A physician of Articles
Written by Dr. Husted. Plain language, sources named, no sponsorship.
- Why I measure depression treatment by function, not just moodMood is subjective and variable; function is observable and is what patients actually want back. Dr. Husted describes how he pairs the PHQ-9 with written functional goals at every depression visit, why symptom scores and function often diverge, what the STAR*D trial says about accepting partial response, and the rule that a plan that is not moving the numbers gets changed at that visit.
- When to consider Deep TMS: how I decide with my patientsDeep TMS is FDA-cleared for major depression and sits naturally at the point where the STAR*D data show medication odds falling, after two adequate antidepressant trials. Dr. Husted walks through the questions he asks before recommending it: diagnosis, adequacy of prior trials, safety exclusions, the 36-session schedule at the Palm Beach Gardens center, side effects, how response is measured and who should be steered elsewhere.
- Spravato in practice: what I tell patients before their first sessionSpravato is FDA-approved esketamine nasal spray for treatment-resistant depression and for depression with acute suicidal thinking. Dr. Husted, who oversees the Spravato program at Stedfast Psychiatry, lays out the conversation he has before every patient's first dose: the evidence from TRANSFORM-2 and SUSTAIN-1, the REMS rules on in-office dosing and two-hour monitoring, what dissociation feels like, the induction schedule, who should not take it and how response is judged.
- Anxiety that does not respond to the first medication: my next stepsAbout half of patients with an anxiety disorder do not respond to the first medication, and most of the time the explanation is not that medication does not work for them. Dr. Husted describes his sequence: confirm the trial was adequate in dose and duration, reconsider the diagnosis, address caffeine, alcohol, cannabis and sleep, then switch, augment or add cognitive behavioral therapy, while avoiding long-term benzodiazepines.
- Running a 13-office psychiatry practice: what physician oversight actually meansMost day-to-day care at Stedfast Psychiatry is delivered by nurse practitioners and physician assistants under physician supervision. Dr. Husted, the practice's founder and clinical lead, describes what that supervision consists of: common rating scales across every office, written escalation criteria, regular chart review, a cross-office case conference, and the decisions that remain with physicians, including candidacy for Deep TMS and Spravato.
- What I learned from research on OCD and PANDAS, and how it shapes my practice todayAs a resident and fellow at the University of Florida, Dr. Husted co-authored papers on the neurocircuitry of OCD and disgust, treatment of refractory OCD, the effect of comorbid tics on fluoxetine response, and the PANDAS hypothesis. He describes six lessons from that work that he applies daily in an adult depression and anxiety practice, from adequate dosing to predefined response criteria to separating hypothesis from fact.
See Dr. David Husted
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