What is the difference between compulsive and impulsive behaviors? What are examples of these? Pharmacist Michael talks about several examples of disorders that fall into these categories.
Do you suffer from anxiety?
Have you tried different therapies with no luck?
Do anti-anxiety medications lead to adverse effects?
This post will compare Vistaril vs Xanax for anxiety treatment.
Did you know that anxiety disorders are the most prevalent mental health conditions and cause significant disability? According to the National Comorbidity Survey Replication (NCS-R), the lifetime prevalence of anxiety disorders in the United States is about 32%.
It is not surprising that anxiety disorders can lead to a loss of productivity greater than other mental health disorders. Even though there are many treatments for anxiety symptoms, only 60-85% of patients experience at least a 50% improvement in their symptoms using current medical and psychological treatments.2
Below are some symptoms of general anxiety3
The symptoms of panic disorder are listed below:
Disclosure: This post may contain affiliate links, meaning, at no additional cost to you, I may earn a commission if you click on, or make a purchase through a third-party link.
Alprazolam (XANAX) is a benzodiazepine used for the treatment of general anxiety disorder and panic attacks. In 2013, more than 48 alprazolam prescriptions were dispensed in the United States.4
Although alprazolam is an effective medication for treating anxiety, it does have some serious adverse effects. Some of the more significant unwanted side effects are listed below:
Alprazolam is also a controlled substance which means it has a high potential to be addictive. Therefore, other treatment options are preferred in those patients with a substance use disorder history.
The symptoms of withdrawal from alprazolam are as follows5
Even those using alprazolam as an anxiety treatment may become psychologically and physically addicted. Since this drug decreases abnormal brain excitement and produces a calming effect, it has a high potential for misuse. It also has a swift onset of action and short duration, increasing its abuse potential and severity of withdrawal symptoms. Alprazolam’s severe withdrawal symptoms may be especially dangerous when abrupt discontinuation after long-term use.
As a medical professional, I only recommend alprazolam for the short-term treatment of severe anxiety.
I strongly suggest contacting a healthcare provider if you believe you are addicted to alprazolam or other medication.
One more interesting fact regarding alprazolam. This is one of the few drugs that I have heard patients complaining that the generic form does not work as well as the brand name. This may be an imagined phenomenon, but I have heard it from several patients.
Hydroxyzine pamoate is an antihistamine that non-selectively blocks peripheral and central histamine receptors. This medication can be used for medical conditions other than anxiety such as itching, nausea and vomiting, insomnia, and as a surgical adjunct.
As with any drug, Vistaril has side effects, some of which are listed below.
More severe side effects of Vistaril include:
The recommended dose of Vistaril for anxiety in adults is 50-100mg by mouth every six hours as needed. Unlike Xanax, Vistaril is not a controlled substance but is a prescription medication. Hydroxyzine may interact with other anticholinergic agents, CNS depressants, and agents that prolong the QTc interval. Be sure to contact your doctor or pharmacist if you are taking other prescription medications before initiating Vistaril.
Both Xanax and Vistaril can help relieve the symptoms of anxiety. However, they both cause drowsiness and will interact with other CNS depressants, including ethanol. They are both prescription drugs, but Xanax is a controlled substance, so it is not suitable for those with a history of addictive behavior. In my professional opinion, Xanax is a better option for the short-term relief of severe anxiety and panic attacks. I believe it is more effective than hydroxyzine. Unfortunately, I was only able to find one study comparing the two agents in the setting of pre-anesthesia. This study came to the following conclusion:
“Alprazolam and hydroxyzine are both efficient and safe pre-anesthetic medications. However, a more pronounced, although modest, anxiolytics and the the absence of side effects favors the use of alprazolam over hydroxyzine.”6
Both alprazolam and hydroxyzine should be avoided during pregnancy. Xanax carries a possible risk of teratogenicity and risk of neonatal withdrawal symptoms, and floppy infant syndrome. Xanax is a better choice than hydroxyzine when breastfeeding, according to Epocrates (accessed 11/28/2021). Epocrates states, “May use low doses of alprazolam short-term with breastfeeding, otherwise monitor infant closely. There is a possible risk of CNS depression in the infant when the breastfeeding mother takes alprazolam.
Anxiety can be a debilitating condition and can lead to poor quality of life in some individuals. As with most diseases, there is a broad range of severity in the various anxiety disorders. My concern is that patients will go straight to their provider and end up with a prescription to treat their anxiety when a drug-free alternative may work just fine. In addition, there are non-drug options available for anxiety symptom relief.
One of the best treatments for anxiety is CBT. Cognitive Behavioral Therapy is the most researched form of psychotherapy in history. CBT is a psychological treatment that helps patients recognize thought patterns that are contributing to their anxiety. I believe we are all prone to thinking errors. Suppose we can learn to recognize these and train our minds to think differently. In that case, we can decrease our anxiety and depression symptoms without introducing chemicals into our bodies. The other problem is that when we become anxious, these thinking errors become distorted and amplified, leading to more anxiety.
I strongly suggest giving CBT a try before starting any anti-anxiety or antidepressant medication. The results will likely surprise you. If you don’t have the time to spend in therapy sessions, there is a book I recommend reading. I have included a link to this book below. I have read this book several times, and it has helped me deal with my thinking errors and helped many others do the same.
Smoking, drinking too much alcohol, eating the wrong types of foods, and not getting the proper amount of sleep can all make anxiety symptoms worse. Exercise can significantly help. Read my recent blog post on anxiety for more information on lifestyle changes.
As many of you know, I am the owner of Sunshine Nutraceuticals. I believe that natural supplements are a vital piece of the health and wellness puzzle. I also think that one of the possible uses of these supplements is to treat anxiety symptoms.
If you are having a hard time coping with daily living or are considering hurting yourself, please call 911 and get help NOW. Regardless of how bad things seem, you can be helped. A person with a mental health disorder is no different than someone with heart disease, diabetes, or asthma; they just have a different organ of their body affected.
Back to our two drugs. Alprazolam should not be used for the long-term relief of anxiety. As mentioned earlier, it can be addictive and has a short duration of action. We often use a benzodiazepine such as alprazolam while waiting for the long-term anxiety medication to work. To treat anxiety, the drugs we start with are antidepressants, specifically selective serotonin reuptake inhibitors (SSRI’s). These medications often take several weeks to show maximum benefit, so it is critical to have a backup.
If you have any questions regarding this topic or any other subject, don’t hesitate to contact me by clicking the link in the author box below. Remember to take care of your mind and body always!
Michael J. Brown, RPh, BCPS, BCPP
Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.
Feel free to send Michael a message using this link.
We have all experienced anxiety during our lives. Most of us are able to cope with stress and anxiety but it can become problematic and may even cause other more serious medical issues. In this post, I am going to give you 9 ways to obtain anxiety relief without drugs. Most of these techniques can be learned quickly and some you may already know.
One of the quickest and easiest ways to reduce stress and anxiety is to remove yourself from the current situation. I like to take a quick walk outside when possible. Just breathing fresh air can really help. Take some time to appreciate nature. Pick up a leaf and notice how remarkable nature can be. Walk to a river or stream and just watch and listen to the running water. Taking a walk not only helps with anxiety but can also improve blood flow to your brain and help you think more clearly.
Exercise is one of the best weapons against stress and anxiety. It is so important that it is one of my five pillars of health. We all know the many benefits of exercise. If you find yourself experiencing stress and anxiety, make time for physical activity. It is important that you pick a form of exercise you enjoy. If you don’t like the activity, you probably won’t stick to it. I recommend setting aside at least 30 minutes a day, five days a week for exercise.
Sleep is also one of my five pillars of health. I have found that if I don’t get enough sleep, I become more easily stressed and my anxiety level increases. Most of us need at least seven to eight hours of sleep per night. This will vary depending on the individual. When we are under stress, our bodies need more sleep. Be sure to practice good sleep hygiene as well.
Drinking alcohol can make anxiety and stress much worse. It can decrease sleep quality and using it to relax can backfire. Click here for a more in depth discussion on why you should avoid drinking alcohol.
The quickest and easiest way to reduce anxiety is to concentrate on your breathing. I like to use square breathing. Breathe in for 3 seconds, hold your breath for 3 seconds, breath out for 3 seconds, hold your breath for 3 seconds, and repeat as many times as necessary. This takes your mind away from whatever it is that is causing the stress.
I believe positivity can improve almost anything. Always remember that things can always be worse. Think of what you are grateful for and consider keeping a gratitude journal. Writing these things down can improve happiness and reduce anxiety.
Coffee and caffeinated beverages can keep you alert, but too much caffeine may make stress and anxiety worse. Know your limits. Be sure to stop drinking caffeine several hours before going to sleep.
Our Anxiety Formula is specifically designed to help reduce the symptoms caused by stress and anxiety. Order yours today by clicking on this link.
Disclosure: This post may contain affiliate links, meaning, at no additional cost to you, I may earn a commission if you click on, or make a purchase through a third-party link.
Michael J. Brown, RPh, BCPS, BCPP
Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.
Feel free to send Michael a message using this link.
Do you need to take a vitamin D supplement?
Many of us are deficient in vitamin D. The only way to be sure is to have a blood test performed. The test used is the 25-hydroxy vitamin D test. Our hospital lab lists the normal blood level to be 30.0-100.0 ng/ml. The Vitamin D council lists the ideal level between 40-80 ng/ml. I recommend supplementation in patients who have a level less than 30 ng/ml.
What’s the big deal? I live where there isn’t much sun! Why do I need Vitamin D?
It turns out that vitamin D performs many important functions in our body. As more research is completed, we are finding this vitamin helps with physical and mental health.
Vitamin D is one of the four fat-soluble vitamins (A,D,E and K). This vitamin is not found in many foods but is added to milk, tofu, and orange juice. Shitake mushrooms are also a good source of vitamin D.
Our bodies synthesize vitamin D when the skin is exposed to ultraviolet light from the sun. If we aren’t getting enough sunlight and eating enough foods rich in vitamin D, we are likely deficient in this vitamin.
The other way to get this vitamin is to take a supplement. All supplements are not created equal. The Sunshine Nutraceutical Vitamin D supplement is made in the USA in an FDA inspected facility. Our supplement contains 5,000 IU of vitamin D3 in a soft gel capsule.
AD
Disclosure: This post may contain affiliate links, meaning, at no additional cost to you, I may earn a commission if you click on, or make a purchase through a third-party link.
Osteoporosis occurs when the body loses too much bone tissue or is unable to replace bone loss efficiently. This causes the bones to become weak and are more easily broken. People with this condition may break a bone simply by bumping into something or sneezing.
The first sign that you have osteoporosis is usually when you break a bone. People with reduced bone density do not feel any different. The chances of a person with osteoporosis breaking a bone is 50% for women and 25% for men during their lifetime
You have a higher risk of breaking a bone if you:
The most important mineral in your bones is calcium. Vitamin D helps the bones absorb calcium. If you don’t get enough vitamin D, calcium cannot be absorbed for use by the bones. More calcium in the bones increases density which decreases the chance of a bone fracture
The incidence of broken bones increases during the winter months. Some researchers believe this is due to lower levels of vitamin D
A study published on August 1st, 2019 examined the effect of vitamin D levels on fractures in 287 elderly women with at least one previous bone fracture. This study concluded that vitamin D deficiency was associated with an increase in fracture severity as well as bone loss.
People with Generalized Anxiety Disorder (GAD) spend a great deal of time worrying excessively about many different things.
They may be convinced the world is coming to an end or always worry about money, health issues, family members, or their jobs.
This disorder can be debilitating if it becomes severe. People with this disorder may be afraid to leave their houses.
A study published in 2019 looked at the effects of vitamin D on GAD. Thirty patients with GAD and vitamin D deficiency were split into two groups of 15 patients each. One group received standard of care (SOC) only, while the treatment group received SOC plus 50,000 IU vitamin D weekly for three months.
The Generalized Anxiety Disorder 7-Item (GAD-7) scale was used in both groups to measure changes in anxiety levels. The vitamin D group had significant increases in serotonin levels, and their GAD-7 scores also improved. The group receiving SOC only showed no changes in GAD-7 scores or serotonin levels.
Attention-Deficit/Hyperactivity Disorder (ADHD) is characterized by a persistent pattern of impulsivity, inattention, and or hyperactivity that interferes with occupational, social, or academic functioning. This disorder may begin in infancy and may continue throughout adulthood.
The effect of vitamin D on ADHD was studied using fifty ADHD patients and fifty non-ADHD controls. The Conners’ Parent Rating Scale (CPRS) was used to assess ADHD symptoms, and serum 25-hydroxyvitamin D levels were measured using an ELISA kit.
Vitamin D levels were assessed using the following scale:
Serum 25OHD less than 10 (severe deficiency)
10-29 (mild deficiency)
>30 (sufficient vitamin D level)
Patients with ADHD had significantly lower serum levels of vitamin D (16.57 +/- 9.09 ng/ml) compared to the control group (22.01 +/- 12.67 ng/ml).
A severe vitamin D deficiency was 3.36 times more likely to be found in the ADHD group.
This study supports the monitoring of vitamin D levels in patients with ADHD.
Tuberculosis (TB) is a disease caused by Mycobacterium tuberculosis. This disease mainly affects the lungs but may also affect the kidneys, brain, or spine. It is spread by tiny droplets in the air produced when an infected patient coughs or sneezes. This disease can be life-threatening.
A nested case-control study was conducted looking at the effect of vitamin D on decreasing the progression of tuberculosis (TB).
Vitamin D has shown to have some impact on immunity. Vitamin D deficiency may also increase the risk of TB due to its effect on diabetes. Diabetes is a known risk factor for TB, and vitamin D is known to decrease diabetes risk.
In this meta-analysis, it was determined that low vitamin D levels were associated with the progression of TB. This effect was found to be dose-dependent. This raises the possibility of using vitamin D supplementation in high-risk populations to help decrease TB risk.
A prospective cohort study of 498 older women was conducted in 2012 to determine the effect of vitamin D on dementia. All subjects received baseline cognitive testing utilizing the Pfeiffer Short Portable Mental State Questionnaire. Only those scoring above 8 (normal cognitive function) were included in the study.
After a seven-year period, the Mini-Mental Status Exam (MMSE) and Grober and Buschke test were conducted to screen for dementia.
It was determined that the subjects with dementia had a lower average vitamin D intake than those without. (50 vs 59 ug/wk).
The subjects in the highest vitamin D intake quintile had a lower incidence of dementia than those in the remaining four quintiles combined (4.1% vs. 17%).
This study did depend on accurate reporting of vitamin D intake by the subjects tested. About half of the subjects were lost to follow-up during the study period.
Another small randomized controlled study was conducted in 2015 to determine the effect of vitamin D supplementation on the treatment and prevention of Alzheimer’s disease. Subjects were 60 years of age or older with an MMSE score of less than 24.
Two groups were randomized. The active group had a baseline vitamin D level of 8.2 ug/ml. This group received 4,000 IU vitamin D supplementation daily. The control group had a baseline vitamin D level of 9.3 ug/ml and received no vitamin D supplementation.
The MMSE was administered every three months. No difference was found between the two groups after three months, but a significant difference occurred after six months (24 vs. 22). Although the sample size was small, a positive effect of vitamin D supplementation was observed.
If you are interested in reading about Lewy Body Dementia follow this link.
I became interested in vitamin D due to its effects on depression. I see a large number of depressed patients and have noticed many have a sub-therapeutic vitamin D level.
People who are depressed feel unhappy most of the time. They may lose interest in things they have enjoyed in the past. Depression can cause the person may sleep too much or too little. They may have a difficult time concentrating and isolate. Depressed patients may have a change in appetite and may have low self-esteem.
Researchers believe vitamin D may increase the amount of serotonin in the brain.
Increasing serotonin and other monoamines are the mechanisms of action of many antidepressants available today.
Even though there seems to be a link between vitamin D and depression, conflicting evidence still exists.
There have been many studies conducted, but it remains unclear whether vitamin D helps treat depression or whether vitamin D levels are just lower in depressed patients.
A study conducted in the Netherlands in 2014 showed low vitamin D levels were associated with the severity and presence of depression. This study followed 1102 depressed patients aged 18-65 years and 790 patients who were not currently depressed but had been in the past.
A study in Finland in 2015 found higher serum concentrations of vitamin D were associated with a lower incidence of depression. The investigators believe higher vitamin D levels protect individuals from becoming depressed.
I am a firm believer in utilizing vitamin D supplements for those who are depressed. My recommendation is to take 5000 IU daily. Vitamin D levels can be obtained during your yearly health check-up.
Although I am not depressed, I take vitamin D daily to prevent depression. I live in Oregon and don’t get much sun, especially during the winter months. My vitamin D levels have been low in the past.
Yes, because vitamin D is a fat-soluble vitamin, it can accumulate. Hypercalcemia, an increased level of calcium in the blood, is the major consequence of taking too much vitamin D. Hypercalcemia can cause nausea, vomiting, frequent urination and weakness. It may also lead to the formation of kidney stones. A person would need to take a very high dose of vitamin D over a long period to become toxic.
Vitamin D is a critical substance used by our bodies in many ways. I have highlighted many uses of this vital vitamin in this post.
I have noticed in my practice that a large percentage of depressed patients have a low vitamin D level. I believe keeping your level therapeutic is a good step in feeling better and helping your body function as efficiently as possible.
I always recommend vitamin D supplementation in any patient with a level less than 30 ng/ml. It is an easy preventative measure.
If you have any questions or need further information, please feel free to contact me. As always, I want to thank you for reading my blog. If you have any subjects you would like to learn about; please let me know.
We can all live a happy, healthy, healing life!
Michael J. Brown, RPh, BCPS, BCPP
Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.
Feel free to send Michael a message using this link.
Disclosure: This post may contain affiliate links, meaning, at no additional cost to you, I may earn a commission if you click on, or make a purchase through a third-party link.
All of us become anxious throughout our lives for different reasons. We may be thinking about a test or speaking engagement and believe we are not prepared.
Our kids may be late getting home or fail to answer their phones. Many of us are afraid of heights or flying in airplanes. Preparing for surgery, being called into the supervisor’s office, getting lost in the woods, can all cause various levels of anxiety.
Anxiety is just a normal part of life.
When fear and anxiety lead to trouble sleeping or problems functioning in daily life, it is time to think about treatment options.
What are some of the options we can accomplish ourselves?
Can we teach ourselves to be less anxious?
The answer is yes, and we can. I am going to teach you some ways to decrease your anxiety level.
I used to be much more anxious than I am today. I have read a great deal about anxiety and work in mental health, so I am surrounded by the subject daily.
Weighted blankets are often used in children with autism spectrum disorder (ASD) to provide a “cocooning” feeling. They have also been used in the elderly.
The weighted blanket’s effectiveness has previously been shown to be related to the mass of the person using it. A blanket that weighs more than ten percent of a person’s body is more beneficial.1
A study published in the Journal of Sleep Medicine & Disorders on May 25, 2015, found a chain-weighted blanket was able to improve the quality of sleep in patients with insomnia. The subjects who used the weighted blanket had a calmer night’s sleep and exhibited less movement throughout the night. They also believed the blanket provided higher quality and a more comfortable night’s sleep.2
I have the pleasure of sharing an office with Kendra Munroe, OTR-L. Kendra is an Occupational Therapist (OT). She states weighted blankets should not be used in patients with open wounds, broken bones, or a history of sexual trauma.
Kendra prefers to use blankets that weigh no more than ten percent of the patient’s total body weight. She mainly uses weighted blankets from a company called Salt Of The Earth because she states they are well made.
For a more comprehensive explanation of weighted blankets and how to choose the best type for your situation, click here.
I also asked Kendra about “The Tapping Method.” This is something I had not been exposed to before working on our unit.
Munroe states this method is usually used for patients with anxiety or depression. It regulates the body by using its natural rhythms. It is best to match the speed of the heartbeat when tapping, according to Kendra.
Kendra recommends not using The Tapping Method on patients who aren’t open to it. It usually won’t work for them.
She excludes those unable to follow a pattern, such as those with dementia, as well as actively manic patients.
Play the video above to learn more.
The two breathing exercises below can help relieve tension and make you feel more relaxed:
This is a breathing exercise where you:
Square breathing can help with anxiety and make you feel more relaxed. It can also help with sleep and lower blood pressure.
These two breathing techniques can help tremendously if practiced. I suggest taking a few minutes each day on the above exercises until they become second nature.
When you start to feel anxious, proper breathing is an excellent initial intervention for quick relief.
Progressive muscle relaxation (PMR) is a technique that was developed in the 1920s by a physician attempting to get his patients to relax. This method works by counteracting the effects of the fight-or-flight response. This response helps protect us from danger.
In some people, the fight-or-flight response becomes a problem by creating an increase in unnecessary anxiety symptoms. It may even lead to a panic attack at times.
The adrenalin released during this response increases the heart rate. Stress hormones are also released. This may cause shortness of breath, sweating, trembling, and at times a feeling of impending doom.
Follow these steps to increase relaxation. This exercise may be especially helpful when feeling highly anxious or having a panic attack.
Like the breathing techniques mentioned above, this exercise will become more productive with practice. I recommend doing this a couple of times per day until it feels natural. You can then utilize the technique whenever you feel anxious or stressed.
Guided imagery is the use of words to guide a person to imagine a specific scenario designed to bring about the desired effect. This technique is often used to help with pain relief or to reduce stress and anxiety.
There are many apps available for the iPhone that utilize guided imagery. I am a firm believer in this technique, and if you want the best results, my suggestion is to click on the link below. Healthjourneys has many products available designed explicitly for anxiety relief.
Like the other skills mentioned in this article, guided imagery will become much more effective with practice. Give it a try!
I am not affiliated with Healthjourneys in any way.
One thing I have learned while working with psychiatric patients is that lack of sleep can make almost any condition worse.
We all need adequate sleep to recharge our body and mind. I thought this post would be a great place to remind my readers about how to maximize sleep. Here are the general sleep hygiene standards:
Frequent nighttime awakenings and daytime sleepiness are the main signs that you need to work on sleep hygiene. Getting this down can improve your physical and mental health.
Thinking errors can turn us all into our worst enemies.
There are three broad types of thinking errors. In this article, I am going to explain some of the most common type 2, or self-defeating thinking errors that can lead to depression, anxiety, and general unhappiness.
Catastrophic thinking is where one concentrates on the worst-case scenario. This certainly can increase anxiety and prevent the individual from taking appropriate action.
This type of thinking usually has no basis in reality. Consider the following example:
You call your daughter, but she doesn’t answer her phone. You convince yourself something horrible has happened to her. Maybe she is in the hospital or was involved in a car accident? You have a hard time concentrating and start to get extremely anxious. In reality, she is just away from her phone.
Fortune telling happens when the person assumes they will fail before even trying because they have not succeeded in the past. This thinking error is linked to anxiety as well as depression.
An excellent example of this is thinking is: “I will never get the job I just interviewed for.” Without knowing who else applied and exactly what kind of person the company is looking for, you cannot legitimately conclude you won’t get the position.
The person focuses only on the negative aspects of a situation or person. They may also think negatively about themselves. We have all been around this type of person. They are always complaining about how bad things are.
Mind reading occurs when a person thinks he knows another person’s thoughts or intentions.
This person may be convinced his friend is thinking about something negative in regards to him. None of us can read minds, so he should confront his friend if he believes they have an issue. Chances are, the friend doesn’t have an issue at all. Don’t waste time trying to guess what others are thinking.
There are other thinking errors, but this gives you an idea of how our thoughts can make us anxious.
Whenever you find yourself thinking about something that might be a thinking error, write it down.
Then next to it, in a separate column, list the reasons the statement is erroneous.
I have done this, and it helps. You will soon start to correct yourself without needing to complete the exercise. It is possible to train our minds to think differently with a little practice.
There are also natural substances that can help with anxiety as well as depression. Turmeric, which is a spice used in many foods, has been shown to have many beneficial health-related properties. For more information, read the article by clicking the link below.
Anxiety is something that will be with us throughout our lives. Although it serves a purpose in keeping us on track and protection us from danger in some situations, it can become overwhelming and detrimental.
The tactics described above can help reduce anxiety and help to increase the quality of your life.
Please remember, if your anxiety becomes too much to handle, or you are unable to function, seek professional help. An anxiety disorder is no different than diabetes or heart disease. It too can get out of control at times and deserves proper treatment.
Anxiety relief is one of my favorite topics. I have learned over the years to control it using the techniques described above.
If you have any questions, please click the contact me link next to my picture below and send me an email. You may also sign up to receive our newsletter by filling out the form on the top of this page. This contains news about our company, sales on our products, and links to our blog posts.
Remember to have a happy, healthy, healing life.
Michael J. Brown, RPh, BCPS, BCPP
Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.
Feel free to send Michael a message using this link.
