Dr. Peter Gobar, MDCareful medication management for depression, anxiety and psychosis in Boynton Beach

How I evaluate

I start every evaluation by listening to the whole story before I ask my own questions. Patients usually know what is wrong with their lives even when they cannot name the diagnosis, and the details they volunteer early, about sleep, about work, about what changed and when, are often the most useful information I will get. Then I fill in the rest systematically: the psychiatric history, including every medication tried and for how long; the medical history, because thyroid disease, sleep apnea, anemia and a dozen other conditions can look like depression or anxiety; family history; alcohol and other substances; and the circumstances of the person's life, including their work, their relationships and the beliefs they draw on.

I use standardized rating scales at the first visit and at every follow-up. A score is not a diagnosis, but it gives us both a number to compare against next time, which is more reliable than memory. I order laboratory tests when the picture warrants them and I review any recent results a patient brings.

How I decide on medication

I prescribe when there is a diagnosis that medication treats and when the likely benefit outweighs the risks for this particular patient. That sounds obvious, but it rules out a lot of prescribing: medication for a stressful situation that will resolve on its own, a second antidepressant added before the first has had a fair trial, a sedative continued for years because nobody reviewed it.