I am a graduate of Stanford University, Weill Medical College of Cornell University (MD), and Rockefeller University (MS, molecular neuroscience). I received residency training in adult psychiatry at Stanford Medical Center. I am experienced in psychopharmacology, cognitive-behavioral therapy, dialectical behavioral therapy, and community psychiatry, and I have a special interest in addiction psychiatry and process addictions, particularly eating disorders.
I currently have a private psychiatry practice in Walnut Creek and San Rafael, California. I provide psychiatric consultation to two local residential treatment centers and I am involved in several research projects with California Pacific Medical Center in San Francisco. My past roles have included work as a psychiatrist in the Kern County Mental Health System of Care in Bakersfield, California, a psychiatrist at North Bay Psychiatric Associates in San Rafael, California, and as a therapist and assistant medical director in a residential addiction treatment program in Marin County. In addition, I was affiliated with the Schuman-Liles Clinic in Oakland, California, for four years, where I practiced outpatient psychiatry in a community mental health setting.
In the past, I have worked with DBT Associates of the Peninsula in Los Altos, California, as a therapist and DBT skills trainer. I also worked with the Center for Health Care Evaluation at the Palo Alto Veterans Affairs Medical Center, developing more effective ways of prescribing opioids for chronic pain. I have taught at Stanford University, Stanford Medical School, the California School of Professional Psychology, and the Embry-Riddle Aeronautical University. I am currently on the Board of Directors for Anjna Patient Education, a student organization at Stanford Medical Center dedicated to improving patient education in free clinics in underserved areas.
Originally from Oswego, Illinois, I have lived in New York City and in the Bay Area for many years. I am an avid runner and reader, and I have a vital interest in health care policy and the evolution of modern psychiatry.
My readers should be aware that I am a former psychiatric patient, in longstanding, continuous recovery for many years. My experiences as a patient shaped many of my opinions of psychiatric rehabilitation, diagnosis, medication management, and mandatory treatment. Moreover, today I am keenly aware not only of the benefits of professional diversion and monitoring programs and long-term care, but also of the discrimination that psychiatric patients endure throughout their lives. Many of these ideas permeate my writings and practice philosophy.
Disclosure: I receive no compensation for this blog.
Please visit my web site at www.stevebalt.com. You may also email me at email@example.com. I do read all emails and comments to this blog, but please accept my apologies if I do not respond directly to you (at least not right away!).
Steve Balt, MD
Thanks for your website, which is such a welcomed breath of fresh air. I have actually used the term “checklist psychiatrist” out of frustration upon reading some of the aftercare referrals of patients I see in my practice, prior to discovering it on your website. You’ve obviously devoted much time to what I consider an invaluable and relatively rare voice of reason in our field. Please keep up the great work!
Thanks much, Dr. Z. Appreciate the feedback!
Nice to see some original thought in the field.
I just tweeted your site (under @MentalillPolicy ) . You are writing some terrific and original stuff. tx. for it.
I love your blog. It’s on my must-reading list every morning.
And thank you for always being so kind and respectful to those of us on the patient side of things.
Dear Dr. Balt,
I enormously appreciate your comments and your website. The information that you are offering is rare and exceptional. I hope that everyone and anyone who reads what you have to offer understands that your ideas are thoughtful, skilled and compassionate.
Stefan P. Kruszewski, MD
Harrisburg, PA 17110
July 24th, 2011
Are you on twitter? Wanted to follow you there but couldn’t find a handle.
thanks for the post on the site about lurasidone..agreed!!! what has happen
ed to our field?…thanks again…mike
I am a clinical psychologist employed in an academic medical center, and I found your web site through a post on KevinMD.com. I enjoy your cogent, thoughtful posts and look forward to reading more.
I noticed you followed my blog and don’t think I came by to say thank-you! So thanks! Your blog is an excellent read. Lots of posts that really interest me.
Steve, thanks for following my blog. I remember readng your blog post about the marketing blitz for Nuedexta earlier this year after having sold short some stock in Avanir Pharmaceuticals (AVNR). As you pointed out, it was remarkable how far they were willing to go to redefine PBA as a new disease state for which they had the only possible treatment, rather than a syndrome for which multiple existing generic therapies are available. Of course, reality is now catching up to them. It’s amazing to think what better uses there could have been for the hundreds of millions spent on marketing alone. Another example of the “efficient market” at work..
It’s nice to hear a doc with these views that I have held for many years as a doctorally trained psychotherapist turned family nurse practitioner turned psychiatric nurse practitioner—there are some nurse practitioner’s out there that encompass the biopsychosocial model such as myself. In every field, psychiatry, nurse practitioners there are those that are erudites in their field and those that are less so. I encourage you to open your minds to the NP’s in the world of psychiatry–medical school and your training does not make you the best–it’s just different–my three master’s degrees, residencies and 20 years of clinical experience in various treatment centers, community mental health centers, mobile crisis teams, family therapist teams has made me a positive influence on my patients; the majority get better. I do both therapy and med reviews in 15″ to 30″ believe it or not—it can be done although not ideal–it is what it is–anyways–
Wanted to let you know that NP’s are not all minimum standards of care–there are those like myself who give competent, superb and the highest standards of care focusing on both complex psychopharmacology and therapeutic modalities. Thought you should be aware of this from an independent NP out there in the world!
Would love to hear your thoughts on schizoaffective disorder. Will you be writing about this disorder anytime soon?
You have the monopoly on useful inftomaoirn-aren’t monopolies illegal? 😉
Dear Dr Balr
I am a retired dentist living wirth my daughter who has a daycare.
Today, a new family registered theur four yr old to attend. After they left, I noticed on their application firm a permission slip (signed) for us to administer chloridine at noon time.
I was shocked after looking up the drug and finding out about the Riley case.
My grandson was forrced to take adderell during his early elementary school years, then he home-schooled and stopped.
I believe that teachers are just lazy, and I fo not believe in ADHD.
I feel like giving the kid a placebo, and jkeeping the Chloridine hidden. I realize it’s a complicated situation ethically.
We are a small licensed daycsre in Florida (6 kids) and I think everyone of these kida is wild.
If they were in “normal” daycare they would probably be on drugs.
Just saw you took over as editor of TCPR! Very cool.
May I use your head maze image on a library guide?
I’m a family doctor in Metro Denver. Just completed an online survey about NUEDEXTA, which I had never heard of. Read your article; pretty scary stuff. Any thoughts on the appeal of this as a street drug? Seems like an ideal way to consume large amounts of dextromethorphan, though with more risk of cardiac arrhythmia. Seems extremely dangerous to me. Also concerned about the apparent impending marketing to primary care physicians.
Get your butt back to thought broadcast! You’ve been AWOL for over a year now.
You use so many side thoughts/sentences in parenthesis that your sarcasm –er…your “point” you’re trying to make is difficult to read. I know about using parenthesis too often and had to break myself from the habit. It isn’t anything to battle, it is just the mark of a poor writer until someone points it out. When the writer learns better, viola! the writer no longer is referred to as a “poor” writer.
Come on back, Doc! If only to say a formal “goodbye, for now.” Closure is important and therapeutic!
I agree with John—let us at least know if you’re doing well. As a co-recovering person and a health care provider (RN), I worry when good folks like you drop out of sight.
I am wondering why medications are even still being prescribed?
Here’s the book that opened my eyes to psychiatry.
Anatomy of an Epidemic, Robert Whitaker.
I highly recommend this read, especially for someone that has been prescribed any medication. They are dangerous. Educate yourself.
I really appreciate the blog you wrote about Nuedexta. Do you have any current thoughts about it? I think you were incredibly insightful.
My mother has been on Nuedexta for the past 2/12 months with no noticeable improvement. She has dementia and is in a rest home. When another another doctor took her off of Namenda & Aricept, it caused her to experience an immediate decline. (It was awful!) A psychiatrist stepped in and immediately diagnosed PBA – without even personally assessing her. She was asleep at the time he came to visit! She has been yelling and crying since, but it never seems inappropriate. Sometimes she doesn’t have words and just screams; but other times she says things like: “I’m scared; something’s wrong with my brain; I’m stupid; I don’t understand; I don’t know what to do”. I certainly would scream and cry under the same circumstances.
I have been trying to get the doctor to take her off the Nuedexta and to give her something else for her agitation since the 2 week trial period elapsed. It seems terribly cruel to let her continue to endure this mental torture, so I have been trying to read everything I can to help make a decision. I even called the company. I hadn’t read your blog yet, but something about this whole thing made me think money was behind it. Low and behold, I just found a website that tells how much money doctors make from medicine. In the period of August 2013 to December 2014, of the $156,000 this doctor has made in kickbacks from pharmaceutical companies, $117,000 of it is from Nuedexta. I am having the doctor take my mother off the medication tomorrow.
Do you know if it has to be weaned?
Firstly, thank you Steve for an excellently written and informative article, which has convinced me to go down the generic Doxepin road.
I’ve have insomnia (early waking), and have tried to tackle it from various angles over the years, and it’s only in the last few days that I’ve heard about Doxepin.
It’s reassuring that Doxepin, in it’s low dosage form, i.e. 3mg and 6mg, is considered safe and does not cause many of the symptoms found at higher doses.
I am in the process asking my sleep specialist if he can prescribe me Doxepin, however my only concern is that Silenor is not available anywhere in the UK, only the generic Doxepin which starts at 10mg.
However, I will see whether I can obtain the liquid form, in which case I’ll simply buy a measuring syringe from a local chemist and use this to measure out 6ml doses, which I believe equate to 6mg.
I’m crossing everything in the hope that this will finally free me from the curse of insomnia.
Thanks once again.
Correction, 0.006ml = 6mg, however you can purchase the liquid form in a strength where 10mg = 0.1ml, therefore 6mg would equal 0.6ml.
[…] Note one of the comments to this post, from a fellow psychiatrist, Steve Malt: […]
Thanks for writing thiis