Psychiatry & Psychotherapy in Orlando
Expert Psychiatrist in Orlando Specializing in Depression, Anxiety, ADHD, Bipolar, Schizophrenia and OCD
Dr. David Puder – Expert in treating OCD, schizophrenia, bipolar disorder, ADHD, depression, and anxiety in Orlando and Winter Park
Meet Dr. David Puder: Personalized Mental Health Care in Orlando
I’m Dr. David Puder, a board-certified psychiatrist based in Orlando, dedicated to providing compassionate and evidence-based care for individuals struggling with depression, anxiety, ADHD, bipolar disorder, schizophrenia, and OCD. My approach is rooted in understanding each person’s unique challenges and developing personalized treatment plans that promote healing and growth. Whether you’re seeking support for yourself or a loved one, I’m here to help you take the next step toward a healthier, more fulfilling life. I also teach mental health professionals from around the world and have shared my knowledge through various writings and lectures. Below, you will find links to these resources, including my general approach: The 5 Factors and Domains of Psychiatric Care.
Depth-Oriented Psychotherapy: Addressing the Roots of Emotional Distress
Depth-Oriented Psychotherapy: Depth-oriented psychotherapy focuses on uncovering and addressing deeper, often unconscious processes that influence a person’s emotions, behaviors, and thought patterns. Unlike more symptom-focused therapies, depth-oriented approaches aim to explore the underlying issues that contribute to psychological distress, such as unresolved traumas, internal conflicts, and maladaptive coping mechanisms. This form of therapy can be especially beneficial for individuals looking to understand themselves better, heal from past wounds, and achieve long-lasting emotional growth.
Approach to Depth-Oriented Psychotherapy in My Practice:
In my practice, depth-oriented psychotherapy is an integral part of the therapeutic process for those dealing with complex emotional issues. This approach allows patients to delve deeper into their internal experiences, leading to profound insights and transformative change. My approach includes:
Exploration of Unconscious Processes: Identifying unconscious conflicts, desires, and fears that may be driving current distress. This process often involves exploring early life experiences, attachment patterns, and relational dynamics.
Insight and Awareness: Facilitating self-awareness and insight into how past experiences shape present behaviors and emotions. This awareness empowers patients to make more informed and healthier choices in their lives.
Integration and Healing: Helping patients integrate these insights into their daily lives, fostering healthier relationships, improved self-esteem, and more adaptive coping strategies.
Benefits of Depth-Oriented Psychotherapy:
Encourages deep self-reflection and personal growth.
Addresses the root causes of emotional and psychological issues.
Promotes long-term emotional resilience and stability.
Dr. Puder's Writing and Lectures on Depth-Oriented Psychotherapy:
How to Fix Emotional Detachment
This lecture discusses the impact of emotional detachment and how depth-oriented approaches can help patients reconnect with their emotions and form healthier relationships.Therapeutic Alliance Series (Part 1, Part 2: Meaning and Viktor Frankl’s Logotherapy, Part 3: How Empathy Works and How to Improve It, Part 4: What is Transference and Countertransference?, Part 5: Emotion, Part 6: Attachment Types and Application, Part 7: Connecting with the Psychotic Patient, Part 8: Using Microexpressions)
Several episodes from this series delve into the importance of the therapeutic alliance, empathy, and understanding transference and countertransference, which are key components of depth-oriented psychotherapy.How to Pick a Good Therapist emphasizes the importance of finding a therapist with the right qualities to ensure effective therapy. The episode identifies three key characteristics of effective therapists: cognitive (intellectual curiosity and continuous learning), emotional (self-awareness and emotional regulation), and relational (strong interpersonal skills and therapeutic alliance). It discusses how these traits contribute to a successful therapeutic relationship and provides practical advice on evaluating therapists and understanding the value of a good fit in therapy.
More articles and lectures on psychotherapy:
Emotional Shutdown – Understanding Polyvagal Theory explains how polyvagal theory provides insight into the body's physiological responses to trauma and stress, such as dissociation or emotional shutdown. It discusses how understanding these responses can enhance therapeutic strategies for trauma treatment.
Affective Neuroscience in Psychotherapy with Francis Stevens, Ph.D. focuses on how understanding emotional brain circuits can enhance psychotherapy and improve emotional regulation.
Viktor Frankl’s “Man’s Search For Meaning” discusses Frankl’s experiences in concentration camps and his philosophy of finding purpose through suffering. The episode explores how meaning-making can help individuals endure hardship and foster resilience in both life and therapy.
Marcus Aurelius’ “Meditations”discusses Stoic principles for mental health, advocating for inner peace through self-reflection.
Dostoevsky – Crime and Punishment analyzes psychological themes of guilt and redemption, offering insights into moral and psychological conflicts.
A Journey Learning Psychotherapy reflects on the development of therapeutic skills and the evolving nature of psychotherapy practice.
What is psychodynamic theory? examines how unconscious processes and early experiences shape behavior, aiding in addressing emotional conflicts in therapy.
Understanding and Treating Depression
Depression is a common but serious mood disorder that affects how a person feels, thinks, and handles daily activities. It can manifest as persistent sadness, loss of interest in activities, changes in appetite, sleep disturbances, and feelings of hopelessness. Effective treatment addresses the biological, psychological, and social factors contributing to the condition.
Approach to Treatment of Depression in Orlando:
In my practice, I take a comprehensive and individualized approach to treating depression. This involves a thorough assessment to understand the unique factors contributing to each patient's condition, such as developmental history, lifestyle, and personal history. My treatment approach includes:
Medication Management: While medications can play a crucial role in managing depression, not all patients are treated with medications. My approach is personalized—some patients may benefit from starting or adjusting antidepressant therapy to help stabilize mood and improve overall functioning. However, for others, the focus may be on reducing or simplifying their current medication regimen. I work closely with each patient to determine the best approach, which may involve:
Starting Medications: Prescribing and managing antidepressants or other medications when appropriate.
Reducing or Simplifying Medications: For patients who wish to minimize their reliance on medications, I offer guidance on safely tapering or simplifying their treatment plans.
Focusing on a Holistic Pathway: For those interested in a more holistic approach, we may prioritize psychotherapy, lifestyle modifications, and complementary therapies, such as mindfulness, nutrition, and exercise, over pharmacological treatments.
The decision to use, adjust, or forgo medications is always made collaboratively, respecting each patient’s preferences, goals, and overall health needs.
Dr. Puder's Writing and Lectures on Medication Management for Depression:
The History, Mechanism and Use of Antidepressants
This episode explores the development of antidepressants, from the discovery of tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) to the advent of selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). It discusses how antidepressants are used, the criteria for prescribing them, and the factors that influence their effectiveness, including genetic predispositions and the severity of depression. It also covers the potential benefits of combining medication with exercise and therapy for a comprehensive treatment approach.
The article "Is Depression a Chemical Imbalance?" challenges the idea that depression is solely due to a serotonin deficiency, a concept popularized by early antidepressant marketing. Current research suggests depression involves complex changes in brain circuitry, including synaptic dysfunction and atrophy in key areas like the prefrontal cortex and hippocampus. While antidepressants and SSRIs can be effective for some, they don't address the root causes and work best when combined with therapy and lifestyle changes.
Nortriptyline and the Tricyclic Antidepressants
This episode delves into TCAs like Nortriptyline, discussing their mechanisms, indications, and the reasons they are no longer first-line treatments for depression. It covers their narrow therapeutic index, potential side effects such as increased risk for seizures and suicidality, and their continued use in certain cases, such as treatment-resistant depression and neuropathic pain. It also emphasizes the importance of monitoring plasma levels and understanding individual metabolic differences to optimize treatment and minimize risks.
Duloxetine and the SNRIs Deep Dive Part 1 & Part 2
The continuation of the SNRI discussion, this episode further explores the pharmacological properties, clinical applications, and polypharmacy considerations when using Duloxetine and other SNRIs. It highlights the importance of understanding drug-drug interactions, particularly involving the CYP450 system, to avoid adverse effects and optimize treatment outcomes.
Practical Psychopharmacology and Psychopharmacology Mediators
These discussions provide practical insights into psychopharmacology, focusing on how to tailor medication plans to each patient's needs while minimizing side effects through rational polypharmacy. They also cover the role of psychopharmacology mediators, including neurotransmitter systems and metabolic pathways, to optimize treatment outcomes and manage drug interactions effectively.
Psychotherapy: We offer a range of psychotherapeutic approaches to address depression, including:
Cognitive Behavioral Therapy (CBT): A highly effective, evidence-based approach that focuses on identifying and changing negative thought patterns and behaviors that contribute to depression. CBT helps patients develop healthier thinking styles and coping mechanisms to manage symptoms.
Lifestyle Modifications: Emphasizing exercise, nutrition, and sleep hygiene as crucial components of a holistic treatment plan.
Advanced Treatments: When necessary, exploring options like ketamine treatment, transcranial magnetic stimulation (TMS), or ECT for treatment-resistant depression.
Treating Depression in Orlando in unique populations
Post Partum Depression contains unique approaches as both for therapy and psychiatric medications
Older patients sometimes have unique issues that could look like depression or anxiety but really be hypoactive delirium.
Dr. Puder has written about Suicidal thoughts in Depression:
Catatonia in Depression is a complex condition that, when accurately diagnosed, can be effectively treated with the right interventions. Discover more about recognizing and managing this condition in the article: Catatonia: Diagnosis and Treatment.
Depression with Psychosis (psychotic depression) involves a combination of depressive and psychotic symptoms, requiring specialized treatment beyond standard depression therapies. Psychotic depression is often underrecognized due to underreporting of symptoms like hallucinations or delusions, which significantly impacts treatment outcomes and increases suicide risk. Proper diagnosis and tailored treatments, including the careful use of antidepressants and antipsychotics, are crucial for managing this condition effectively. For more detailed insights, visit the episode's page: Psychotic Depression.
Depression in patients with cancer:
How medications could make depression worse:
Treatment for Borderline Personality Disorder in Orlando:
Borderline Personality Disorder (BPD) is a complex mental health condition characterized by intense emotional instability, impulsive behaviors, and unstable relationships. BPD often co-occurs with depression, adding layers of complexity to diagnosis and treatment. Episodes from the "Psychiatry & Psychotherapy Podcast" cover several facets of BPD:
The history, symptoms, and neurobiological aspects of BPD, including the interplay of environmental factors, genetics, and brain science, are discussed to provide a comprehensive understanding of the disorder’s development and manifestation (Episode 115).
There is a focus on the distinction between BPD and Complex PTSD, exploring their overlapping symptoms like emotional dysregulation and trauma, but also highlighting critical differences in their treatment approaches (Episode 215).
Schema Therapy is discussed as a targeted psychotherapeutic approach for BPD, helping patients identify and change deeply entrenched negative thought patterns and behaviors (Episode 130).
Effective treatments like Dialectical Behavior Therapy (DBT), Mentalization-Based Therapy (MBT), and Transference-Focused Psychotherapy (TFP) share common factors: a strong therapeutic alliance, validation, and structured approaches to help patients understand and manage intense emotions and interpersonal conflicts.
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