Dear Doctor: Amy Mednick
The New York City psychiatrist on working in private practice, becoming a TMS provider, and supporting mental health in challenging times.
By Danielle Schostak
An adult psychiatrist with her own private practice in Midtown Manhattan, Amy Mednick is a compassionate doctor constantly looking for ways to better help her patients. In her eagerness to expand what she has to offer at her practice, she became a Transcranial Magnetic Stimulation (TMS) provider. Thanks to her work and also this dynamic, newly-covered technology, she’s become a sought-after psychiatrist in the area. Read on to learn more TMS, its benefits, and why Dr. Mednick decided to add it to her practice.
How did you find psychiatry as a specialty?
Psychiatry was never really on my radar. In college, I had briefly considered studying psychology based on some professors whom I really looked up to in my undergraduate courses. One of my professors had once invited a patient to our class, and I was so fascinated by the patient and their relationship (I actually wrote a whole play about it, long before I realized that I was interested in psychiatry). In retrospect, the choice made a lot of sense: I love to read and write, to study characters and personalities, and that fits nicely into the picture with psychiatry.
When I went to medical school, I was taking it all in, not totally sure what I wanted to do. Initially, I thought I’d fall back on neurology because of my passion for how the brain works. However, when I was doing my required psychiatry rotation at a state hospital, the decision really hit me. It was an emotional rotation, the patients there were really sick, but it made me realize that psychiatry was what I wanted to do. I furthered that instinct when I checked out neurology more and realized that psychiatry was the place where I could do the most–not just identify the disease, but also have a deeper impact and relationship with my patients.
How does teaching play into your career at this point in time?
I love what I do so much, so it’s really fun for me to teach other people about it–it’s a thrill! I do some interdisciplinary teaching to social workers and therapists. Teaching them is really unique because they don’t do what I do, but we have a lot of overlap in the people we treat. One of the lectures I give is part of a psychopathology course online for the social work program at Columbia University. I teach that once a semester. It’s an exhaustive primer in a really short amount of time, which is a challenge. For these students, psychopharmacology is a black box, so they are really excited and grateful to learn as much as they can.
Most of the time, I teach first-year psychiatry residents. I teach them the basics, which they are thirsty for because they’re thrown into everything at the beginning of their residency. It’s nice for them to have a space to talk through things in a focused way. I also like to share cases and stories with them. They are in the thick of things at the hospital and don’t get as much exposure to the outpatient and long-term relationship-building parts of psychiatry that often come after residency. It’s great to be able to show them that early on, so they can see the possibilities and be excited for their future.
How did you get started with your private practice?
I started growing my private practice right out of residency, and it’s been my job full-time since 2014. I liked outpatient medicine and I have a good mind for business, so I knew it would be my next step.
My practice is small, compassionate, and accessible to all my patients. I accept insurance and thus see a lot of patients who are young professionals that might not have looked for help otherwise. Many of them come to me thinking they just have a bit of normal anxiety, sadness, or other issues, and they are often surprised that it’s much bigger than that. They don’t realize that not everyone feels the way they feel all the time, and that they can get help. It’s so rewarding to treat this population because depression and anxiety can respond so well to treatment and drastically improve quality of life.
What brought you to Transcranial Magnetic Stimulation (TMS)?
My practice was moving locations, and I had some extra space in the new office. I was trying to decide what I wanted to do with it. I had been peripherally following TMS, which is an FDA-approved, non-medication approach to treating patients whose depression has been resistant to other treatments. The therapy stimulates areas of the brain that are underactive. Though TMS was FDA approved in 2008 for depression, insurance only started covering it in the last few years. It has really great results with almost zero side effects. Medications are so powerful and help a lot of people, but there are limitations. Now that TMS is more accessible, I thought it would be a perfect fit for my new space. I became a provider of TMS this past June and it’s been exciting to have a new service offering that will expand my business and help more patients.
What has the response been among your patients?
The response has been really positive. Of course, no one treatment works for everyone, but it has been exciting to see results. For some patients, it has been very robust, like a fog suddenly lifting after a small number of treatments, enough for their friends and coworkers to notice and comment. For others, it has been more subtle, and it has taken longer to see, especially for those who have lived with depression longer than they have lived without it.
The other day a patient of mine, who has been suffering from a deep depression her whole life, laughed about something minor while we were talking. It occurred to me with a jolt that it was the first time I had ever heard her laugh in the years I have known her. Another patient who despite always appearing friendly in the past, suddenly appeared with a beautiful smile that I had never seen before — it was almost as if a different patient was sitting in my office.
I feel lucky to have chosen a profession where the work is so incredibly rewarding, and where you can see the results right in front of your eyes, talking to you. It feels good to be able to help so many people and to have the tools available to do so. Treating people over time, getting to know them well, and then see them change their lives is amazing. I feel very fortunate that the thing I get to do every day as my job is so fun and rewarding.
How have the past several months changed how you practice? Are there any technologies or protocols you implemented during Covid that you intend to continue?
In my psychopharmacology treatments, the practice itself (but not the content) has changed surprisingly little. It turns out that medication management, which involves a lot of talking about symptoms, side effects, and reviewing options, lends itself really well to a virtual format. It’s been very convenient for my patients to be able to fit in a conversation with me in the middle of their workday without taking time off or getting on a subway. I will probably continue this in large part post-Covid. My TMS practice of course has had to continue in person, but we’ve been able to adopt Covid safety protocols without disrupting the therapeutic environment very much.
How have you been advising patients to cope with the stressors of 2020, particularly depression and anxiety? What are some go-to techniques that you think might benefit everyone?
Depression and anxiety are serious medical illnesses, and there are excellent treatment options available for both involving medication and/or psychotherapy. I think the hardest part of dealing with mental health in 2020 is that no one knows where “normal” is anymore — neither doctor nor patient. So on the one hand, it’s important to remember that no one has got it all together—we all just have to strive for the day-to-day and not any semblance of perfection. On the other hand, when illnesses do become severe, it’s important to seek treatment, regardless of the cause or the universality of the situation.
The best marker of getting to that latter point is if you aren’t functioning well, or aren’t able to actually do the things that would make you feel better. (For example, there are people who say “Of course I’m depressed, there’s a pandemic going on.” While it’s normal to be sad, angry, frustrated, exasperated, or even hopeless, it is NOT normal to be depressed. If you seriously can’t get yourself out of bed, if things have lost meaning or joy for you, if you are preoccupied with death — there is no “of course” about this and it must be treated.)
We’re entering a pretty unique season, with the weather getting colder, the days getting shorter, and social distancing due to Covid remaining a factor. What are some ways people can support mood during this time (keeping in mind they may be more isolated than normal, etc)?
I’m worried about the shortening days as I have seen how severely they affect many New Yorkers even in “normal” years. This year more than ever before, I have been recommending the use of a phototherapy lamp. When used properly, under a doctor’s advice, these can be very effective at lifting the winter blues, essentially “tricking” the part of the brain that regulates the sleep/wake cycles based on light of a certain spectrum (which we don’t see at this latitude from about October through April). That will be even more essential these days, when many of us work, eat, sleep, and play in the exact same small spaces and so there are so many fewer helpful cues and boosts from environmental changes.
Vital Signs
If I weren’t a doctor, I’d be…a writer.
One thing I wish more people knew…where to find help.
Everybody needs some belly laughs sometimes.
Favorite NYC neighborhood: Gramercy
Best NYC fall activity: The pickle festival, Lower East Side
Go-to type of exercise: Yoga
You can learn more about Dr. Amy Mednick here.
Know a great female doctor in NYC? We’d love to meet her, introduce us here!
