Appointments and Insurance

How long is the wait for a new or follow-up appointment?

We work very hard to offer you an appointment within a few business days from your request, excluding weekends and holidays.

Do you take my insurance?

Health insurance is an important component of our medical system. However, the realities of the industry too often impose insurance company policies and ‘rules’ between you and your doctor. Nowhere is this more problematic than in psychiatric medicine where time and personal connection are often critical elements of an accurate diagnosis and effective treatment plan. Diagnosing and recommending treatment for mental health conditions can be complex and the information you provide to your psychiatrist may be far more intimate or personal than at other medical appointments. In addition, unlike doctors you may see for other conditions and ailments, psychiatric conditions cannot currently be ‘tested’ for with labs, scans or other instruments. The most effective tool our doctors have for carefully diagnosing and treating these important conditions is time. Insurance models of care do not allow for spending the time that we believe you deserve and require to be treated competently and compassionately. For these and other reasons, our doctors do not maintain contracts with any insurance company or third party payer. We believe that you should have the choice of what information is released to an insurer, and whether they have power over your treatment. We realize the extra burden this places upon you, but hope that the peace of mind that you get from complete privacy and ample time to share with your doctor is a valuable trade-off.

Symptoms, Biology and Family Risks

“Does (Depression, etc.) run in my family?”, “Will my child get it?”

The interaction of heredity, genetics, and psychological risk factors is extremely complex and much remains unknown. However, Dr. Mee has received extensive research training at UC Irvine and the Veterans Administration from top neuroscientists in the country and been awarded over $1 million in federal and private foundation research grant funding to pursue clinical and basic research. Dr. Mee has published research findings in topics ranging from suicidality, depression, psychological pain, substance abuse and pharmacology. 

As a result of this rigorous academic background, patients have experience and educational opportunities during the course of treatment that are rarely found outside of dedicated university medical centers. Dr. Mee specifically discusses with patients and their family currently understood aspects of genetic risk, the importance of environmental exposures and other factors interacting to produce symptoms of frequently diagnosed disorders, including depression, panic and substance abuse.

“I was told that my depression (anxiety) was due to a chemical imbalance. Is that true, and what does it mean?”

This is one of the most common questions that patients ask. However, in most cases it is not technically true. While all emotional and behavioral conditions, such as depression, involve changes in certain chemicals that our brains produce, the actual cause of depression and the way in which medicines treat depression remain unknown to medical science. Our brain structure and chemical makeup is so delicate and complex that if these chemicals (called neurotransmitters) were actually out of ‘balance’ we could not live.

What is known about depression is that its cause is likely about 40–50% genetic (biological), leaving the rest to non-genetic (environmental) influences such as early life development issues or emotional trauma in your life. That’s why it runs in families and may be seen as actual depression, or possibly masked as substance abuse or suicidal thinking. While we understand that current medicines used to treat depression affect certain chemicals and brain systems, this does not explain how depression comes about in the first place. Much of the current university research on depression is focused on exactly this question.

Confused? These huge holes in our knowledge of depression, anxiety and all behavioral/emotional disorders are part of the reason we believe it's critical for psychiatrists in the 21st century to actively stay informed and participate in relevant research. The good news is this: Even though science doesn't know the exact causes of most mental health conditions, modern medicine and psychotherapy are usually very effective in treating the symptoms and allowing a return to normal functioning. We can help you work with your issues to build a healthy, happy life.

Treatment

"How long does it take for the medication to work?"

Depending upon the condition you are being treated for and the medication type, your medication should become effective within a few weeks to a few months, although some patients report feeling some improvement within days or hours.

"My doctor gave me a medication that increases serotonin for my depression, does that mean my serotonin is too low? Can it be measured?"

Although the causes of depression remain unknown, most medications used to treat it cause a microscopic increase in an important neurotransmitter called serotonin between brain cells. This does not really mean your brain serotonin is low, since medications increase it at all relevant brain cells within hours but it usually takes weeks or months to see improvement in symptoms. Serotonin is definitely involved in some way with depression and anxiety but exactly how, where, and when in the brain this occurs will require more research to be fully understood.

Brain serotonin cannot be accurately measured outside of a research lab and there are no known normal ranges to even compare it to. Moreover, there is no conclusive evidence that brain-wide low levels of serotonin cause depression. Because of the 'blood-brain barrier' (a special filter that protects your brain from many foreign chemicals) there is no reliable procedure to use peripheral blood for checking the brain's serotonin level nor would it be helpful for diagnosing depression.

"I don't want to be put into a hospital!"

That's good, because we don't want to put you in a hospital either! Although this is a common worry for new patients, the fact is that only a tiny fraction of patients require hospitalization for behavioral health issues. Virtually all current psychiatric medicines are available for our doctors to use, making hospitalizing patients generally unnecessary. We do everything in our power to avoid hospitalizing patients except under the most urgently unsafe situations such as active suicidal thinking and/or behavior. Generally, we hospitalize fewer than a couple of patients every year.

"Will the medication make me think about suicide?"

This is a common and often misunderstood issue, and much disinformation has been disseminated by the popular media. The answer requires some background information. The risk factors involved in suicidal thoughts are not fully understood. Dr. Mee has published and is currently conducting research into understanding some of these risk factors, particularly emotional or psychological pain. Some of the most important risk factors for developing suicidal thinking probably include the presence of depression, severe psychological pain, hopelessness, social isolation, substance abuse and young age. More than a decade ago, a study was published that suggested all antidepressant medications increase suicidal thinking in individuals under the age of twenty-four. While the definitive answer to this question remains uncertain, many scientists have important and substantial disagreements with this conclusion. Partly this is due to the method by which the conclusion was reached. It's also important to note that the actual suicide rate from all of this data was no different for medication or placebo.

We are left then with the issue of "What do we do now?" Since depression is a major risk factor for suicide then we have to treat the depression. Unfortunately, the fear sparked by this 'conclusion' has led to many practitioners refusing to treat young people, and may have resulted in an increase in teen suicides. Needless to say, these important questions are still being sorted out, but the majority of evidence supports careful treatment of depression with close monitoring for the development of suicidal thinking.

"What about psychotherapy? What is it and do the doctors at AIP perform therapy?"

Psychotherapy is a term used to describe any number of psychological treatment approaches that are the result of over 100 years of psychological research and treatment. Since most mental health conditions are partially genetic (or “chemical”) and partially environmental, the best approach is to address both causes. Medications cannot change genes yet but they can help to treat the result of these genetic causes and psychotherapy is aimed to address the environmental aspects. Together, we believe patients get better sooner and have longer lasting recoveries. Psychiatrists are medical doctors who are trained in the use of medications and psychological treatments for mental disorders. We are the primary healthcare specialists licensed to apply both forms of treatment in California. Dr. Mee utilizes a number of approaches to psychotherapy depending upon the condition in question. For example, in depression, we want to identify the sources of pain, usually psychological pain, and take approaches to increase our sense of power over those sources of pain. This and other approaches are naturally pain relieving and complement rather than replace medication approaches. While many patients already have therapists that they are working with, we are happy to provide psychotherapy for those who are not currently working with a therapist. Our doctors will be happy to discuss this in much more detail at your evaluation appointment.