Lievy Psychiatry, LLC

10/14/2026

🌙 Newer Medications for Chronic Insomnia: What You Should Know

Struggling with chronic insomnia? Newer treatment options are changing how we approach sleep disorders!

💊 Dual Orexin Receptor Antagonists (DORAs):
• Dayvigo (lemborexant)
• Quviviq (daridorexant)
• Belsomra (suvorexant)

These medications work by blocking orexin, a neuropeptide system that promotes wakefulness, helping the brain transition into sleep.

💤 Other options:
• Qulipta is not an insomnia medication. Low-dose doxepin and ramelteon may also be appropriate for select patients.

✨ Clinical takeaway: Cognitive behavioral therapy for insomnia (CBT-I) remains the first-line treatment for chronic insomnia. Medication selection should be individualized based on sleep-onset difficulties, nighttime awakenings, comorbidities, and potential adverse effects.

Better sleep starts with the right treatment plan! 💤

10/08/2026

It’s always nice to get out and talk to your medication reps. Ask about cost savings coupons, patient assistance, prior authorization, and more….let them spoil you with education, colleagues, and yummy dining.

Ingrezza- Vmat2 inhibitor for treating TD. Don’t make the mistake and use anticholinergics. Your patients symptoms will become worse in severity.

09/22/2026

Protandim — what is it?

Protandim is a multi-herbal dietary supplement marketed to activate the Nrf2 pathway, which regulates cellular antioxidant and stress-response mechanisms. It is not an FDA-approved medication and is not approved to treat or prevent a disease.

The traditional Protandim Nrf2 formulation has included:

* Bacopa monnieri
* Milk thistle/silymarin
* Ashwagandha (Withania somnifera)
* Green tea extract
* Curcumin/turmeric

What is the proposed benefit?

The rationale is that Nrf2 activation may increase endogenous antioxidant enzymes such as superoxide dismutase (SOD) and catalase, potentially reducing oxidative stress. Small human studies have demonstrated changes in biochemical markers, but that is not the same as demonstrating clinical benefit for conditions such as depression, anxiety, diabetes, cancer, cardiovascular disease, or aging.

Important safety/interaction considerations

Because it contains several botanicals, interactions can occur. In particular:

* Green tea extract can interact with medications.
* Milk thistle, curcumin, and ashwagandha may also affect drug metabolism or pharmacologic effects.
* Green tea extract has been associated with rare liver injury, particularly with concentrated extracts.
* Ashwagandha can affect thyroid function and has also been associated with rare liver injury.
* Pregnancy/breastfeeding: generally avoid unless specifically cleared by the clinician because safety data are inadequate.

A current interaction database identifies numerous potential medication interactions with the formulation.

Bottom line

Protandim is better viewed as a supplement with a biologically plausible mechanism than as an established treatment. Evidence that it changes oxidative-stress biomarkers exists, but evidence that it improves meaningful clinical outcomes is much more limited. The FDA previously issued LifeVantage a warning concerning disease-treatment/prevention claims made in marketing.

09/10/2026

Know the difference when educating…

09/08/2026

Restructure your practice with Carmen!! A true gem in our field..

09/04/2026

09/03/2026

If you’re looking for supplements that may help with ADHD, the evidence is much weaker than for stimulant or non-stimulant ADHD medications, but a few are worth considering—especially when there is a nutritional deficiency.

Supplements with the most reasonable evidence

Supplement Potential role Typical approach
Omega-3 (EPA/DHA) May modestly help attention/impulsivity in some people, but evidence is inconsistent Look for a product providing a meaningful amount of EPA, often ~1–2 g/day combined EPA+DHA
Magnesium May help sleep, relaxation, and possibly ADHD symptoms, particularly if deficient Often 200–400 mg/day elemental magnesium
Zinc May help ADHD symptoms primarily when zinc is low Usually supplement only after assessing intake/deficiency
Iron Low ferritin/iron has been associated with ADHD symptoms; supplementation may help if deficient Check ferritin/iron studies first rather than taking empirically
Vitamin D Correcting deficiency is reasonable; evidence for directly treating ADHD is limited Dose based on 25-OH vitamin D level.

The strongest rationale for minerals such as iron, zinc, and magnesium is when a deficiency exists; taking high doses when levels are normal hasn’t been convincingly shown to improve ADHD.

What I’d be cautious about

I wouldn’t recommend relying on ginkgo, St. John’s wort, ginseng, tyrosine, or “ADHD booster” proprietary blends. Evidence is poor, and some can interact substantially with medications. St. John’s wort, in particular, has many drug interactions.

If you’re an adult with ADHD, a practical supplement regimen to discuss with your clinician would be omega-3 + magnesium, while checking ferritin, vitamin D, B12/folate, and zinc if clinically appropriate.

06/21/2026

Several supplements have some evidence for helping certain ADHD symptoms, though they generally have smaller effects than prescription medications and work best when there is a deficiency or specific need.

Supplements with the strongest evidence

1. Omega-3 fatty acids (fish oil)
* May improve attention, focus, and impulsivity.
* Look for products containing both EPA and DHA, with a higher EPA content often preferred.
* One of the most studied supplements for ADHD.
2. Iron
* May help if iron levels are low.
* Low ferritin (iron stores) has been associated with worse ADHD symptoms in some studies.
* Iron should only be supplemented if deficiency is confirmed, as excess iron can be harmful.
3. Zinc
* Low zinc levels may contribute to inattention and hyperactivity.
* Supplementation appears most helpful in people who are deficient.
4. Magnesium
* May help with restlessness, sleep difficulties, and irritability when magnesium levels are low.

Supplements with emerging evidence

* N-Acetylcysteine (NAC) – may help with emotional regulation, irritability, and some repetitive behaviors.
* L-theanine – may promote calm focus and improve sleep quality.
* Saffron – some small studies have found improvements in ADHD symptoms comparable to stimulant medications, but more research is needed.
* Vitamin D – deficiency is common and may contribute to mood and attention problems.

Supplements with limited or preliminary evidence

* Black seed oil (from Nigella sativa)
* Kanna (Sceletium tortuosum)
* Ginkgo biloba
* Rhodiola

Before starting supplements

If you’re considering supplements for ADHD, it can be helpful to check:

* Ferritin (iron stores)
* Vitamin D
* Zinc (if deficiency is suspected)
* Magnesium status

For most adults with ADHD, the best evidence-based supplement regimen is often:

1. Omega-3 fish oil
2. Correct any iron, zinc, magnesium, or vitamin D deficiencies
3. Consider L-theanine or saffron as adjuncts

04/15/2026

Peptides:

1. Mood improvement & depression support

Some peptides interact with brain pathways tied to mood:
• semaglutide (GLP-1 class) – Beyond metabolic effects, may reduce depressive symptoms in some people by stabilizing blood sugar and affecting brain reward/mood centers.
• oxytocin – Known as the “bonding hormone,” it can enhance feelings of trust, connection, and reduce social anxiety in certain settings.

👉 Potential benefit: improved emotional regulation, reduced depressive symptoms, better social engagement.

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2. Reduced anxiety and stress response

Some peptides appear to calm the nervous system:
• selank – Studied (mainly outside the U.S.) for anxiety; may act on GABA pathways similar to anti-anxiety meds but without heavy sedation.
• semax – May help with stress resilience and cognitive function.

👉 Potential benefit: decreased generalized anxiety, improved stress tolerance, clearer thinking under pressure.

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3. Cognitive function & brain recovery

Some peptides are being explored for neuroprotection and brain repair:
• cerebrolysin – Used in some countries for stroke and cognitive decline; may support neuroplasticity.
• BPC-157 – Mostly known for physical healing, but early research suggests possible effects on brain healing and mood regulation.

👉 Potential benefit: improved memory, focus, and recovery from brain injury or burnout.

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4. Addiction and compulsive behavior reduction

This is one of the more interesting emerging areas:
• GLP-1–related peptides (like semaglutide) may reduce cravings by affecting dopamine reward pathways.
• Early studies suggest reduced urges in conditions like substance use disorder and even compulsive eating.

👉 Potential benefit: fewer cravings, better impulse control.

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5. Sleep and circadian rhythm support

Sleep is tightly tied to mental health:
• melatonin (technically a peptide hormone) helps regulate sleep cycles.
• Better sleep → improved mood, reduced anxiety, sharper cognition.

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What’s actually solid vs. still experimental

Stronger evidence:
• GLP-1 medications (like semaglutide) for indirect mental health benefits
• Melatonin for sleep-related mental health support

Moderate / emerging evidence:
• Oxytocin (social anxiety, bonding)
• Cerebrolysin (neurological recovery)

Limited / experimental:
• Selank, Semax, BPC-157 (promising but not well-regulated or widely approved)

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Important cautions
• Many peptides are not FDA-approved for mental health treatment in the U.S.
• Quality and dosing can vary widely (especially from online sources).
• Effects on mental health can be unpredictable—some people report mood swings or increased anxiety.

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Bottom line

Peptides can support mental health in a few key ways:
• Regulating mood and stress pathways
• Reducing cravings and compulsive behaviors
• Improving sleep and cognitive function