Responsible prescribing
An online psychiatrist that doesn't prescribe controlled substances
Safe, evidence based psychiatric care for adults, without controlled substances.
Written under the clinical direction of Shariq Refai, MD, MBA, FAPA, board certified psychiatrist · Last updated October 4, 2026 · Editorial policy
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What we don't prescribe
Care without controlled substances
shrinkMD is a non-controlled psychiatry practice. We don't prescribe benzodiazepines like Xanax, Klonopin, Ativan, or Valium on an ongoing basis, stimulants for ADHD like Adderall, Vyvanse, Ritalin, or Concerta, or opioids and sedatives like Ambien or Restoril.
We start with treatments that are safe and that last. For most conditions that means non-controlled medication chosen carefully, paired with therapy when it helps. You can read how we approach prescribing on our medication management page.
Why this policy exists
The clinical case for non-controlled care
Controlled substances have real uses, and there are patients and situations where a benzodiazepine or a stimulant is the right medication. The concern isn't the medication itself, it's the pattern that emerges when a psychiatric practice runs on volume: rushed visits, thin evaluation, and prescribing patterns shaped by patient pressure or platform incentives rather than a careful clinical fit.
By taking controlled substances off the table entirely, we protect three things. The evaluation stays long enough to actually diagnose. The prescribing decision isn't shaped by dependence or misuse risk. And the practice attracts patients who want durable, evidence-based treatment rather than a quick refill.
This is a real trade-off. Some patients we could otherwise help will need to go elsewhere, and we'll say so plainly on the first visit rather than after several sessions.
The non-controlled alternatives we actually use
What we prescribe instead
For anxiety disorders, first-line options include SSRIs (sertraline, escitalopram, fluoxetine, paroxetine), SNRIs (venlafaxine, duloxetine), buspirone, hydroxyzine for as-needed use, and beta blockers for performance situations. None are controlled substances. Cognitive behavioral therapy and exposure work sit alongside medication for the best outcomes.
For depression, the same SSRI and SNRI families are first-line, with bupropion, mirtazapine, vortioxetine, and vilazodone as alternatives when the first choice does not work. Trazodone helps with sleep-related depression without the dependence profile of a controlled hypnotic.
For ADHD, non-stimulant options include atomoxetine (Strattera), viloxazine (Qelbree), guanfacine ER (Intuniv), clonidine ER (Kapvay), and off-label bupropion. These take longer to work than stimulants and generally have smaller effect sizes, but they are legitimate first-line choices when a stimulant is not the right fit.
For sleep, we use trazodone, hydroxyzine, doxepin, ramelteon, and melatonin at appropriate doses, along with real cognitive behavioral therapy for insomnia (CBT-I). We do not use zolpidem, eszopiclone, or benzodiazepines as long-term sleep medications.
For mood stabilization, lithium, lamotrigine, valproate, and second-generation antipsychotics remain the standard, none of which are controlled substances.
If you take a controlled medication
Switching, tapering, or finding the right fit
If you currently take a controlled medication and want to keep it, we may not be the right practice for you, and we'll gladly point you toward a clinician who manages those medications. If you want to come off one, we can support a careful taper coordinated with your current prescriber where appropriate.
For benzodiazepines specifically, safe tapering usually takes weeks to months, not days, and is often best coordinated with the original prescriber who knows the full dosing history. Cold-turkey withdrawal from a benzodiazepine can be dangerous. If you want to come off but your current prescriber will not taper you, we can help you find a psychiatrist or addiction medicine physician who will.
For stimulants, tapering is usually simpler because the physical dependence profile is different, but the functional impact of coming off a stimulant that was actually helping ADHD symptoms deserves a real conversation before the change.
Who this policy is right for
The patients who benefit most
Patients who have never taken controlled substances and want a psychiatrist who will not default to them. Patients who used to take a controlled substance and want to stay off. Patients whose primary conditions (major depression, generalized anxiety, panic disorder, OCD, bipolar disorder, PMDD, postpartum depression, seasonal depression, insomnia) are well-treated by non-controlled options. Parents, healthcare workers, and safety-sensitive employees who prefer no controlled prescribing on their medical record for any reason.
If none of that applies to you, that's a reason to talk to a different psychiatrist. It's not a moral judgment; it's a fit question. See our care-finder for the other paths that exist.
How this shows up in care
What a first visit actually looks like
Your first visit is a full 45 to 60 minute video evaluation with a board certified clinician who takes a detailed history, including any prior controlled substance use. If a controlled medication is what you need to move forward, we will say so on that first visit and refer you to a clinician who prescribes it, rather than waste your time or ours.
If a non-controlled plan fits your situation, we set it up in that first visit and follow up on the same schedule as any evidence-based psychiatric plan: reassessment at 2 to 6 weeks depending on the medication, then at intervals that match your response and side-effect profile.
“My mental health is very important to me. I appreciate that my thoughts and questions are considered when discussing treatment and medications.”
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Frequently asked questions
Good questions, clear answers
Will shrinkMD prescribe Adderall or other stimulants?
No. shrinkMD doesn't prescribe stimulants or any other controlled substances. If you specifically need stimulant ADHD medication, a different practice would be a better fit.
Why doesn't shrinkMD prescribe controlled substances?
We focus on treatments that are safe and durable. A non-controlled approach reduces risks like dependence and misuse, and for most conditions it's effective when paired with the right plan and follow-up. The policy also lets us keep evaluations at full length rather than shortening them to serve controlled-substance volume.
What can shrinkMD prescribe?
Non-controlled psychiatric medications: SSRIs, SNRIs, buspirone, hydroxyzine, beta blockers, bupropion, mirtazapine, trazodone, doxepin, atomoxetine, viloxazine, guanfacine ER, clonidine ER, lithium, lamotrigine, valproate, second-generation antipsychotics, and other evidence based options chosen and monitored for your situation.
Can I get help tapering off a benzodiazepine or stimulant?
We can coordinate a careful taper when appropriate, typically alongside your current prescriber who knows the full dosing history. Cold-turkey withdrawal from a benzodiazepine can be dangerous, and safe tapers usually take weeks to months.
Do I need to disclose prior controlled substance use at intake?
Yes, and honestly. It's part of a real psychiatric evaluation, it's protected by the same privacy standards as any medical information, and it changes the treatment plan meaningfully. Withholding it makes it harder to help you.
Care you can trust
Physician led online psychiatry for adults, cash pay, with no controlled substances and the same clinician over time. Join the waitlist for your state.
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