FAQ’s About Dr. Neal Ranen

Yes, my office manager, Ava, and patient coordinator, Jen, are eager to help with any questions or scheduling.

As a physician, I can prescribe medication and order lab tests (such as thyroid or B12 levels) in addition to doing psychotherapy, whereas a psychologist cannot.

It’s helpful to understand what is entailed in becoming a psychiatrist. As a psychiatrist, after completing my undergraduate studies (as a psychology major in addition to taking a pre-med track), I went to medical school and graduated as a physician. After graduating from medical school, physicians then do further specialty training in the area in which they intend to practice. This can be internal medicine, ophthalmology, surgery, psychiatry, etc. During medical school, I did intensive coursework and clinical rotations in psychiatry, both in general psychiatry and specialty areas, in addition to my education in the other medical disciplines. After medical school, I then did a 4-year residency in psychiatry at The Johns Hopkins Hospital. The bulk of my first year of residency (the first year of residency is sometimes referred to as the internship year) was actually in internal medicine (9 months) even including as a doctor in the ICU, with psychiatry comprising the remainder of that year. The next 3 years were all exclusively in psychiatry. After completing my residency, I became Board-eligible in psychiatry, and, indeed, passed my Board examinations to become a Board-Certified Psychiatrist. I then went on to do additional training consisting of a yearlong fellowship at Hopkins in Neuropsychiatry to achieve an even deeper understanding of the underpinnings of psychiatric conditions, such as brain pathways and brain chemistry. Although my practice is focused on general adult psychiatry (depression, anxiety, ADD/ADHD, Bipolar, OCD, etc.), because of my expertise in neuropsychiatry and other specialized experience in the elderly, I became Board Certified in both General and Geriatric Psychiatry (I remain Board-Certified in both of these areas). So, as a psychiatrist, I am fully licensed as a physician (technically my license reads that I’m licensed as a Physician and Surgeon) who specialized in psychiatry. Altogether, my training to become a psychiatrist spanned 13 years between undergraduate, medical school, residency, and fellowship. This is the most extensive amount of combined overall education and training required by any mental health professional. I believe this provides a deep understanding of the human condition and human physiology. The body is so interconnected such that an understanding of how our bodies holistically affect the brain and our mental state is invaluable.

As I don’t participate in insurance plans, my office will provide you with the insurance-preferred receipt, called an HCFA, for you to submit to obtain any out-of-network reimbursement you may be entitled to. Many patients see a good portion of the visits covered, others less so; it all depends on your plan.

However, Medicare and Medicaid plans will not cover out-of-network providers – because of Medicare’s unique rules, and that I have fully opted out of Medicare, if you do have Medicare you will not be able to submit, and we would be unable to provide, an HCFA receipt for reimbursement.

The most important thing is not to stress because you’ll just be letting me know what you’ve been going through and how you feel, and I’ll be asking questions to hone in on what’s going on. Nonetheless, it’s helpful to start thinking about things, have some information available, and even jot down some notes beforehand. Again, my job is to help figure out what’s going on, so I can lead you through the information if you don’t have time to prepare.

Some questions to contemplate:

What part of how you’re feeling is bothering you the most?

When did symptoms first start?

What do you consider to be your baseline in terms of how you feel, when was the last time you felt like that, and how far off from that are you now?

When were you last happy?

How do you, and how would others, describe your personality? For example, are you more a glass-half-full or glass-half-empty person? Do you fall somewhere in between?

Who do you consider to be your support system?

What accounts for seeking an appointment now?

Is anything different in your life, or did your symptoms start (or persist) without new changes or stressors?

Think about your Family History.

In some cases, a family history of psychiatric conditions is well known, but in others, the subject wasn’t openly discussed.  Think about whether anyone has a specific diagnosis.  Do you believe family members had undiagnosed psychiatric conditions? Did anyone have treatment with either therapy or medication? What medications might they have tried and were they helpful? Sometimes a response a family member has can inform about what might work for you (although not always!).

Think about your own past mental health history.

Have you seen a psychiatrist or other mental health provider before?  Were you given a specific diagnosis and do you feel it was accurate? Have you been on medications or supplements before, did they help, and did you have any side effects? What worked best (medication and non-medication approaches)? Did your symptoms change over time?  What did you like or not like about therapy or medication?

It is helpful to get records from prior providers. Also, often medication records from the pharmacy can be helpful.

It is helpful to write out a timeline of life events, your symptoms, medication history and why you took them at the time. If you have had significant life events, do you feel these have played a role in how you feel?  It is helpful to know medication doses, if possible because different kinds of symptoms sometimes respond to different doses. Don’t forget to include supplements and any other over-the-counter medication.

Think about what coping strategies are helpful to you, and which have been counterproductive.

My office will also be sending you a form to jot down your medical history and current medications to help organize this information.

Do your best to organize your thoughts, but you don’t have to feel like you have everything figured out before your appointment because this is something we’ll accomplish together!

On the surface the philosophy is straightforward — to accurately come up with an impression of the contributing factors, which leads to recommending evidence-based, scientifically sound treatments with the goal of having a more enjoyable and satisfying life. But there is much more that goes into that process, including the framework and attitude taken in obtaining information and presenting conclusions and recommendations. 

Mental health is influenced by our genetics, our circumstances, and our psychology (our characteristic ways of responding to things, including ways we recognize and ways we don’t).  This is a holistic approach that is sometimes referred to as the Bio-Psycho-Social model.  This approach is important to understanding you in terms of your unique admixture of these influences.  Depending on the individual, one or more of these areas will predominate.  This leads to recommendations that aim to treat you as a whole person, and may include talk therapy (psychotherapy) to help you, for example, recognize your strengths (that you yourself may even be discounting), address automatic or self-defeating negative thoughts or behaviors and assumptions about yourself, others, and the world around you that lead to them, or to cope with stress over which you have no direct influence; the targeted, informed, judicious use of medication (Dr. Ranen also considers evidence-based supplements and also remains on the cutting edge of evolving biological treatments) and taking you off medications that are not indicated or potentially even having an opposite effect; and an assessment of a person’s social environment and routine.  So, the process is highly personalized, with recommendations that are customized for you.  You will not just be a patient but a unique individual with distinctive needs. One or all of the approaches might be right and preferred by you.

The key is starting with a foundation of non-judgmental, unbiased, and careful listening, removing any stigma, shame, judgment, or blame, employing empathy, sensitivity, and even humor. I place importance both on having a warm and caring environment and being an expert in diagnosis and treatment.  The goal is for you to feel empowered with the knowledge and support to take the next step.

Some do but I do not only treat with medication. I may consider a variety of different approaches for your symptoms that may include the targeted, customized use of medication, therapy, supplements, and holistic/wellness approaches.

Some individuals seek care from me primarily for medication management and this is perfectly appropriate too. I am an expert in psychopharmacology and remain on the cutting edge of evidence-based medication options. For example, I recently completed the Harvard Psychopharmacology Master Class.

The targeted, informed use of medication can be extremely helpful for many people, and I am very experienced in prescribing and monitoring medication.

A decision about medication comes after obtaining a careful psychiatric and medical history, and extensive discussion with you about the options.

As an aside, patients often comment that only in retrospect, after symptoms are improved, do they realize the kind of headwinds they had been fighting and that with treatment things have just become less effortful and more enjoyable.  Not having recognized chronic symptoms because they became the norm, patients will often comment that they feel even better than what they had assumed was their well baseline.

Another analogy to experiencing psychiatric symptoms that I sometimes use is that it’s like swimming upstream, and it’s almost as if the harder you try to swim the stronger the current becomes. Medication can help remove that current – we all still need to swim but it’s not as exhausting.  This also acknowledges that we still all need to navigate life and that therapy or just charting a healthier course on one’s own after symptom relief with medication is often still important. For some people, everything would be really good in their lives if not for their psychiatric symptoms, and treatment of the underlying psychiatric condition with medication alone can be the remedy with little need for additional counseling.

Yes, many psychiatrists, myself included, work with psychologists as well as other therapists. You may be seeing a psychologist but seek care from me as well for diagnostic clarification and medication management. No formal referral is needed; you can call and set up an appointment with me directly, although many psychologists will also specifically recommend me to their clients.