Medication management that starts with a diagnosis,
not a prescription.

Welmivia's approach begins with confirming the diagnosis and ruling out masqueraders: thyroid dysfunction, testosterone deficiency, DHEA depletion, and metabolic disruption from prior medications all produce depressive syndromes that antidepressants alone will not resolve. Medication selection is individualized, pharmacogenomic testing (BrightKaire) is available when multiple prior trials have failed, and side effects (sexual dysfunction, weight gain, cognitive dulling) are addressed within the treatment relationship.

Evaluation → written plan → medication selection → pharmacogenomics if indicated → metabolic and hormonal review if not responding

If you have tried two or more antidepressants at adequate doses without adequate response, you have treatment-resistant depression by clinical definition. The evaluation examines whether prior trials were adequately dosed, whether pharmacogenomic mismatch explains non-response, whether subclinical thyroid dysfunction or hormonal deficiency is contributing, and whether metabolic factors are limiting response. Augmentation strategies (T3 thyroid augmentation, lithium augmentation, atypical antipsychotics) are used precisely and within a documented rationale.

TRD workup → pharmacogenomics → thyroid/hormonal assessment → augmentation strategy with documented rationale

GAD, social anxiety disorder, panic disorder, and specific phobias are treated with evidence-based first-line pharmacotherapy (SSRIs, SNRIs, and buspirone) alongside consideration of adjunctive options including low-dose beta-blockers for performance anxiety and oxytocin for social anxiety. Benzodiazepines are used judiciously, with explicit documentation of rationale and a clear exit plan. Hormonal contributors (progesterone deficiency, HPA axis dysregulation) are assessed when clinical presentation warrants.

SSRIs/SNRIs first-line → adjunctive agents as indicated → hormonal and HPA axis review for refractory presentations

Stimulant selection, titration, and monitoring (including cardiovascular assessment and appetite/weight tracking) managed within your ongoing care relationship. Non-stimulant options (atomoxetine, viloxazine, bupropion) available for patients who cannot tolerate stimulants. Comorbid anxiety, sleep disruption, and mood instability are addressed as part of the same treatment relationship. GH secretagogues (CJC-1295/Ipamorelin) available for ADHD presentations with significant executive function impairment and disrupted sleep architecture.

Comprehensive ADHD eval → stimulant or non-stimulant selection → comorbidity management → executive function and sleep support as indicated

Bipolar disorder management requires careful attention to the metabolic burden of mood stabilizers and antipsychotics. Welmivia monitors thyroid function in lithium-treated patients, tracks metabolic labs for antipsychotic-treated patients, and addresses testosterone suppression from valproate in male patients. GLP-1 therapy is available for patients with antipsychotic-associated metabolic syndrome.

Mood stabilizer optimization → metabolic monitoring → thyroid tracking (lithium) → hormonal assessment if indicated

PTSD pharmacotherapy uses evidence-based first-line agents (sertraline, paroxetine, and prazosin for trauma-related nightmares) alongside adjunctive options including intranasal oxytocin for hyperarousal and DHEA for HPA axis dysregulation. Antidepressant-induced weight gain and sexual dysfunction are especially burdensome in a population already managing body image distress; these side effects are addressed proactively.

Evidence-based pharmacotherapy → HPA/hormonal review → side effect management → psychotherapy coordination

PMDD and perimenopausal mood disorder are fundamentally hormonal-psychiatric conditions frequently misdiagnosed as standard MDD. Welmivia evaluates progesterone, estradiol, and FSH alongside standard psychiatric assessment, and offers targeted hormonal treatment within a psychiatric framework. Low-dose SSRIs remain appropriate for PMDD and are offered as a first option; hormonal management is available when pharmacotherapy alone is insufficient.

Hormonal eval (progesterone, E2, FSH) → SSRI first-line option → progesterone/estradiol for root cause treatment

Sleep disruption is present in virtually every psychiatric condition. Welmivia treats insomnia with evidence-based pharmacotherapy (low-dose trazodone, mirtazapine, hydroxyzine) alongside careful attention to whether sleep disruption is primary or secondary to an underlying condition. Benzodiazepine and Z-drug hypnotics are used with explicit intent and a taper plan. CJC-1295/Ipamorelin is available for patients with disrupted slow-wave sleep architecture and comorbid ADHD or cognitive impairment.

Sleep-specific pharmacotherapy → underlying disorder assessment → sleep architecture support as indicated