Ron McCaslin, PMHNP

10/07/2026

One of the hardest parts of psychiatric medication management is that two people can have the same diagnosis, take the same medication, and have completely different experiences with it. One person does great. Another has side effects. Another feels nothing at all.

That is why tools like GeneSight and BrightKaire are so interesting.

GeneSight is a pharmacogenomic test, meaning it looks at certain genes that can affect how your body processes psychiatric medications. Some people metabolize certain medications faster, some slower, and that can matter when we are thinking about medication choice, dosing, side effects, and why a medication may not have worked well in the past.

It does not and should never replace a psychiatric evaluation or tell us, with 100% certainty, “this is the medication that will work.” But it gives us another piece of information that can be really helpful when we are trying to make thoughtful medication decisions.

BrightKaire is a little different. And honestly, the science behind it is pretty incredible.

BrightKaire starts with a blood sample and uses a patient’s own cells to create neurons in a lab. Those patient-derived neurons can then be studied to see how they respond to different antidepressant medications. That information is combined with genetic and clinical data to help guide treatment decisions.

“Why are these tests so important, Ron? And if they are, why haven’t I done them before?”

GeneSight helps us better understand how your genetics may affect the way your body handles medication. BrightKaire gives us additional information about how cells derived from your own biology respond to different antidepressants. Both give us more individualized information than we would have from symptoms alone.

Psychiatry will probably never be as simple as running one test and getting a perfect medication answer. It shouldn’t be. The brain is too complicated for that, and there are a lot of things that influence how someone responds to treatment. But when someone has already tried several medications, struggled with side effects, had only partial improvement, or simply wants to make treatment decisions with as much information as possible, these tools can be incredibly useful. These tests can mean hope.

We are big believers in using every meaningful piece of information available; clinical history, symptoms, past medication response, genetics, and newer tools like functional testing to make treatment feel a little less like guessing and a lot more personalized. Because ultimately? That is what good psychiatric care should be.

09/25/2026

If you’ve heard of Spravato but aren’t totally sure what it is or why it’s different, check out this post from Aster Behavioral Health.
It breaks down how Spravato works, what treatment actually looks like, and some of the remission data in treatment-resistant depression. Definitely worth a read if you’re curious about where it fits in psychiatric treatment.

Spravato is one of those treatments people have heard of, but very few people actually know what it is. It is often described as “the ketamine spray,” which is not completely wrong, but it leaves out the part that makes it so interesting. Spravato is esketamine, a medication related to ketamine, and it works through a very different pathway than most of the antidepressants people have been taking for decades.

Most traditional antidepressants focus on serotonin, norepinephrine, dopamine, or some combination of the three. Spravato primarily works through the brain’s glutamate system, including NMDA receptors. In simple terms, it gives psychiatry another system to work with when the usual medication pathways have not been enough.

Ron, why does that matter?

That matters most for people with treatment-resistant depression, which generally means depression that has not adequately improved after at least two antidepressant treatments. If you have ever watched someone go through the cycle of starting a medication, waiting several weeks, increasing it, waiting again, switching to something else, and starting over, you can understand why having a completely different treatment option matters.

And the remission data is worth talking about. In a large study of adults with treatment-resistant depression, 27% of patients receiving esketamine nasal spray plus an antidepressant were in remission by week 8, compared with 17% of those receiving quetiapine XR plus an antidepressant. By week 32, remission was reported in 49% of the esketamine group. That doesn’t guarantee half of the people who try Spravato will go into remission, but it does show why this treatment has generated so much interest in a group of patients who have already had limited success with other options.

Here is another thing a lot of people do not know: Spravato is not something you take home. Treatment has to happen in a certified healthcare setting. The patient gives themselves the nasal spray while being supervised, then stays for at least two hours afterward. During that time, staff monitor things like blood pressure, alertness, and how the person is feeling.

Why two hours? Because Spravato can temporarily cause dizziness, sleepiness, nausea, increased blood pressure, changes in perception, or dissociation. Dissociation can feel different from person to person, but some describe it as feeling detached from themselves, their body, or their surroundings.

Patients also cannot drive themselves home after treatment. They should not drive or operate machinery again until the following day after getting a restful night of sleep.

The schedule is probably different than most people expect, too. For treatment-resistant depression, treatment usually starts twice a week for the first four weeks, then decreases to once a week, and eventually may be spaced to once weekly or every other week depending on how someone responds.

And one of the more recent changes is that Spravato can now be used either on its own or together with an oral antidepressant for treatment-resistant depression. It is also FDA-approved, along with an oral antidepressant, for depressive symptoms in adults with major depressive disorder who are experiencing acute suicidal thoughts or behaviors.

None of this means Spravato is a miracle treatment. It is not appropriate for everyone, it has real risks and contraindications, and not everyone responds to it.

What makes it important is that “treatment-resistant” does not necessarily mean “nothing else will work.” Sometimes it means it may be time to approach depression through a different pathway.

Spravato is one of the treatment options we offer at Aster Behavioral Health, and for the right patient, it can be another evidence-based option when more traditional treatments have not been enough.

09/14/2026

I came across a WGN Medical Watch story this weekend about the rise in children and teens showing up in emergency departments during a mental health crisis, and I think there’s an important conversation for parents underneath that headline.

We’ve gotten pretty good at recognizing what a mental health emergency looks like. A child says they want to die, they’re self-harming, they’re completely unable to function, or their behavior has escalated to a point where everyone involved is worried about immediate safety. Those situations absolutely need urgent attention.

But mental health struggles usually don’t start there.

More often, they build quietly. A child starts avoiding school. Sleep changes. They seem more irritable or withdrawn. They complain of headaches or stomachaches more often. Grades slip. They stop enjoying things they used to like. They worry constantly, melt down more easily, or just seem different in a way that’s hard to put your finger on.

And this is not a small subset of kids. The American Academy of Pediatrics estimates that 13–20% of children in the U.S. are living with a mental, emotional, or behavioral disorder at any given time. Another 19% have symptoms significant enough to cause distress or interfere with daily life, even if they do not meet criteria for a specific diagnosis.

That means there are a lot of kids who are struggling somewhere in the middle. Not in crisis, but not really okay either. Sometimes a parent can’t name a specific symptom at all. They just say, “They haven’t seemed like themselves lately.”

That is worth paying attention to.

The CDC’s most recent national data also found that nearly 3 in 10 high school students reported poor mental health during the previous month. That doesn’t mean every one of those students needs psychiatric treatment, but it does reinforce how common it is for kids and teens to be carrying more than adults may realize.

The American Academy of Pediatrics recommends routine mental and behavioral health screening throughout childhood, including anxiety screening beginning around age 8 and depression and su***de-risk screening beginning around age 12, or earlier when there are concerns. The reason is simple: we have a much better chance of helping kids when we notice problems before they become emergencies.

Screening also does not automatically mean a diagnosis, and it definitely does not automatically mean medication. Sometimes it means recognizing that a child is overwhelmed. Sometimes it means therapy, addressing sleep, school stress, bullying, family changes, ADHD, anxiety, depression, trauma, or another issue that may be contributing. Sometimes medication is appropriate, and sometimes it isn’t.

The point is not to label every hard season. Kids have rough weeks. Teenagers have moods. Families go through stressful stretches.

But parents know their kids.

If something has changed and it keeps nagging at you, you do not have to wait until things are “bad enough” to bring it up with a pediatrician or mental health provider. Early conversations matter, and early support gives families more options.

One of the simplest places to start is with something like, “I’ve noticed you haven’t seemed like yourself lately. How are you doing?”

You may not get much of an answer the first time, especially from an older child or teenager. Keep the door open anyway.

When we talk about the youth mental health crisis, the goal cannot only be getting better at responding once a child reaches the emergency room. We also have to get better at noticing when they’re struggling earlier.

That is where prevention starts.

09/12/2026

I miss 9/12.

Not the fear. Not the grief. Not what had happened the day before. I miss the way people treated each other afterward.

People checked in. They called family. They helped strangers. They were softer with one another. For a brief moment, it felt like we remembered that we were all on the same team.

From a mental health perspective, that kind of connection matters more than we sometimes realize.

Feeling seen matters.
Feeling supported matters.
Feeling like you belong matters.

We talk a lot about the mental health crisis in this country, but sometimes I think we overlook one of the simplest pieces of it: people need people.

We shouldn’t need something terrible to happen before we slow down, check in, give someone grace, or tell people we love them.

I miss 9/12.

Maybe we could use a little more of it today 🇺🇸

09/09/2026

72°, gray, rainy, and somehow still giving baked apple weather. There’s something about a gloomy September day that makes slowing down feel a little more acceptable.

Sometimes, mental health care looks like the bigger things, therapy, medication, boundaries, hard conversations. But sometimes it also looks like noticing what your nervous system has been asking for all week and giving yourself 30 quiet minutes to answer it. Today, ours looks like baked apples, cinnamon, a warm kitchen, and absolutely no need to be productive while they were in the oven.
Small comforts don’t fix everything. They’re not supposed to. But they can remind your brain and body: you’re allowed to have moments that feel good, even in the middle of a hard or gray day.

So if today feels a little dreary, consider it part of your treatment plan to make something warm, put on the cozy clothes, and let the rain do its thing. 🍂

PMHNP-approved September prescription:
•Something warm
•A slower pace
•A little comfort
•Zero guilt about it
Repeat as needed

Shoutout to Mind Over Batter for the recipe and our favorite local orchard for the apples 🍎

09/03/2026

Sometimes the signs are obvious. Sometimes they look like withdrawing, giving things away, increased substance use, sudden changes in mood, or simply saying, “I’m tired of feeling like this.”

And sometimes, there are no signs anyone recognized at all.

Mental health struggles do not always look the way we expect them to. Check on your people. Ask the uncomfortable question. Listen without immediately trying to fix it. Asking someone directly if they’re thinking about su***de does not put the idea in their head, but it can open the door to an honest conversation and help someone feel less alone.

If you or someone you know is in crisis, call or text 988 to reach the Su***de & Crisis Lifeline.

You deserve support before it becomes an emergency 💙

08/30/2026

The Sunday scaries are scaring 😬

You know the feeling:
It’s Sunday afternoon and suddenly your brain is already at work on Monday. The emails. The schedule. The school drop-off. The stuff you forgot to do Friday. The 47 things you “should probably get done tonight. Your brain loves to treat Monday like an emergency before Monday even gets here.

Try this instead:
Do one small thing that makes tomorrow easier, and then call it good.

Lay out the clothes.
Pack the bag.
Check the calendar.
Write down the thing you’re afraid you’ll forget.

Then go enjoy the rest of your Sunday. Monday will still be there tomorrow. You don’t have to live it twice. 🤍

08/18/2026

🥰

08/18/2026

Back-to-school season comes with a lot of excitement, but it can also bring big feelings. New routines. Earlier mornings. New teachers. New expectations. Social pressure. Sports, homework, and packed schedules.

If your child or teen seems more anxious, irritable, overwhelmed, distracted, or just not quite themselves as school starts, it may be more than “just adjusting.” A little extra patience, consistency, and connection can go a long way. And if those struggles start interfering with school, sleep, friendships, or life at home, it may be time for some additional support.

Here’s to a school year with a little less pressure to have it all together and a little more room to ask for help 💙

08/09/2026

Big things are coming, and we want you to be a part of it! 🥳

We’re growing at Aster Behavioral Health at Medico! 🪻

We’re looking for an experienced Lead Therapist to help us build and shape our therapy program from the ground up.

This is a unique role for an LCSW, LCPC, LMFT, or Clinical Psychologist who loves clinical work but is also excited about leadership, collaboration, and having a real voice in how a behavioral health program grows. You’ll work closely with our psychiatric team while helping develop a thoughtful, patient-centered therapy department.

📍 South Loop, Chicago
💙 Flexible scheduling
🌿 Leadership + clinical role
🤝 Integrated therapy & psychiatric care
💰 $57–$63/hour

Know someone who would be a great fit? Please share or tag them below!

View the full position & apply on Indeed⁠

https://www.indeed.com/m/viewjob?jk=0908b9dd8c493d5a