Dr. Rubin specializes in the diagnosis and treatment of treatment-resistant depression and bipolar disorder.
He utilizes the techniques learned as the Chief Resident of the Yale Research Center, and refined through twenty years experience supervising Columbia University psychiatry residents in diagnosis and treatment, and thirty years of clinical experience.
Course of Treatment
Treatment begins with an initial evaluation, lasting one hour, in which symptoms, prior treatments and aspects of the patient's family and developmental history are explored. At the end of the evaluation, we discuss the most promising treatment options, as well as their risks and benefits. When possible, patients are offered options based upon their personal preferences.
Patients are also given a time-frame for expecting the resolution of symptoms, as well as a realistic assessment of which symptoms will respond to medication, and which require adjunctive psychotherapy. Patients who require psychotherapy are offered a treatment plan in which medication is combined with the most effective therapy alternatives.
Services for:
Depression
The hallmarks of a depression which responds to medication are the symptoms of sadness, lack of interest in usual activities and inability to experience pleasure for at least several weeks. The most treatment-responsive depressions are those that are not resulting from a severe loss or persist for several months after the loss has occurred.
Bipolar Disorders
The defining features of treatment-responsive bipolar disorder are prolonged episodes of depression lasting at least several weeks, and periods of heightened mood and activity. Usually the mood states are not appropriate reactions to actual events in the patient's life.
Anxiety disorders embrace varied syndromes:
Generalized Anxiety is characterized by severe anxiety upon awakening or overacting to minor stresses and includes excessive worry and pessimism.
Panic Disorder is defined by brief episodes of a pounding heart, dizziness and difficulty breathing. These episodes can be easily prevented by appropriate medications. More difficult to treat is the resulting avoidance of settings in which the anxiety attacks occurred or places where the patients feel confined such as elevators, highway driving, bridges, subways or malls. The avoidance must be treated as an independent condition through the techniques of cognitive-behavioral therapy.
Obsessive-Compulsive Disorder is characterized by repeated unnecessary actions such as checking or washing and/or persistent unrealistic overwhelming fears. Generally medication can reduce the frequency and intensity of compulsions and the obsessive thoughts but often requires the techniques of cognitive-behavioral therapy for a full cure.
Social anxiety disorder is characterized by severe apprehension prior to social interactions such as parties and business-meetings. Socially anxious people are severely self-conscious and fear becoming the center of attention during class, at meetings or while eating. They will ruminate at apparent gaffs for days or may become so anxious during social events that they will have panic attacks.
Asperger's Syndrome (now included among the pervasive developmental disorders) is defined as an inability to relate to others due to difficulties in grasping social conventions or intuiting facial expressions or body language. Often people with this disorder cannot mimic facial expressions or speech patterns required of social interactions. While Asperger's is defined by its social difficulties, it is often accompanied by symptoms of obsessive compulsive disorder or attention deficit disorder.
Schizophrenic disorders
The hallmark symptoms of schizophrenia are phantom voices and irrational fears and suspicions that cannot be confirmed by others. Sometimes these conditions are complicated by intermittent periods of severe depression and/ or periods of excessive activity.
Attention Deficit Disorder
It is remarkable how frequently this disorder is overlooked in adults who often present with a history of failures at work, school and relationships due to inattention, impulsiveness, disorganization and procrastination.
People most likely to benefit from treatment
The people most likely to respond to treatment have persistent, severe symptoms which make it difficult to achieve their goals. They have not responded to prior therapy or medication treatments and their current therapist is recommending that they be evaluated for medication.
The people least likely to respond to treatment have mild or moderate symptoms of few weeks duration which are clearly reactive to a current loss of a job or relationship. Others that are not likely to respond are those that have current or recent alcohol or drug problems.
Payment
Treatment is covered by Cigna, Aetna, Blue Cross, Emblem (GHI and HIP) and by United Health Care as an out-of-network provider.
Rates for those who are not insured:
One hour evaluation: $350
Follow-up sessions: 20-30 minutes: $135
Generally patients are seen during the first phase of treatment every two-three weeks until symptoms resolve (usually by two months) and then monthly to bimonthly for maintenance.
