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Still Performing, but Running on a Disrupted Clock
For many high-performing adults, sleep is evaluated almost entirely by quantity: How many hours did you get? But there is another part of sleep that deserves more attention: when you sleep, and how consistently your body knows when sleep is supposed to occur. A new study published in Translational Psychiatry offers an interesting look at what happens when circadian rhythms are deliberately disrupted. Healthy participants underwent 15 days of experimentally induced circadian d
Rinnah MacVittie, PMHNP-BC
3 days ago4 min read
What Happens to the Brain When Work Never Really Ends?
For many professionals, the workday no longer has a clear ending. You may leave the office, close the laptop, or finish the last scheduled meeting, but work remains accessible. Email is on your phone. A colleague can reach you instantly. Tomorrow's problems are already waiting in an inbox you can check from bed. None of this necessarily feels dramatic. Checking one email at 8:30 PM may take only two minutes, and answering a quick message while watching television hardly feels
Rinnah MacVittie, PMHNP-BC
5 days ago4 min read
OCD Assessment: The Symptom Is Only the Beginning
One of the easiest ways to miss OCD is to ask the right question at the wrong level. “Do you check things repeatedly?” “Do you worry about contamination?” “Do you have intrusive thoughts?” Those are reasonable questions. But none of them, by itself, tells us whether someone has OCD. The more revealing question is often: What happens next? A person has an intrusive thought. What do they do with it? Do they dismiss it and continue with their day, or do they begin reviewing, res
Rinnah MacVittie, PMHNP-BC
Oct 155 min read
Good Psychiatric Care Requires Context
A medication list tells you what someone takes. It does not tell you why they need it. A diagnosis tells you something important about a person’s symptoms. A screening score can help quantify their severity. A medication history can show what has been tried before. But none of these, by themselves, tells the whole clinical story. Psychiatric symptoms develop within context. Sleep matters. Physical health matters. Relationships matter. Work demands matter. Substance use, hormo
Rinnah MacVittie, PMHNP-BC
Oct 141 min read
OCD is often recognized by its stereotypes long before it is recognized by the people actually living with it.
The visible examples are familiar: repeated handwashing, checking locks, arranging objects, or needing things to be “just right.” But OCD can also take place almost entirely inside the mind through intrusive thoughts, mental reviewing, reassurance seeking, repeated research, avoidance, and an exhausting effort to become completely certain about something that cannot be made completely certain. I’ve just completed a new 12-chapter guide to obsessive-compulsive disorder for the
Rinnah MacVittie, PMHNP-BC
Oct 131 min read
Why I Sometimes Don’t Recommend Medication
I prescribe psychiatric medication. I have also completed psychiatric evaluations where my recommendation was not to prescribe anything at all. Those two decisions are not contradictory. The purpose of a psychiatric evaluation is not simply to determine which medication matches a diagnosis. It is to understand what is happening well enough to decide what kind of intervention is most likely to help. Sometimes that intervention is medication. Sometimes it isn't. A symptom does
Rinnah MacVittie, PMHNP-BC
Oct 94 min read
The Gut Microbiome and Mental Health: Interesting Science, Unfinished Evidence
The idea that the gut microbiome might help explain depression or bipolar disorder is understandably compelling. It offers a tangible biological connection and raises the possibility of more personalized care. But when evaluating research in this area, I want to know how far the evidence actually takes us, especially when a biological finding might be interpreted as a reason to buy a test or start a supplement. A study published in Molecular Psychiatry on September 14, 2026,
Rinnah MacVittie, PMHNP-BC
Oct 83 min read
A Diagnosis Is a Starting Point, Not a Treatment Plan
Two people can have the same diagnosis and need very different treatment. A diagnosis matters. It gives clinicians a framework for understanding symptoms, considering evidence-based treatments, communicating clearly, and anticipating how an illness may evolve over time. But a diagnosis is not a treatment plan. Consider two adults with major depression. One may be sleeping twelve hours a day, struggling with low energy, and barely able to concentrate. Another may be sleeping f
Rinnah MacVittie, PMHNP-BC
Oct 71 min read
More Adults Are Asking: Do I Have ADHD?
Something interesting is happening in adult psychiatry: more adults are wondering whether difficulties they have lived with for years might actually be ADHD. A recent JAMA Medical News article examines this increase and the challenge facing clinicians who are increasingly being asked to evaluate ADHD in adulthood. Since 2021, first-time ADHD diagnoses among adults age 30 and older have risen substantially. At the same time, a 2025 systematic review of 40 studies across 17 cou
Rinnah MacVittie, PMHNP-BC
Oct 64 min read
Ketamine for Bipolar Depression: Encouraging Evidence—and Questions That Still Matter
For someone living with bipolar depression, continuing to work and meet responsibilities can conceal how difficult daily life has become. When several treatments have failed to provide adequate relief, news of another option can carry considerable hope. That makes it especially important to explain emerging research with both optimism and precision. A small randomized clinical trial published in JAMA Psychiatry on September 2, 2026, adds encouraging evidence for intravenous k
Rinnah MacVittie, PMHNP-BC
Oct 52 min read
Are You Resilient, or Have You Just Become Very Good at Enduring?
Resilience is one of the most admired qualities in high-performing people. You handle pressure, adapt quickly, solve problems, and keep showing up when circumstances become difficult. When something goes wrong, you figure out what needs to happen next and keep moving. Those abilities can be genuine strengths. But there is a distinction we don't talk about enough: resilience includes recovery. Endurance only requires continuation. From the outside, the two can look remarkably
Rinnah MacVittie, PMHNP-BC
Oct 44 min read
A Psychiatric Diagnosis Should Explain Something, Not Just Label It
There can be enormous relief in finally having a name for something you have struggled with for years. ADHD. Depression. Bipolar disorder. PTSD. Anxiety. A diagnosis can validate an experience that previously felt confusing or inexplicable, provide language for what has been happening, and, importantly, point toward treatments that may help. But I think we sometimes ask too little of a psychiatric diagnosis. A diagnosis should do more than attach a name to a collection of sym
Rinnah MacVittie, PMHNP-BC
Oct 33 min read
When Success Becomes a Coping Strategy
Achievement is usually treated as evidence that things are going well. The promotion. The advanced degree. The growing business. The full calendar. The reputation for being the person who can always handle one more responsibility. And often, achievement is healthy. Ambition can provide purpose, structure, confidence, financial security, and a genuine sense of satisfaction. But sometimes success is doing another job, too. Sometimes it becomes a coping strategy. For some high-p
Rinnah MacVittie, PMHNP-BC
Oct 23 min read
The Goal Isn't More Medication. It's the Right Treatment.
Good psychiatric care is not measured by how many medications someone takes. Medication can be remarkably effective. For the right person, the right treatment can reduce suffering, restore functioning, improve sleep, quiet intrusive thoughts, stabilize mood, or make concentration possible again. But prescribing a medication is not the same thing as developing a treatment strategy. Over time, psychiatric treatment can become increasingly complex. One medication is started. Ano
Rinnah MacVittie, PMHNP-BC
Sep 301 min read
Are You Resilient, or Have You Just Become Very Good at Enduring?
Resilience is one of the most admired qualities in high-performing people. You handle pressure, adapt quickly, solve problems, and keep showing up when circumstances become difficult. When something goes wrong, you figure out what needs to happen next and keep moving. Those abilities can be genuine strengths. But there is a distinction we don't talk about enough: resilience includes recovery. Endurance only requires continuation. From the outside, the two can look remarkably
Rinnah MacVittie, PMHNP-BC
Sep 294 min read
Success does not rule out ADHD. Sometimes, it helps hide it.
Adults with ADHD do not always look disorganized, unsuccessful, or obviously distracted. Some build remarkably effective systems around their difficulties. They arrive early because being merely “on time” is too risky. They rely on detailed calendars, reminders, lists, routines, and deadlines. They may work longer than their peers, use urgency to generate focus, or repeatedly check their work because they do not trust themselves to remember every detail. From the outside, the
Rinnah MacVittie, PMHNP-BC
Sep 281 min read
“I’m functioning” is not always the same as “I’m well.”
In psychiatry, functioning matters. Can someone work? Maintain relationships? Meet responsibilities? Keep appointments? Manage a household? These are important questions. But for high-functioning adults, they can also tell an incomplete story. Some people continue performing at an exceptionally high level while experiencing significant depression, anxiety, executive dysfunction, sleep disruption, or chronic psychological strain. The promotion still happens. The deadlines are
Rinnah MacVittie, PMHNP-BC
Sep 271 min read
Why Two People With the Same Diagnosis May Need Completely Different Treatment
Two people can walk into a psychiatric office with the same diagnosis and leave with very different treatment plans. That isn't inconsistency. It is often what good psychiatric care should look like. Consider two successful professionals who both meet criteria for major depressive disorder. One is sleeping ten hours a night, struggling to get out of bed, gaining weight, feeling mentally slowed, and barely generating enough energy to get through the workday. The other is sleep
Rinnah MacVittie, PMHNP-BC
Sep 263 min read
Depression does not always look like someone who can't get out of bed.
Sometimes, it looks remarkably functional. A person may continue going to work, managing a team, caring for a family, exercising, socializing, and meeting every obligation expected of them. They may even continue succeeding. And still be depressed. In high-functioning adults, depression can present less as an obvious collapse and more as a gradual loss of interest, energy, emotional range, and capacity for enjoyment. Work gets done, but almost entirely through discipline. Act
Rinnah MacVittie, PMHNP-BC
Sep 241 min read
OCD Beyond the Stereotypes: When Intrusive Thoughts, Doubt, and the Need for Certainty Take Over
Key Concepts OCD is not simply about cleanliness, organization, or perfectionism. Obsessive-compulsive disorder can involve contamination and checking, but it can also center on harm, morality, sexuality, religion, relationships, health, identity, responsibility, mistakes, memory, or the possibility of having done something wrong. Obsessions are intrusive, not intentional. An unwanted thought, image, impulse, sensation, feeling, or doubt is not the same as a desire, belief, p
Rinnah MacVittie, PMHNP-BC
Sep 1171 min read
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