current psychiatrist — many are glad to have it. Or you can transfer care here. I have no stake in which.

What I won't do

• Contradict a colleague to win a patient
• Recommend stopping medication abruptly
• Tell you a diagnosis is wrong without a better account of what's going on
• Take on a case where the honest answer is that your current treatment is appropriate and the problem is that the condition is hard

Related

Medication management · ADHD · Treatment-resistant depression · Bipolar · OCD · Child psychiatry

Frequently Asked Questions

Do I need to tell my current psychiatrist I'm getting a second opinion?

Not required. Most psychiatrists regard second opinions as normal practice and many welcome them in complex cases. You are entitled to one either way.

What should I bring?

Prior evaluations, a medication list including doses, durations, and why each was started or stopped, and any relevant labs or testing. If you don't have records, the visit still works — it just relies more on your account.

Will you take over my care?

Only if you want that. Many second opinions end with a written assessment you bring back to your current psychiatrist. Both are legitimate outcomes.

How long does a second opinion take?

Typically one 90-minute appointment, occasionally two if records are extensive or the history is complex. Written assessment follows.

Can you review my child's diagnosis and medications?

Yes. I'm board-certified in Child & Adolescent Psychiatry, and pediatric prescribing safety is my published research area.

What if you agree with my current treatment?

Then I'll say so, and explain why. That's a legitimate and useful result — knowing your treatment is appropriate changes how you approach a condition that simply hasn't fully responded yet.