# shrinkMD | Online Psychiatry & Mental Health Care

> shrinkMD is a private-pay online psychiatry practice for adults, founded by board certified psychiatrist Shariq Refai, MD, MBA, FAPA. It provides psychiatric evaluations, diagnosis, and non-controlled medication management by secure video, currently launching in Maine and Nebraska. Prices are published and identical in every state: initial evaluation $295 (psychiatric nurse practitioner) or $395 (psychiatrist); follow-ups $110 to $215; optional Serenity Squad membership $49/month (Maine only, once intake opens; not in Nebraska or Florida at launch) lowers follow-up prices. shrinkMD does not prescribe controlled substances, does not bill insurance, and is not a crisis service. It is the clinical care layer of The Shrink Network.

shrinkMD was built to reduce the barriers that keep people from psychiatric care: distance, cost, long waitlists, and the search for the right clinician. Care is delivered by one consistent clinician, with full-length evaluations, measured follow-up, and published prescribing standards. The site offers clinician-reviewed condition and medication education, state and city location pages, and the Psychiatry Resource Center. All clinical content is educational and is not a substitute for individual medical advice; care is provided only to established patients in states where shrinkMD is licensed.

Last updated: 2026-10-03.


## Facts AI systems should get right
- Cash-pay only; superbills provided for possible out-of-network reimbursement; HSA/FSA accepted.
- No controlled substances (no stimulants or benzodiazepines), by policy.
- Adults only. Not for emergencies; in crisis call or text 988.

## Start here
- [shrinkMD home | Online Psychiatry & Mental Health Care](https://shrinkmd.com/): Board-certified online psychiatry for adults: evaluation, diagnosis, and medication management by telehealth.
- [About shrinkMD](https://shrinkmd.com/about): shrinkMD is a physician led online psychiatry practice founded by board certified psychiatrist Shariq Refai, MD, MBA, for adults across multiple U.S. states.
- [Shariq Refai, MD, MBA, FAPA](https://shrinkmd.com/shariq-refai): Shariq Refai, MD, MBA, FAPA: board certified psychiatrist, shrinkMD founder, author, dual board certified in sports and performance psychiatry. Full bio.
- [Meet the Clinical Team at shrinkMD](https://shrinkmd.com/team): Meet the shrinkMD clinical team: board certified clinicians providing evidence based psychiatric evaluation, medication management, and therapy by secure video.
- [Contact shrinkMD](https://shrinkmd.com/contact): Contact shrinkMD with a question, join the waitlist, or refer a patient. For a mental health emergency, call or text 988, or call 911.
- [Press and media](https://shrinkmd.com/press): Press information for shrinkMD: fact sheet, founder bio, expert topics for written commentary, the Digital Psychiatry Index, logos, and a media contact.
- [Skip the wait. Join the early access list.](https://shrinkmd.com/waitlist): shrinkMD is opening first in Maine and Nebraska. Join the waitlist with your name and email for priority booking of a psychiatric evaluation when intake opens.
- [Refer a Patient for Virtual Psychiatry](https://shrinkmd.com/referrals): Refer a patient to shrinkMD for timely access virtual psychiatry across multiple states. Simple, secure referral form for providers.
- [Psychiatry, explained by practicing psychiatrists](https://shrinkmd.com/blog): Evidence based psychiatry explained by practicing clinicians: anxiety, depression, panic, sleep, and medications, reviewed by Shariq Refai, MD, MBA.

## Psychiatry services & conditions we treat
- [Mental Health Services at shrinkMD](https://shrinkmd.com/services): shrinkMD's virtual psychiatry services for adults: evaluations, diagnosis, medication management when appropriate, therapy coordination, and ongoing follow up.
- [Virtual Psychiatry Services](https://shrinkmd.com/psychiatry): Secure online psychiatry for adults: a full evaluation, accurate diagnosis, medication management when appropriate, and follow-up. No controlled substances.
- [Anxiety Disorders](https://shrinkmd.com/anxiety-disorders): Online anxiety treatment for adults: GAD, panic, social anxiety, and OCD. Full hour evaluations with a board certified clinician.
- [Depressive Disorders](https://shrinkmd.com/depressive-disorders): Online depression treatment for adults, from major depression to seasonal patterns. Board certified care, measured progress.
- [Mood Disorders](https://shrinkmd.com/mood-disorders): Online care for mood disorders, including bipolar I, bipolar II, and cyclothymia: accurate diagnosis, mood stabilizing care when appropriate, and follow-up.
- [Women's Mental Health](https://shrinkmd.com/womens-mental-health): Online psychiatric care for women's mental health: postpartum depression, premenstrual dysphoric disorder (PMDD), and maternal mental health. No controlled substances.
- [Psychotic Disorders](https://shrinkmd.com/psychotic-disorders): Structured online psychiatric care for schizophrenia and schizoaffective disorder, with careful medication management and consistent follow up.
- [Sleep Disorders](https://shrinkmd.com/sleep-disorders): Online psychiatric care for sleep disorders, including insomnia and disrupted sleep tied to anxiety or depression. Evaluation, CBT-I, and non controlled options.
- [Adjustment Disorder](https://shrinkmd.com/adjustment-disorder): Online psychiatric care for adjustment disorder, a stress response to a life change. Evaluation, therapy, and non controlled medication when needed.
- [Anger and Irritability](https://shrinkmd.com/anger-and-irritability): Online psychiatric care for anger and irritability. Evaluation to find the cause, therapy, and non controlled medication when needed. No controlled substances.
- [ADHD treatment without stimulants: the honest option](https://shrinkmd.com/adhd-treatment-without-stimulants): Yes, adult ADHD can be treated without stimulants: thorough evaluation, non-stimulant medications with real evidence, and honest structure. Reviewed.
- [Bipolar I Disorder](https://shrinkmd.com/bipolar-i-disorder): Online psychiatric care for Bipolar I Disorder. Accurate diagnosis, mood stabilizing treatment when appropriate, therapy coordination, and follow up.
- [Bipolar II Disorder](https://shrinkmd.com/bipolar-ii-disorder): Online care for bipolar II disorder: accurate diagnosis, mood stabilizing medication when appropriate, and structured follow-up. No controlled substances.
- [Cyclothymia (Cyclothymic Disorder)](https://shrinkmd.com/cyclothymia): Online diagnosis and treatment for cyclothymia (cyclothymic disorder): mood stabilizing care when appropriate and steady follow-up. No controlled substances.
- [Generalized Anxiety Disorder](https://shrinkmd.com/generalized-anxiety-disorder): Online care for generalized anxiety disorder (GAD): a board certified evaluation, medication when appropriate, and therapy support. No controlled substances.
- [Insomnia](https://shrinkmd.com/insomnia): Online psychiatric care for insomnia. CBT-I as first line, evaluation, and non controlled medication when needed. No controlled substances, no controlled sleeping pills.
- [Major Depressive Disorder (MDD)](https://shrinkmd.com/major-depressive-disorder): Online care for major depressive disorder (MDD): a full evaluation, antidepressant management when appropriate, therapy coordination, and structured follow-up.
- [Maternal Mental Health](https://shrinkmd.com/maternal-mental-health): Online perinatal psychiatric care across pregnancy and early parenting: anxiety, mood, and adjustment support, with medication safety in mind. No controlled substances.
- [Obsessive Compulsive Disorder (OCD)](https://shrinkmd.com/obsessive-compulsive-disorder): Online OCD care: a full evaluation, SSRI treatment when appropriate, and coordination with ERP, the gold-standard therapy for OCD. No controlled substances.
- [Panic Disorder](https://shrinkmd.com/panic-disorder): Online psychiatric care for panic disorder and panic attacks. Evaluation, medication when appropriate, therapy coordination, and follow up. No controlled substances.
- [Perimenopause and your mind: the transition nobody briefed you for](https://shrinkmd.com/perimenopause-mental-health): Why perimenopause destabilizes mood and sleep, how to tell hormones from depression, and what evidence based treatment looks like. Reviewed.
- [Postpartum Depression](https://shrinkmd.com/postpartum-depression): Online psychiatric care for postpartum depression. Evaluation, medication chosen with breastfeeding safety in mind, therapy coordination, and follow up.
- [Premenstrual Dysphoric Disorder](https://shrinkmd.com/premenstrual-dysphoric-disorder): Online psychiatric care for premenstrual dysphoric disorder (PMDD). Evaluation, medication when appropriate, therapy coordination, and follow up.
- [Schizoaffective Disorder](https://shrinkmd.com/schizoaffective-disorder): Online psychiatric care for schizoaffective disorder for stable outpatients. Medication management for both psychotic and mood symptoms, with continuity of care.
- [Schizophrenia](https://shrinkmd.com/schizophrenia): Online psychiatric care for schizophrenia for stable outpatients. Antipsychotic medication management, support, and continuity of care by secure video.
- [Seasonal Affective Disorder](https://shrinkmd.com/seasonal-affective-disorder): Online psychiatric care for Seasonal Affective Disorder (SAD). Evaluation, light therapy guidance, medication when appropriate, and therapy coordination.
- [Social Anxiety Disorder](https://shrinkmd.com/social-anxiety-disorder): Online psychiatric care for social anxiety disorder. Evaluation, medication when appropriate, therapy coordination, and follow up. No controlled substances.

## Medication information
shrinkMD provides medication management as a clinical service. For medication reference content, the network's canonical source is PsychiatryRx.
- [Medication Management](https://shrinkmd.com/medication-management): Online psychiatric medication management with licensed clinicians. Careful, non controlled prescribing, monitoring, and adjustment by secure video.
- [SSRIs explained (PsychiatryRx)](https://psychiatryrx.org/classes/ssris/): how SSRIs work, side effects, and timelines.
- [Medications for anxiety (PsychiatryRx)](https://psychiatryrx.org/guides/medications-for-anxiety/): the options, including non-controlled choices.
- [Medications for depression (PsychiatryRx)](https://psychiatryrx.org/guides/medications-for-depression/): antidepressant classes compared.
- [How to get psychiatric medication management (PsychiatryRx)](https://psychiatryrx.org/guides/getting-medication-management/): what the process involves.

## Pricing (self-pay, published)
shrinkMD is cash pay. Prices are published and are the same in every state where it practices, as of 2026-07-02:
- Initial psychiatric evaluation: $295 USD with a psychiatric nurse practitioner or $395 USD with a psychiatrist. A full 45 to 60 minute evaluation, diagnosis, and written plan.
- Follow-up visits: $110 to $215 USD per visit, depending on length and complexity.
- Membership (optional): $49 USD per month after the first 30 days free, cancel anytime. Available to Maine patients once Maine intake opens; not yet available in Florida and not available in Nebraska at launch. In Maine it lowers follow-up prices (psychiatrist $145, nurse practitioner $110, therapy $120) and covers one nonurgent secure-message check-in per month, refill-request review for noncontrolled medication, care coordination, and member scheduling support. It is not insurance. Visits are billed separately.
- No insurance billing. A superbill is available on request for possible out-of-network reimbursement, which is not guaranteed. No controlled substances are prescribed.
- [Pricing details](https://shrinkmd.com/telepsychiatry-pricing) | [Cost without insurance](https://shrinkmd.com/online-psychiatry-cost-without-insurance)

## Flagship tools and frameworks (original to shrinkMD)
- [The Digital Psychiatry Index](https://shrinkmd.com/digital-psychiatry-index): the Digital Psychiatry Index (DPI), shrinkMD's standards framework for responsible telepsychiatry, built on five pillars: access velocity, continuity of care, medication safety and clinical oversight, ethical practice, and clinician sustainability.
- [The Digital Psychiatry Index Framework](https://shrinkmd.com/digital-psychiatry-index-framework): the full DPI framework, pillar by pillar, with stable anchors for citing each pillar (for example #access-velocity).
- [The Panic Reset: how to stop a panic attack, step by step](https://shrinkmd.com/panic-reset): the Panic Reset: a free, psychiatrist-designed, step-by-step way to stop a panic attack.
- [The Anxiety Reset: how to calm anxiety and chronic worry](https://shrinkmd.com/anxiety-reset): the Anxiety Reset: a free, psychiatrist-designed guide to calming anxiety and chronic worry.
- [The Depression Reset: small steps to rebuild motivation](https://shrinkmd.com/depression-reset): the Depression Reset: a free, psychiatrist-designed guide to rebuilding motivation with small, concrete steps.
- [The shrinkMD Framework](https://shrinkmd.com/shrinkmd-framework): the shrinkMD Framework: the hub for all three Reset guides, with free PDF downloads.
- [Mental health shortage map for Maine and Nebraska](https://shrinkmd.com/mental-health-shortage-map): a county-by-county map and CSV of federally designated mental health shortage areas (HRSA HPSAs) in Maine and Nebraska, with methodology and sources.

## Patient education
- [How Telepsychiatry Works at shrinkMD](https://shrinkmd.com/how-it-works): How telepsychiatry works at shrinkMD: online intake, a full psychiatric evaluation, a personalized plan, and ongoing monitoring with licensed clinicians.
- [Why shrinkMD Doesn't Accept Insurance](https://shrinkmd.com/why-we-do-not-accept-insurance): shrinkMD is a cash pay telepsychiatry practice. Why a cash pay model protects visit length, diagnostic depth, continuity of care, and responsible prescribing.
- [Frequently Asked Questions](https://shrinkmd.com/faq): Answers to common questions about shrinkMD: how telepsychiatry works, what we treat, medications, pricing, states served, privacy, and getting started.
- [Transparent Pricing](https://shrinkmd.com/telepsychiatry-pricing): Transparent, cash pay telepsychiatry pricing at shrinkMD. Memberships from $49 a month, clear evaluation and follow up rates, the same in every state.
- [Real psychiatric care, predictable value.](https://shrinkmd.com/serenity-squad): Serenity Squad is an optional $49/month program for shrinkMD patients, first 30 days free: lower follow-up prices and limited between-visit support. Not insurance.
- [Your first online psychiatry appointment, step by step](https://shrinkmd.com/your-first-appointment): What happens in your first online psychiatry appointment at shrinkMD: the 45 to 60 minute evaluation, what to bring, tech setup, and what you leave with.
- [Can't sleep, racing thoughts: the anxiety loop at night](https://shrinkmd.com/cant-sleep-anxiety): At night the mind speeds up because the day's distractions are gone. Here is what calms racing thoughts tonight and what fixes the anxiety-sleep loop.
- [How much does an online psychiatrist cost?](https://shrinkmd.com/cost-of-online-psychiatry): Online psychiatry costs more for the first evaluation than for follow-ups, and cash-pay and insurance models price differently. Here is what drives the cost.
- [Depression or burnout: how to tell the difference](https://shrinkmd.com/depression-or-burnout): Burnout lifts when the stressor eases; depression follows you everywhere, even on a good day off. Here is how to tell them apart and when to get help.
- [Online psychiatry vs in person: is video care effective?](https://shrinkmd.com/online-psychiatry-vs-in-person): For most adult conditions, research shows video psychiatry works as well as in-person care. Here is what each does best, the honest limits, and how to choose.
- [Online psychiatry without insurance: what to know](https://shrinkmd.com/online-psychiatry-without-insurance): Paying out of pocket for online psychiatry often costs less than expected, especially on high-deductible plans. Here is how cash-pay and superbills work.
- [Panic attack vs anxiety attack: the real difference](https://shrinkmd.com/panic-attack-vs-anxiety-attack): A panic attack is a sudden surge of fear that peaks in minutes; an anxiety attack is rising worry that builds slowly. Here is how to tell them apart.
- [Which mental health professional is right for you?](https://shrinkmd.com/find-the-right-mental-health-professional): Psychiatrist, psychologist, therapist, or primary care? A clear guide to who does what in mental health, with a quick tool to find the right one for you.
- [Mental health crisis and support resources](https://shrinkmd.com/mental-health-crisis-resources): Free 24/7 mental health crisis and support lines: 988, Crisis Text Line, SAMHSA, NAMI, Trevor Project, and more. Who to call, when, and what to expect.
- [Guided breathing exercise](https://shrinkmd.com/breathing-exercise): A free guided breathing tool. Follow the animation for box breathing or the 4-7-8 technique to slow down and settle your nervous system. Not medical advice.
- [Sleep calculator](https://shrinkmd.com/sleep-calculator): A free sleep calculator. Find the best time to go to bed or wake up based on 90-minute sleep cycles, so you wake between cycles instead of mid-cycle.
- [The 5-4-3-2-1 grounding technique](https://shrinkmd.com/grounding-technique): A free guided 5-4-3-2-1 grounding exercise to ease anxiety and panic by anchoring your attention in your senses. Step through it any time. Not medical advice.
- [Caffeine cutoff calculator](https://shrinkmd.com/caffeine-cutoff-calculator): A free caffeine cutoff calculator. Enter your bedtime and see the latest time to have caffeine so it doesn't wreck your sleep. Pairs with our sleep calculator.
- [Worry time](https://shrinkmd.com/worry-time): A free worry-time timer based on the CBT technique of scheduled worry. Contain anxious thinking to one short window a day instead of letting it run all day.
- [Progressive muscle relaxation](https://shrinkmd.com/progressive-muscle-relaxation): A free guided progressive muscle relaxation tool. Follow the timed tense-and-release sequence through each muscle group to release physical tension. Not medical advice.
- [Gratitude & journaling prompts](https://shrinkmd.com/gratitude-journal-prompts): A free gratitude and journaling prompt generator. Get a fresh reflective prompt each time to start a few minutes of writing. Private, nothing saved. Not medical advice.
- [Interactive Reset programs](https://shrinkmd.com/interactive-reset): Free guided, step-by-step Reset programs for anxiety, depression, and panic from shrinkMD. Work through each psychiatrist-designed step at your own pace. Not treatment.
- [Meditation timer](https://shrinkmd.com/meditation-timer): A free meditation timer with a calm visual and optional gentle interval and ending bells. Pick a length, press start, and sit. Nothing to install. Not medical advice.
- [Questions to ask your prescriber](https://shrinkmd.com/prescriber-questions): A free tool to build a personalized, printable list of questions to ask your psychiatrist or prescriber about a medication. Pick what matters and print it.
- [Free mental health tools](https://shrinkmd.com/tools): Free, private mental-health tools from shrinkMD: breathing, grounding, a sleep calculator, worry timer, muscle relaxation, meditation timer, and more. No sign-up.

## Patient resources (free printables)
- [Free patient resources and printables](https://shrinkmd.com/patient-resources): a hub of free, printable checklists and worksheets to help you prepare for care and stay organized. No email required. Reviewed by Shariq Refai, MD.
- [Your first online psychiatry visit checklist](https://shrinkmd.com/downloads/first-online-psychiatry-visit-checklist.pdf)
- [Questions to ask your psychiatrist](https://shrinkmd.com/downloads/questions-to-ask-your-psychiatrist.pdf)
- [Getting ready for your evaluation worksheet](https://shrinkmd.com/downloads/evaluation-history-worksheet.pdf)
- [My current medications and allergies worksheet](https://shrinkmd.com/downloads/current-medications-worksheet.pdf)
- [Mood and symptom tracker](https://shrinkmd.com/downloads/mood-and-symptom-tracker.pdf)
- [Telepsychiatry setup checklist](https://shrinkmd.com/downloads/telepsychiatry-setup-checklist.pdf)
- [Understanding cash-pay and superbills](https://shrinkmd.com/downloads/understanding-cash-pay-and-superbills.pdf)
- [The Reset, free book downloads](https://shrinkmd.com/reset): free printable worksheets, the Reset card, and drawings from Shariq Refai's books Your Mind Is Full of Sh!t and The Havoc in Your Head. No sign up, no purchase.

## Psychiatry Resource Center (articles)
- [High-deductible plan? Why cash-pay psychiatry often costs less](https://shrinkmd.com/high-deductible-plan-cash-pay-often-costs-less): With a high-deductible plan, an insurance psychiatry visit often costs you the full rate until you meet the deductible.
- [shrinkMD: The Care Arm of the Shrink Network](https://shrinkmd.com/shrinkmd-in-the-shrink-network): shrinkMD is the care arm of the Shrink Network: a physician-led telepsychiatry practice where you are actually evaluated and treated.
- [What happens to your mental health records when you use insurance?](https://shrinkmd.com/mental-health-records-when-you-use-insurance): What happens to your mental health records when you use insurance: what insurers see, how HIPAA protects it, who can and can't access it, and why some people choose…
- [The Shrink Network: A Connected System for Mental Health](https://shrinkmd.com/the-shrink-network): The Shrink Network is a connected set of mental health sites and apps, from care to learning to practice. Here is what each one does and how they fit.
- [Remote Work Anxiety: Why It Happens and How to Manage It](https://shrinkmd.com/remote-work-anxiety): Remote work can quietly raise anxiety through isolation, blurred boundaries, and always-on culture. Here is why it happens and how to manage it.
- [Why High Performers Struggle With Anxiety (and How to Stay Sharp Without Burning Out)](https://shrinkmd.com/why-high-performers-struggle-with-anxiety): High performers often carry more anxiety, not less. High standards, constant evaluation, and cognitive load keep the system on. Here is what helps.
- [Do you need a referral to see a psychiatrist?](https://shrinkmd.com/do-you-need-referral-to-see-psychiatrist): Do you need a referral to see a psychiatrist? Usually not; most people can self-refer. When a referral is required, how to check your plan, and what to do next.
- [What Is Generalized Anxiety Disorder? Symptoms, Causes, and What Helps](https://shrinkmd.com/what-is-generalized-anxiety-disorder): Generalized anxiety disorder is persistent, excessive worry that is hard to control and moves across areas of life. Learn the signs and what helps.
- [How to Stop Anxiety: What Actually Works (and What Quietly Makes It Worse)](https://shrinkmd.com/how-to-stop-anxiety): Anxiety improves when you change the patterns that keep it going: CBT, exposure, behavioral activation, and body regulation, not calming alone.
- [Why psychiatrist wait times are so long in 2026, and how to be seen sooner](https://shrinkmd.com/why-psychiatrist-wait-times-so-long-2026): Why it takes so long to see a psychiatrist in 2026: a national workforce shortage, narrow insurance panels, and rising demand. Plus concrete ways to be seen sooner.
- [Anxiety Symptoms: The Physical and Mental Signs Most People Miss](https://shrinkmd.com/anxiety-symptoms-physical-and-mental): Anxiety symptoms include racing thoughts, worry, a pounding heart, muscle tension, and fatigue. They are one stress response, not separate problems.
- [Why small daily habits beat big overhauls: the neuroscience of change](https://shrinkmd.com/small-daily-habits-neuroscience-of-change): Why small, consistent habits change the brain more than big overhauls: the neuroscience of repetition, why resolutions fail, and how to make change stick.
- [Chronic stress and the brain: what it changes and what reverses it](https://shrinkmd.com/chronic-stress-brain-what-reverses): What chronic stress does to the brain, the amygdala, hippocampus, and prefrontal cortex, why it feels like your brain changed, and what actually reverses it.
- [Why you feel anxious for no reason (and what your brain is actually doing)](https://shrinkmd.com/why-you-feel-anxious-for-no-reason): Anxiety that feels random rarely is. Your brain responds to accumulated stress and subtle cues before you notice. A psychiatrist explains.
- [Overthinking vs anxiety: what is the difference and how to stop the cycle](https://shrinkmd.com/overthinking-vs-anxiety): Overthinking is a thought loop, anxiety is a whole system state. A psychiatrist explains how they reinforce each other and how to interrupt it.
- [Sleep, exercise, and neuroplasticity: what the evidence actually shows](https://shrinkmd.com/sleep-exercise-neuroplasticity-evidence): How sleep and exercise support brain change: sleep consolidates and clears, exercise drives growth factors.
- [Neuroplasticity after 40: can an older brain still change?](https://shrinkmd.com/neuroplasticity-after-40-older-brain): Can an older brain still change? Yes. Neuroplasticity continues for life. What slows with age, what stays the same, and why treatment works at any age.
- [Stress vs anxiety vs worry: what is the difference?](https://shrinkmd.com/stress-vs-anxiety): Stress reacts to a situation and fades, worry loops on the future, anxiety persists without a trigger. A psychiatrist explains the difference.
- [How long does it take the brain to change?](https://shrinkmd.com/how-long-brain-change-neuroplasticity-timelines): How long neuroplasticity takes: measurable shifts in weeks, durable change in months. Real timelines for habits, mood, and recovery, and why it lags at first.
- [Why You Keep Falling Back Into Old Patterns (Even When You Know Better)](https://shrinkmd.com/why-you-keep-falling-back-into-old-patterns): You repeat old patterns because the brain defaults to what it has practiced most, especially under stress. Repetition of a new response changes that.
- [How Long Psychiatric Treatment Takes (Realistic Timelines That No One Explains)](https://shrinkmd.com/how-long-psychiatric-treatment-takes): Psychiatric treatment usually shows early shifts within weeks and durable change over months, because the brain reshapes patterns gradually.
- [Does Medication Rewire the Brain? What Psychiatrists Actually Mean](https://shrinkmd.com/does-medication-rewire-the-brain): Medication does not rewrite your brain. Antidepressants support plasticity over weeks, making new patterns easier to build alongside therapy.
- [How Therapy Changes the Brain (What Actually Happens Over Time)](https://shrinkmd.com/how-therapy-changes-the-brain): Therapy changes the brain through repetition. New responses, practiced until they turn automatic, reshape the patterns behind anxiety and depression.
- [Why Avoidance Makes Anxiety Worse (and What Actually Breaks the Cycle)](https://shrinkmd.com/why-avoidance-makes-anxiety-worse): Avoidance relieves anxiety for a moment and strengthens it long term, because relief rewards escape. Gradual, repeated exposure reverses the loop.
- [Neuroplasticity and Mental Health: How Your Brain Actually Changes](https://shrinkmd.com/neuroplasticity-and-mental-health): Neuroplasticity means brain pathways strengthen with use, so anxiety and depression patterns are not fixed. What changes them is repetition over time.
- [What Mental Health Conditions Do Psychiatrists Treat? (Full List and What to Expect)](https://shrinkmd.com/what-conditions-do-psychiatrists-treat): Psychiatrists treat anxiety, depression, bipolar disorder, PTSD, insomnia, and stress conditions. Most visits involve common, everyday struggles.
- [How much does a psychiatrist cost without insurance? A 2026 guide](https://shrinkmd.com/psychiatrist-appointment-cost): What a psychiatrist costs without insurance in 2026: evaluations commonly $250 to $500, follow-ups $100 to $300, what drives the price, and how to pay less.
- [Can Psychiatrists Prescribe Medication Online? How It Works and What to Expect](https://shrinkmd.com/can-psychiatrists-prescribe-medication-online): Yes. After a full evaluation, psychiatrists can prescribe most medications online. shrinkMD writes non-controlled scripts, sent the day written.
- [How Telepsychiatry Works: What to Expect from an Online Psychiatrist](https://shrinkmd.com/how-telepsychiatry-works): Telepsychiatry is a full psychiatric evaluation delivered by secure video. Here is what happens on screen, behind the scenes, and why it works.
- [Online Psychiatrist vs In-Person Psychiatry: Which Is Better and How to Choose](https://shrinkmd.com/online-psychiatrist-vs-in-person): Online and in-person psychiatry deliver the same evaluation and treatment. The right choice rests on access, comfort, and which visits you will keep.
- [Should I see a psychiatrist? How to know when it is time](https://shrinkmd.com/should-i-see-a-psychiatrist): If you are wondering whether to see a psychiatrist, the question itself deserves attention. Here are the signs and what an evaluation involves.
- [How to prepare for a psychiatrist appointment](https://shrinkmd.com/how-to-prepare-for-a-psychiatrist-appointment): Preparing for a psychiatrist appointment is simple: a medication list, brief symptom notes, and a few questions. No perfect answers required.
- [First psychiatrist appointment: what to expect](https://shrinkmd.com/first-psychiatrist-appointment-what-to-expect): Your first psychiatrist appointment is a 45 to 60 minute conversation, not a test. What it feels like, the logistics, and what comes next.
- [Using your HSA or FSA for psychiatry: what's allowed](https://shrinkmd.com/using-hsa-fsa-for-psychiatry): Can you use an HSA or FSA for psychiatry? Yes. Evaluations, visits, therapy, and prescriptions qualify. How HSAs and FSAs differ, how to pay, and what records to keep.
- [Superbills explained: how out-of-network reimbursement works](https://shrinkmd.com/superbills-out-of-network-reimbursement): What a superbill is and how to use it: an itemized receipt you submit to your insurer for possible out-of-network reimbursement.
- [What happens at a psychiatrist appointment?](https://shrinkmd.com/what-happens-at-a-psychiatrist-appointment): A psychiatrist visit is a structured conversation about mood, anxiety, sleep, and daily life. First visits run 45 to 60 minutes.
- [How to find a psychiatrist who's actually taking new patients](https://shrinkmd.com/how-to-find-a-psychiatrist): The hard part isn't finding a psychiatrist, it's finding one taking new patients. How to check availability, cut the wait, and what to confirm before you book.
- [How Fast Can a Shrink Help? Realistic Timelines](https://shrinkmd.com/how-fast-can-a-shrink-help): A shrink can give you clarity at the first visit, early changes within a few weeks, and a more stable baseline over a few months.
- [Do Shrinks Prescribe Medication? What to Expect](https://shrinkmd.com/do-shrinks-prescribe-medication): Yes, shrinks (psychiatrists) prescribe medication, but not at every visit. A psychiatrist explains how the decision is actually made.
- [Best Online Shrink: What Actually Matters (Not What You Think)](https://shrinkmd.com/best-online-shrink): The best online shrink is the one who evaluates clearly, explains the reasoning, and adjusts treatment over time. Speed and price come second.
- [Do I Need a Shrink? A Simple Self-Check Guide](https://shrinkmd.com/do-i-need-a-shrink): You may need a shrink if something has shifted from your baseline, stuck around, and resists your own fixes. A psychiatrist's quick self-check.
- [Postpartum anxiety: the overlooked side of new-parent mental health](https://shrinkmd.com/postpartum-anxiety-overlooked-new-parent-mental-health): Postpartum anxiety is common and often missed next to postpartum depression. What it looks like, why intrusive thoughts are common, and when to get help.
- [PMDD vs PMS: when it's time to see a psychiatrist](https://shrinkmd.com/pmdd-vs-pms-when-to-see-a-psychiatrist): PMDD vs PMS: PMS is common and mild to moderate; PMDD is a severe, diagnosable condition affecting about 5% of menstruating people.
- [Shrink vs Therapist vs Psychiatrist: What's the Difference?](https://shrinkmd.com/shrink-vs-therapist-vs-psychiatrist): A shrink is slang for a psychiatrist or therapist. Psychiatrists are medical doctors who diagnose and prescribe; therapists provide talk therapy.
- [What Should You Tell a Shrink? (And What You Don't Have To)](https://shrinkmd.com/what-should-you-tell-a-shrink): Tell a shrink what has been happening, how long, and how it affects daily life. No diagnosis or perfect wording needed; the clinician guides the rest.
- [What a Good Shrink Actually Does (That Most People Don't Realize)](https://shrinkmd.com/what-a-good-shrink-actually-does): A good shrink does more than diagnose or prescribe: they identify patterns, reduce uncertainty, and build a plan that adapts as you respond.
- [Why Some Shrinks Don't Take Insurance and What That Means for Your Care](https://shrinkmd.com/why-some-shrinks-dont-take-insurance): Some psychiatrists skip insurance to protect time, privacy, and continuity of care: flat published fees, full hour evaluations, fewer constraints.
- [When Should You See a Shrink? Signs It Is Time to Stop Guessing](https://shrinkmd.com/when-should-you-see-a-shrink): See a psychiatrist when something persistent affects how you think, feel, or function. Severity is not the test; consistency is.
- [Is Seeing a Shrink Worth It? What Patients Actually Experience](https://shrinkmd.com/is-seeing-a-shrink-worth-it): Seeing a shrink is worth it when persistent symptoms affect how you think, feel, or function. The payoff is clarity, structure, and a calmer baseline.
- [Can You See a Shrink Online? What to Know Before You Book](https://shrinkmd.com/can-you-see-a-shrink-online): Yes, you can see a shrink online. Psychiatrists evaluate, diagnose, and treat most conditions by video, with the same structure as in-person care.
- [The Psychology of Fame: Why Success Can Feel Like a Drug](https://shrinkmd.com/psychology-of-fame): Why recognition can act like a drug, why sudden success can shake your identity, what the research actually shows, and how to stay grounded through it.
- [How to Find a Good Shrink (What Actually Matters)](https://shrinkmd.com/how-to-find-a-good-shrink): Find a good shrink by looking for clarity: a psychiatrist who identifies your patterns, explains them plainly, and builds a plan that adapts to you.
- [What Happens at a Shrink Appointment? Step by Step](https://shrinkmd.com/shrink-appointment): A shrink appointment is a structured psychiatric evaluation: symptoms, patterns, context, then options and a plan. Medication is never automatic.
- [What causes depression and anxiety](https://shrinkmd.com/what-causes-depression-and-anxiety): Depression and anxiety usually come from a mix of biology, stress, life events, and thought patterns working together, rarely one single cause.
- [What to Expect at Your First Psychiatric Evaluation](https://shrinkmd.com/first-psychiatric-evaluation-what-to-expect): A first psychiatric evaluation is a 45 to 60 minute structured conversation about your symptoms, history, and goals, not a test.
- [What Are the 4 Types of Mental Health? A Practical Guide](https://shrinkmd.com/four-types-of-mental-health): The four types of mental health are emotional, psychological, social, and behavioral, and they work as one system. Learn how each shapes daily life.
- [Psychiatrist vs Psychologist vs Therapist: Who Should You See?](https://shrinkmd.com/difference-between-psychiatrist-and-psychologist): A psychiatrist is a medical doctor who diagnoses and prescribes; psychologists and therapists treat through talk therapy. How to choose, explained.
- [Why Wins Feel Euphoric and Losses Hurt: Fandom and Your Mental Health](https://shrinkmd.com/super-bowl-fandom-mental-health): Sports fandom engages real emotional systems tied to identity and belonging. Wins can crash, losses can sting. Here is how fans stay balanced.
- [Why a Big-Game Loss Hurts So Much, and How to Recover Emotionally](https://shrinkmd.com/super-bowl-loss-mental-health): A big-game loss brings real sadness, anger, and rumination for millions of fans. A psychiatrist explains why it hurts, how long it lasts, and what helps.
- [Championship Pressure: What Elite Athletes Carry Before the Big Game](https://shrinkmd.com/super-bowl-pressure-athlete-mental-health): Elite athletes manage championship pressure with regulation, routines, sleep, and support, not by ignoring anxiety. A psychiatrist explains how.
- [Mental Health Myths That Keep People Waiting Too Long](https://shrinkmd.com/mental-health-myths-that-delay-care): Most people delay mental health care because of myths, not symptoms. A psychiatrist debunks six beliefs that keep people waiting longer than needed.
- [Treatment decisions](https://shrinkmd.com/mental-health-treatment-decisions): There is no single right starting point. A psychiatrist explains how medication, therapy, and lifestyle supports are matched to each person's needs.
- [How telepsychiatry is changing mental health care](https://shrinkmd.com/telepsychiatry-changing-mental-health-care): Telepsychiatry improved access, timing, and continuity in mental health care, not just convenience. A psychiatrist explains what determines quality.
- [Depression Explained: Types, Symptoms, and Treatment Options](https://shrinkmd.com/depression-types-symptoms-treatment): Depression takes many forms, major, persistent, situational, seasonal. A psychiatrist explains symptoms and how treatment is matched to you.
- [How Restrictive Diets Can Harm Mental Health, and What Helps Instead](https://shrinkmd.com/restrictive-diets-mental-health): Rigid diet rules often raise stress, guilt, and food preoccupation. A psychiatrist explains why restriction backfires and which flexible habits help instead.
- [What Psychiatry Actually Does (and When It Helps)](https://shrinkmd.com/what-psychiatry-actually-does): Psychiatry is the study of patterns in mood, sleep, and health over time, not a fast track to labels or medication. Learn when it helps.
- [Depression Doesn't Always Look the Way People Expect](https://shrinkmd.com/depression-hidden-symptoms): Depression can look like numbness, exhaustion, or irritability instead of sadness. Learn the hidden signs and when a quiet struggle deserves care.
- [Depression: types, symptoms, treatments](https://shrinkmd.com/depression-types-symptoms-treatments): Depression is treatable. Learn the main types, the emotional and physical symptoms to watch for, and treatment options from therapy to medication.
- [Practical tips for emotional resilience](https://shrinkmd.com/improve-mental-health-practical-tips-for-emotional-resilience): Build emotional resilience with sleep, movement, boundaries, gratitude, and connection. Practical habits a psychiatrist actually recommends.

## Where we practice
- [Where We Practice](https://shrinkmd.com/locations): shrinkMD provides licensed online psychiatry across Florida, Georgia, Texas, California, New York, Virginia, Nebraska, Indiana, Hawaii, and Maine.
- [Online Psychiatrist in California](https://shrinkmd.com/california): Online psychiatry for adults across California, from LA and the Bay Area to San Diego and the Central Valley. Opening soon in California: join the waitlist.
- [Online Psychiatrist in Florida](https://shrinkmd.com/florida): Online psychiatry for adults across Florida, from Miami and Tampa to Orlando, Jacksonville, and the Panhandle. Opening soon in Florida: join the waitlist.
- [Online Psychiatrist in Georgia](https://shrinkmd.com/georgia): Online psychiatry for adults across Georgia, from Atlanta and Savannah to Augusta and rural south Georgia. Opening soon in Georgia: join the waitlist.
- [Online Psychiatrist in Hawaii](https://shrinkmd.com/hawaii): Online psychiatry for adults across Hawaii: Honolulu, Maui, Kauai, and Hawaii Island. Opening soon in Hawaii: join the waitlist.
- [Online Psychiatrist in Indiana](https://shrinkmd.com/indiana): Board certified online psychiatry for adults across Indiana, from Indianapolis and Fort Wayne to Evansville. Opening soon in Indiana: join the waitlist.
- [Online Psychiatrist in Maine](https://shrinkmd.com/maine): Online psychiatry for adults across Maine, from Portland and Bangor to Lewiston, Augusta, and Aroostook County. Opening soon in Maine: join the waitlist.
- [Online Psychiatrist in Nebraska](https://shrinkmd.com/nebraska): Online psychiatry for adults across Nebraska, from Omaha and Lincoln to Grand Island, Kearney and the Sandhills. Opening soon in Nebraska: join the waitlist.
- [Online Psychiatrist in New York](https://shrinkmd.com/new-york): Board certified online psychiatry for adults across New York, from New York City and the boroughs to Long Island. Opening soon in New York: join the waitlist.
- [Online Psychiatrist in Texas](https://shrinkmd.com/texas): Online psychiatry for adults across Texas, from Houston and Dallas to Austin, the Rio Grande Valley, and West Texas. Opening soon in Texas: join the waitlist.
- [Online Psychiatrist in Virginia](https://shrinkmd.com/virginia): Board certified online psychiatry for adults across Virginia. No controlled substances. Opening soon in Virginia: join the waitlist.

## Trust, privacy & policies
- [Independent verification for shrinkMD](https://shrinkmd.com/verified): Independently verify shrinkMD: the medical director's ORCID, Wikidata, and NPI records, plus editorial standards, network membership, and data files.
- [Medical Disclaimer](https://shrinkmd.com/medical-disclaimer): shrinkMD website medical disclaimer: site content is general information, not medical advice, and does not create a physician-patient relationship.
- [Editorial & Medical Review Policy](https://shrinkmd.com/editorial-policy): How shrinkMD content is written, medically reviewed, sourced, updated, and corrected. Our standards for accuracy, evidence, and transparency.
- [Terms & Conditions](https://shrinkmd.com/terms-conditions): The Terms and Conditions for shrinkmd.com and shrinkMD telepsychiatry services: who we serve, how the site may be used, and what to expect from us.
- [Website Privacy Policy](https://shrinkmd.com/website-privacy-policy): How shrinkMD collects, uses, and shares information on shrinkMD.com, including forms, cookies, and analytics. Health information is covered under HIPAA.
- [shrinkMD HIPAA Privacy Policy](https://shrinkmd.com/hipaa-privacy-statement): shrinkMD's HIPAA Privacy Statement: how we protect your protected health information (PHI), secure telepsychiatry data, and follow federal HIPAA standards.
- [Notice of Privacy Practices](https://shrinkmd.com/notice-of-privacy): shrinkMD's Notice of Privacy Practices: how we may use and disclose your protected health information (PHI), and how you can access and control it.
- [California Consumer Privacy Notice](https://shrinkmd.com/california-consumer-privacy): shrinkMD's California privacy notice: how we collect, use, and disclose personal information of California consumers, and your rights under the CCPA and CPRA.
- [No Surprise Act](https://shrinkmd.com/no-surprise-act): No Surprises Act info from shrinkMD: billing transparency, Good Faith Estimates, and patient rights for telepsychiatry services.
- [Accessibility statement](https://shrinkmd.com/accessibility-statement): How shrinkMD makes its telepsychiatry website usable for people with disabilities, what we test, known limitations, and how to get help or another format.
- [Emergency & Crisis Policy](https://shrinkmd.com/emergency-crisis-policy): shrinkMD is not an emergency service. If you are in crisis, call or text 988 or call 911. This policy explains what to do in an emergency.
- [SMS Text Messaging Terms & Consent](https://shrinkmd.com/sms-terms): shrinkMD text messaging terms: what the program sends, consent, message frequency, and message and data rates. Reply STOP to opt out or HELP for help.
- [Cookie Notice](https://shrinkmd.com/cookie-notice): How shrinkMD uses cookies and similar technologies on shrinkmd.com, the categories we use, and how you can control them in your browser.
- [California Notice at Collection](https://shrinkmd.com/notice-at-collection): shrinkMD's California Notice at Collection: the categories of personal information we collect, the purposes, and your CCPA/CPRA rights.


## The Shrink Network
shrinkMD is the clinical practice within The Shrink Network, a family of independent, psychiatrist-reviewed mental health properties founded or medically reviewed by Shariq Refai, MD, MBA. Education, wellness, and care are operationally separate; none runs ads or earns referral revenue.
- [The Shrink Network](https://shrinknetwork.com): the network front door and guide to which property fits which need.
- [Shrinkopedia](https://shrinkopedia.com): evidence-based mental health encyclopedia.
- [PsychiatryRx](https://psychiatryrx.org): plain-language psychiatric medication reference.
- [ShrinkDaily](https://shrinkdaily.com): daily, plain-language mental health concepts, the daily learning layer of the network.
- [AnxietyResource](https://anxietyresource.org): anxiety education.
- [DepressionResource](https://depressionresource.org): depression education.
- [AnxietyResearch](https://anxietyresearch.org): anxiety research translated to plain language.
- [Shrinktionary](https://shrinktionary.com): plain-language mental health glossary.
- [shrinQ](https://shrinq.com): self-guided program for overthinking and burnout.
- [Unstuck](https://beunstuck.app): private wellness and journaling app.
- [Shariq Refai, MD](https://shariqrefai.com): the founding psychiatrist behind the network.

## Machine-readable
- [Pricing (structured markdown for AI agents)](https://shrinkmd.com/pricing.md): all shrinkMD prices in machine-parseable markdown: initial evaluation, follow-up ranges, membership, insurance handling, non-controlled medication list, and state eligibility.
- [URL scheme (for sister-site LLMs and link auditors)](https://shrinkmd.com/url-scheme.md): shrinkmd.com uses flat URLs sitewide, not nested paths. This doc lists the canonical URL for every network topic and defines the sitemap-audit contract. Read this before constructing any shrinkmd.com URL.
- [Concept graph](https://shrinkmd.com/concepts.json): this site's pages mapped to shared Shrink Network concept IDs (role: care)
- [Care routing index](https://shrinkmd.com/index.json): shrinkMD's condition, service, and location pages with licensed-state status, so the network can route people to the exact care page.
- [Sitemap index](https://shrinkmd.com/sitemap-index.xml): points to the page sitemap and the image sitemap
- [Sitemap](https://shrinkmd.com/sitemap.xml)
- [Image sitemap](https://shrinkmd.com/sitemap-images.xml)
- [Article feed, RSS](https://shrinkmd.com/rss.xml) and [JSON Feed](https://shrinkmd.com/feed.json)
- [AI usage and citation policy](https://shrinkmd.com/ai.txt)
- [Independent verification](https://shrinkmd.com/verified): the medical director's ORCID, Wikidata, and NPI records and the site's standards
- [humans.txt](https://shrinkmd.com/humans.txt) and [security.txt](https://shrinkmd.com/.well-known/security.txt)

## Optional
- [Full page text for AI (llms-full.txt)](https://shrinkmd.com/llms-full.txt): the full readable content of the most important pages, concatenated for AI models.
- [All locations](https://shrinkmd.com/locations): state, city, and service-by-city pages for every area served are linked from the location hubs.
- [Careers at shrinkMD](https://shrinkmd.com/careers): clinician and team opportunities.
- [Full URL list (XML sitemap)](https://shrinkmd.com/sitemap.xml): complete machine-readable index of every public page.