Practice
Personalized prescribing and monitoring by a board-certified psychiatrist, because medication is only part of the picture
Psychiatric medication management is the process of finding, prescribing, and monitoring medications that help treat mental health conditions. It involves more than writing a prescription. Medication management starts with a full assessment of your psychiatric history, medical conditions, current medications and supplements, past treatment responses, family history, lifestyle factors, and personal goals.
Dr. Laura Fredes, a board-certified psychiatrist, takes time to understand your situation and who you are as a person. She considers how you sleep, what stressors you face, your work and family demands, any medical conditions, and whether therapy or lifestyle changes might reduce your need for medication or enhance its effectiveness. Medication management with a psychiatrist is a different service from a prescription refill. Psychiatry residency includes training in psychopharmacology: the science of how psychiatric medications work, interact with other drugs, and affect different people differently.
The goal is to use medication thoughtfully to reduce suffering, restore functioning, and give therapy and lifestyle changes room to work.
While every situation is unique, medication management is commonly recommended for several categories of psychiatric conditions:
Generalized anxiety disorder, social anxiety, panic disorder, and specific phobias often respond well to SSRIs (selective serotonin reuptake inhibitors) or SNRIs (serotonin-norepinephrine reuptake inhibitors). Some people benefit from short-term anti-anxiety medication for acute episodes, while others need longer-term treatment to manage persistent worry, physical symptoms like racing heart or tremor, or avoidance behaviors.
Major depressive disorder, persistent depressive disorder (dysthymia), and depression with anxiety features typically respond well to antidepressant medication. If you experience persistent sadness, loss of interest in things you normally enjoy, sleep disruption, appetite changes, fatigue, difficulty concentrating, or thoughts of worthlessness, medication can help restore your mood, energy, and ability to function while you engage in therapy.
ADHD is treated only after Dr. Fredes' own complete diagnostic evaluation, since anxiety, depression, sleep problems, and burnout can all look like ADHD. When the diagnosis is confirmed, medication is chosen based on clinical fit, with regular monitoring.
OCD typically requires higher doses of SSRIs than anxiety disorders, and sometimes combination therapy. When treated effectively, medication can quiet the obsessive thoughts and reduce the urgency to perform compulsions, making it possible to engage in behavioral therapy more successfully.
Bipolar disorder, characterized by alternating episodes of elevated or irritable mood (mania or hypomania) and depression, usually requires mood-stabilizing medication as a foundation. These might include lithium, valproate, lamotrigine, or atypical antipsychotics. This is one condition where medication is typically considered essential, not optional.
PTSD symptoms (intrusive memories, nightmares, hypervigilance, emotional numbing) often improve with SSRIs, especially when combined with trauma-focused therapy. Some people also benefit from medications that target sleep disruption or anger.
Chronic insomnia affects mood, cognition, and physical health. Depending on the cause and your preferences, medication options range from low-dose antidepressants to melatonin receptor agonists to other sleep-specific medications. Dr. Fredes also addresses underlying causes like untreated sleep apnea or circadian rhythm disruption.
Postpartum depression, perinatal anxiety, and postpartum OCD are serious medical conditions that benefit from prompt treatment. Dr. Fredes treats patients during pregnancy and after birth and weighs medication choices carefully for pregnancy and breastfeeding. Signs of postpartum psychosis (confusion, hallucinations, paranoia, thoughts of harming yourself or your baby, severe inability to sleep) need emergency care now: call 911 or go to the nearest emergency room. MindMED is an outpatient practice and does not provide emergency or inpatient care; more intensive care, such as an inpatient or perinatal-specific program, is appropriate for severe or rapidly worsening symptoms.
This is not an exhaustive list. If you're uncertain whether medication management is right for you, that's exactly what the initial evaluation is for. Dr. Fredes will help you think through the decision carefully.
At MindMED, we follow a structured, thoughtful approach to medication management:
What to expect: A 60-minute appointment where Dr. Fredes gathers a complete psychiatric history, reviews your current symptoms, explores past psychiatric and medical history, discusses all current medications and supplements, assesses family history, explores substance use, and discusses your goals for treatment. Depending on your situation, baseline lab work (bloodwork, sometimes EKG) may be ordered to establish a safety baseline before starting medication. Together, you'll discuss treatment options, potential benefits and side effects, and create a collaborative plan.
What to expect: Follow-up visits are typically 30 minutes. They usually occur 2–4 weeks after starting a new medication, then monthly until stable, then as needed or every 3–6 months depending on your condition and medication. During these visits, Dr. Fredes monitors how you're responding, assesses for side effects, adjusts doses if needed, coordinates care with your therapist (if you have one), reviews any new symptoms or medication interactions, and aims for the lowest effective dose. You're always welcome to reach out between appointments if urgent questions arise.
Dr. Fredes prescribes a wide range of psychiatric medications, always informed by current scientific evidence and your individual situation. Here's an overview of the main categories:
The first-line treatment for depression and anxiety disorders. SSRIs include sertraline, escitalopram, paroxetine, fluoxetine, and citalopram. They work by increasing serotonin availability in the brain. Side effects are generally mild and often improve over time, though sexual side effects and weight changes can occur in some people.
Similar to SSRIs but also increase norepinephrine, making them useful for depression with low energy or motivation, or anxiety with pain symptoms. Common SNRIs include venlafaxine, duloxetine, and desvenlafaxine.
Used primarily in bipolar disorder, these include lithium (a natural salt with strong evidence in bipolar treatment), valproate, lamotrigine, and others. Some are also used to augment antidepressants in treatment-resistant depression.
Medications like aripiprazole, quetiapine, and lurasidone are used in bipolar disorder, treatment-resistant depression, and psychotic disorders. They've also been shown to augment antidepressants in some cases. Monitoring for metabolic side effects (weight, blood sugar, cholesterol) is important with this class.
Options include melatonin receptor agonists (ramelteon), sedating antidepressants at low doses, and others. Dr. Fredes looks at sleep habits and underlying causes first, but medication can be helpful when insomnia significantly impacts mental health.
Benzodiazepines (alprazolam, lorazepam) are effective short-term but carry risks of dependence. Dr. Fredes prescribes these conservatively and typically as part of a time-limited protocol, not as long-term monotherapy. Buspirone offers an alternative for chronic anxiety with lower abuse potential.
Dr. Fredes treats medication as one tool within a larger picture. Her approach considers the whole person.
This means she asks questions like: How is your sleep? What does your daily routine look like? Are you getting any physical activity? How's your relationship with food and nutrition? Are you using any substances (alcohol, cannabis, other drugs)? What's your stress level? Do you have meaningful relationships and social connection? Are there any unresolved trauma or major life stressors we should address? This information shapes the medication recommendation and the decision of whether medication is even necessary right now.
For many people, addressing sleep problems, increasing exercise, reducing caffeine, improving nutrition, or starting therapy can significantly improve mood and anxiety. Sometimes medication reveals itself to be unnecessary once these factors are optimized. Other times, medication becomes a bridge that stabilizes your mood and energy enough to do the work of therapy and lifestyle change.
Dr. Fredes also takes your supplement use and over-the-counter medications seriously. Many supplements interact with psychiatric medications or have their own psychoactive effects. She'll review everything you're taking and help you make informed decisions about what to continue, what to change, and what might be redundant.
Finally, she prioritizes coordination with your therapist (if you have one) and your primary care doctor. Mental health and physical health are deeply connected. Medication management works best when all your providers are aware of what's happening and communicating regularly.
The initial evaluation typically takes 60 minutes. This appointment includes a detailed psychiatric history, review of current medications and supplements, assessment of medical conditions and past treatment responses, baseline lab work if needed, and collaborative discussion of treatment options and goals.
The duration of medication varies based on your condition, history, and treatment response. Some patients benefit from medication for a defined period and then discontinue successfully. Others manage chronic conditions more effectively with ongoing medication. Dr. Fredes works with each patient to determine the right timeline and regularly reassesses whether medication remains necessary or if adjustments are appropriate.
Past medication challenges are important information. Dr. Fredes carefully reviews what happened, whether it was an ineffective medication, a side effect that was intolerable, or a dosing issue that wasn't optimized. She uses this history to inform her prescribing approach, often starting at lower doses, choosing different medication classes, and monitoring more closely to avoid repeating negative experiences.
Yes, many medication management appointments can be conducted via telehealth video visits, which is convenient for busy schedules and ongoing follow-ups. The initial evaluation can be done by video as well, except ADHD evaluations, which are conducted in person.
Controlled substances are prescribed only when Dr. Fredes' own full evaluation supports it, never at a first visit. Existing stimulant prescriptions are not transferred or continued without a full evaluation, and all controlled-substance prescribing is closely monitored. Initial evaluations for stimulant medication are conducted in person.
Timeline varies by medication class. Some medications, such as sleep aids, work within days. Others, particularly SSRIs and SNRIs for depression and anxiety, typically require 4-6 weeks at an effective dose to show full benefit. During this time, Dr. Fredes monitors your response closely and makes adjustments as needed. Changes are made carefully, one at a time when possible, with regular follow-up to check response and side effects.
We are in-network with Aetna, BCBS TX, Oscar Health, and United Healthcare. If you have a different plan, call (817) 203-4179 and we can walk you through self-pay and out-of-network options. We handle all insurance billing and prior authorizations, so you can focus on your care rather than administrative hassles.
Yes. Medication and therapy tend to work best when the prescriber and therapist are in contact. We regularly communicate with your therapist (with your consent) to ensure medication and psychotherapy are aligned and supporting each other. This coordination is one of our core values and something we actively prioritize in your care.
If a medication isn't producing the expected benefit after an adequate trial, Dr. Fredes reviews the options with you: adjusting the dose, switching to a different medication, adding a second medication, or reassessing whether non-medication factors (sleep, stress, substance use) are interfering with response. Changes are made carefully, usually one at a time, with follow-up and monitoring after each.
We are in-network with:
For patients without insurance coverage, we offer self-pay options with transparent pricing. We also provide superbills for out-of-network reimbursement. View full pricing details →
Schedule a consultation with Dr. Fredes to discuss your care.