Originally Posted by Jerald Block MD

Thanks for the kind words. Be very careful not to change the Zoloft dose unless necessary as it will trigger Deferral hell. That's a low dose but quite enough for many people.

TMS is new but old. It's been around since something like 2008 when it was FDA-certified but was mainly used in specialized clinics. Now there have been enough studies that it has hit mainstream. So, since around 2019, the use of TMS has expanded greatly. I am abivulent about the expansion of its use -- It's a valuable addition but there are some big corporate TMS clinics that are providing doc-in-the-box type care. Nevertheless, I own a machine so, yes, I am quite partial to it for the right kind of patient.

As for HIMS, if we believe the stats...they do a great job with substance abuse. I mean, hit-the-ball-out-of-the-park good w/r to outcomes. Better than most the care outside the FAA.

But HIMS should have no role for other Mental Health issues, like depression or anxiety. Nonetheless, the HIMS folks are involved and I agree, it is more punishment than not. They are familar with and operate from a methodology for substance use that is not really applicable to other mental health issues. That is why, in my profession, we have a subspeciality for substance use disorders. People in that field spend alot of their time "trusting but checking" for sobriety and building structure and accountability into their patient's lives. These are not at all the same needs/demands of someone who is depressed or anxious.

Regards,

Jerald