South Chesapeake Psychiatry

08/16/2026

Meet the team behind South Chesapeake Psychiatry. 👋

From your first phone call to each visit that follows, our team is committed to providing psychiatric care that is personal, responsive, and grounded in compassion, knowledge, and advocacy.

We believe great mental health care begins with listening, treating every person with respect, and building a plan that reflects their individual needs.

If you are looking for medication management or general psychiatric care, we would be honored to be part of your journey.

📞 (757) 908-2124
🌐 www.southchesapeakepsychiatry.com
📍 200 Carmichael Way, Suite 604, Chesapeake, VA

07/18/2026

I run a Spravato center, so I read every interventional psychiatry headline twice.

The first read gets excited. The second read has to build the schedule, and it asks a harder question. Not does it work. Who is going to run it.

That is the whole of Edition 27 of The Neuropsychiatry Brief.

Take COMP360, Compass Pathways' synthetic psilocybin, now with two positive Phase 3 trials in treatment resistant depression. Real science. But the administration session runs six to eight hours with trained staff in the room the entire time, a REMS is coming, and the placebo adjusted effect was roughly three to four MADRS points. Modest, and real. There is no honest world in which insurance pays for someone to sit with one client for a full day, for two doses.

The pattern I keep hitting: the flashiest numbers come from the smallest trials, and the soberest number comes from the most rigorous one. None of them tell you whether you can get the treatment to the person in your chair.

Implementability is not a footnote to efficacy. It is part of efficacy.

An idea that cannot be delivered is not a treatment. It is a very expensive hypothesis.

I run a Spravato center. That one fact changes how I read every headline in interventional psychiatry.

07/16/2026

Honored. Grateful. Motivated.

We're incredibly proud to share that South Chesapeake Psychiatry has been named the 2026 Best of Coastal Virginia – Silver Winner for Best Psychiatric Practice by Coastal Virginia Magazine's Readers' Choice Awards.

While we always strive for the top, this recognition is a reflection of something even more meaningful, the trust our patients, families, referral partners, and community place in us every day. We are sincerely grateful for everyone who took the time to vote and support our team.

A huge congratulations to Leva Psychiatry on earning Gold this year! Mary Crutchfield, Laura Michelle, Sonja McFadden, and Kevin, you've built an outstanding practice and this recognition is well deserved. Congratulations on an incredible achievement!

We'd also like to congratulate our fellow Silver Winners (we tied), Beach Counseling Center! I've known Annie L. Phillips since we worked together at Comprehensive Psych in 2015! It's an honor to be recognized alongside such dedicated mental health professionals who continue to make a difference in our community.

Awards are wonderful, but what matters most is continuing to provide compassionate, evidence-based psychiatric care and improving the lives of those we serve. This recognition only strengthens our commitment to that mission.

Thank you again to everyone who voted for us. We are truly honored.

07/11/2026

I gave a client his second dose of Erzofri this week, and it pulled me back to something I've argued for years: marketing long-acting injectables to time has never made much sense to me.

One month. Three months. Six months. We treat the interval like a promise. But the calendar on the box and the concentration in a patient's bloodstream are two very different clocks.

The pharmacokinetics make it hard to unsee. On the same monthly dose of paliperidone palmitate, trough levels across patients have run from nearly undetectable to the top of the therapeutic window. Same dose. Same schedule. Completely different biology.

The clients I see in ACT sit at the hardest end of that curve, high PANSS scores, aggressive illness, very little margin. In my experience, most don't comfortably make a month on Sustenna, three months on Trinza, or six on Hafyera. But insurance doesn't pay by my experience or the client's. It pays by the label. So we supplement, we bridge, we argue for an early injection — improvising across the gap between when the drug actually ran out and when we're allowed to give it again.

That's the time-gap problem.

It's why Erzofri caught my attention. Not a new molecule, the same paliperidone palmitate, but a different starting architecture: a single deltoid initiation instead of two, and modeling that points toward tailoring exposure to the person rather than to the interval.

The data are early and model-based, and it hasn't shown an efficacy edge over what we already have. I'm not selling it. But for the patient the calendar keeps failing, an option designed to dose the person instead of the schedule is worth attention.

Dose the patient. Not the calendar.

There is a quiet assumption built into the way we talk about long-acting injectable antipsychotics. We describe them by time.

07/01/2026

Nine months ago, I shared the story of a client who taught me one of the most important lessons of my career.

She was homeless, profoundly ill, and I knew she needed to be hospitalized. The first magistrate disagreed. We regrouped, re-petitioned at shift change, and ultimately got her admitted. She spent more than a year in the state hospital, started Clozaril, and slowly began rebuilding a life that had been consumed by severe mental illness.

Last fall, I celebrated a simple trip to McDonald's. A caramel sundae with hot fudge. Sweet tea. Conversation. Laughter. At the time, those moments felt extraordinary because they were.

Today reminded me that recovery isn't measured only by symptom scales or discharge summaries. Sometimes it's measured in grocery carts.

This afternoon, I delivered her medications, watched her take them, and then we headed to Food Lion. She had one thing on her shopping list that mattered more than anything else: sweet tea, twelve gallons to be exact.

By the time we got back to her residence, we needed a luggage cart just to haul all twelve gallons from the car to her room. We laughed the entire time, and I can't count how many times she thanked me.

If you had met her two years ago, you might have wondered whether she would ever be able to enjoy something as ordinary as grocery shopping. Today, I watched her making choices, joking around, planning ahead, and living her life. That's what recovery looks like.

These aren't the stories that make headlines. They don't involve dramatic rescues or groundbreaking medications. They're the quiet moments that happen after months and years of persistence. SHOWING UP, adjusting treatment, building trust, refusing to give up, and believing in someone long before they can believe in themselves.

Those twelve gallons of sweet tea probably won't change the world. But seeing her healthy enough to buy them reminded me why I chose this profession.

These are the moments that keep the fire burning.

I honestly can't imagine doing anything else.

Last August, one of my clients was at her lowest point. I knew she needed to be hospitalized, so I petitioned for it. The magistrate’s response? “All you’ve told me is that she’s homeless.” I can’t describe the frustration I felt in that moment. My voice got louder, my tone sharper, and ...

06/28/2026

Back from Cancun. Rested, and as is apparently my factory setting, already three articles deep into something that has nothing to do with relaxing on a beach.

This time it's inflammation.

For most of my career, when a client's depression would not budge, I reached for the same toolbox everyone does. Switch the SSRI. Augment. Try an SNRI. Add bupropion. Consider esketamine. What I did not routinely ask was whether the depression in front of me was, at least in part, an inflammatory event. That omission is starting to look like a mistake.

The association between depression and inflammation is one of the most replicated findings in biological psychiatry. Roughly a quarter to a half of depressed patients show elevated CRP, and that proportion climbs in the treatment-resistant population, the exact clients who frustrate us most.
Here's the part that grabbed me, because it ties back to the plasticity and glutamate themes I keep circling in this newsletter.

Inflammatory cytokines activate an enzyme that diverts tryptophan away from serotonin and down the kynurenine pathway. So inflammation doesn't just fail to fix the monoamine deficit. It actively manufactures one. Downstream, microglia turn that pathway toward quinolinic acid, an NMDA receptor agonist that pushes on the very glutamatergic machinery we've been trying to modulate with ketamine and similar agents.

It's the same conversation. Arriving from the immune side of the house.
But here's where I have to slow down before the enthusiasm runs ahead of the evidence.

The landmark infliximab trial failed on its primary endpoint. Anti-inflammatory treatment was no better than placebo, until you looked at baseline inflammation. In patients with high CRP, the drug clearly outperformed placebo. In low CRP patients, it did slightly worse. The drug didn't treat depression. It treated inflamed depression. And pooling those patients together guaranteed a null result.

That, to me, is the whole lesson. The right question was never whether anti-inflammatories work for depression. It's who has an immune signature worth targeting, and matching the intervention to the actual biology in front of you.
We are not at standard of care. The biomarker science is ahead of the treatment science, and there's real harm in handing anti-inflammatories to brains that aren't inflamed. Precision cuts both ways.

But the immune system has arguably been sitting in the diagnostic chair the whole time. We just weren't looking at it.

All of this became Edition 24 of The Neuropsychiatry Brief, where I get into the mechanism, the messy trial data, and why identifying the right client, not the right molecule, is the actual work.

The molecules are rarely the hard part.

I want to start this one with a confession. For most of my career, when a client’s depression would not move, I reached for the same toolbox everyone else does.

06/18/2026

"Your story matters.

Symptoms rarely exist in a vacuum. Sleep, stress, mood, cycles, medical history, relationships, and daily responsibilities can all affect how a person feels.

That is why a good hormone conversation should include more than a lab value. It should include your lived experience, your timeline, and your goals."

CTA: "If you have been trying to make sense of changes in your body or mood, start by writing down your story."

06/17/2026

Small steps can lead to big change.
BHRT stands for Bioidentical Hormone Replacement Therapy, a clinician-guided approach to hormone care using hormones that are chemically identical to hormones the body naturally produces.

You do not have to figure everything out before asking for help. If your mood, sleep, energy, cycles, or sense of well-being have changed, the first step can simply be a conversation.

At South Chesapeake Psychiatry, BHRT care starts with listening, context, and careful decision-making.

Start with one step.

05/23/2026

Edition 19 of The Neuropsychiatry Brief is a long one, and I am not apologizing for that because this week I had a lot to say. Usually, I focus on a medication, mechanism, receptor, circuit, clinical trial, or emerging area of neuropsychiatry. This week is different. This week is about the third party in the room: insurance.

It is about prior authorizations, medication denials, specialty pharmacy disruptions, credentialing delays, post-payment audits, and clients being told they cannot have the treatment their clinician believes they need. It is about clinicians spending hours fighting administrative barriers instead of providing care. It is about staff buried under phone calls, appeals, pharmacy issues, and angry clients who often do not realize the office is fighting the same system they are.

And I have had enough.

In this edition, I talk about why I chose not to take insurance in my private practice, the difference between practicing psychiatry with clinical judgment versus cost-containment logic, and the moral injury of knowing what a client needs while watching a payer delay, deny, redirect, or obstruct the plan without carrying the clinical liability.

I am done being quiet about it. If these systems want clinicians to keep absorbing the damage in silence, they are making a mistake. I am bringing the flashlight with one million lumens and pointing it exactly where it needs to go, so I hope they have their sunglasses on. I will write, appeal, file complaints, boost posts, run ads, put up videos, and explain denials in plain language so clients, families, employers, regulators, and policymakers understand what is happening.

Whatever it takes, I will be relentless, because sunlight is not rude, accountability is not aggression, and telling the truth about a broken system is not the problem. The problem is that the system has operated in the dark for far too long.

My hope is that others start becoming comfortable being uncomfortable too. Ask why the medication was denied. Ask who wrote the policy. Ask whether it is evidence-based. Ask who carries responsibility when a denial delays care. Ask why the clinician carries the liability while the payer controls access.

If we are serious about mental health, we have to be serious about the machinery that blocks mental health care. Edition 19 is about that machinery, and I am done letting it run quietly in the background.

We are going to do something different this week. Most editions of this brief begin with a medication, a mechanism, a receptor, a circuit, a trial design problem, or an emerging treatment that may change how we think about psychiatric illness.