EXPERT
Dr. Renee Scharfman Kohanski, M.D.
Psychiatrist
Dr. Renée Kohanski is a medical doctor specializing in psychiatry. Her commitment is to the overall well-being of her patients. She holds active medical licenses in the states of New New Jersey and Connecticut; seeing patients both live and via telemedicine in New Jersey and via telemedicine in Connecticut. Her office is located in Somerset, NJ. Once part of Dr. Kohanski's practice, there is no front-staff office as a barrier, since she provides direct high-quality access for her patients.
Dr. Kohanski is a board-certified psychiatrist with over 30 years of clinical experience. She has expertise training in psychopharmacology (medication), psychotherapy and the connection to general medicine. This affords her patients the option to schedule one appointment for both therapy and medication or she will work in conjunction with your therapist. Her post-graduate fellowship training in forensic psychiatry offers an additional skill set for second opinions and independent medical examinations (IMEs).
As a psychiatrist, Dr. Kohanski diagnoses and treats mental illnesses through a variety of methods. This includes medications, psychotherapy or talk therapy and more, depending on each case. Medications a psychiatrist might prescribe include antidepressants, mood stabilizers, stimulants, anti-anxiety medication and medications for insomnia. Dr. Kohanski treats conditions like depression, anxiety, obsessive compulsive disorder (OCD), eating disorders, bipolar disorder, personality disorders, insomnia, attention deficit disorder (ADD) as well as other conditions.
As a medical doctor, she understands each patient and their unique medical and psychological situation from a holistic perspective. She will all incorporate all these different parts into formulating a tailored treatment approach for each person. Dr. Kohanski takes the time to be thoughtful and to get it right!
Dr. Kohanski is a board-certified psychiatrist with over 30 years of clinical experience. She has expertise training in psychopharmacology (medication), psychotherapy and the connection to general medicine. This affords her patients the option to schedule one appointment for both therapy and medication or she will work in conjunction with your therapist. Her post-graduate fellowship training in forensic psychiatry offers an additional skill set for second opinions and independent medical examinations (IMEs).
As a psychiatrist, Dr. Kohanski diagnoses and treats mental illnesses through a variety of methods. This includes medications, psychotherapy or talk therapy and more, depending on each case. Medications a psychiatrist might prescribe include antidepressants, mood stabilizers, stimulants, anti-anxiety medication and medications for insomnia. Dr. Kohanski treats conditions like depression, anxiety, obsessive compulsive disorder (OCD), eating disorders, bipolar disorder, personality disorders, insomnia, attention deficit disorder (ADD) as well as other conditions.
As a medical doctor, she understands each patient and their unique medical and psychological situation from a holistic perspective. She will all incorporate all these different parts into formulating a tailored treatment approach for each person. Dr. Kohanski takes the time to be thoughtful and to get it right!
34 years
Experience
Dr. Renee Scharfman Kohanski, M.D.
- Somerset, NJ
- New York Med Coll- Valhalla Ny
- Accepting new patients
Courage and Healing in a Time of Cognitive Dissonance
I often think about the world in “pre-COVID” and “post-COVID” terms. The COVID lockdowns have negatively impacted the collective mental health of everyone. To recap, in March...
The Winter Holiday Season
Thanksgiving used to be the unofficial opening of the winter holiday season. Holiday creep has occurred over the years with Halloween being the new open. I’ll go one step further...
The 20th Anniversary of 9/11
Lots of conflicting stuff going on for people and lots of conflicting data. The 20th anniversary of 9/11 looms large and may even pass by the publishing of this blog. Delta variant...
Brain Fog & COVID-19
I’ve noticed a new concern from my patients since we’ve all been living with COVID-19. Specifically, they’re asking me about feeling such things as “brain fog” and they’re very...
Why do antidepressants cause anxiety?
Why do antidepressants cause anxiety?
I find this site to have very knowledgeable readers, so I don't want to give a simple answer because I believe you seek more. The answer READ MORE
Why do antidepressants cause anxiety?
I find this site to have very knowledgeable readers, so I don't want to give a simple answer because I believe you seek more. The answer is complex. First, many antidepressants are actually approved to treat anxiety in addition to depression; in many ways, the term "antidepressant" is misnomer for some molecules. With this in mind, there are some antidepressants that are very activating and the experience of this activation often feels like anxiety. This is especially true if there isn't a "protective" agent already on board to soften the activation.
For medication naive patients, bupropion is one such agent. However, I wouldn't necessarily not use this medication because of this. If this is the correct medication, there are strategies to mitigate or minimize the possibility of anxiety being a side effect and these can be deployed. The most basic one is telling your patient this might happen and proceeding with low-dose on-boarding and using the appropriate formulation (for example immediate vs. intermediate or long-acting release formulation). Layering of medications or perhaps an alternate first line medication might be an option for someone with a chief complaint of anxiety and depression. It all depends on the clinical situation.
On the other hand, there are some other antidepressants classes for which anxiety is not typically an anticipated side effect. However, these agents may have other side effects that would need to be considered in the treatment to see if they are an appropriate first line agent.
Anxiety can also occur because of uncommon or unusual side effects that are not the primary action of the anti-depressants and often are easily be managed by providing specific information to your health care provider about the specific symptoms you are experiencing.
Anxiety also can be experienced in the context of unanticipated drug-drug interactions. It is for this reason I maintain a very close contact with my patients when initiating any new medication and carefully review all their current medications and ask they reach out to me if they have any concerns what-so-ever and being available to receive their calls.
Unusual gene expression causing metabolism of medication to be different than expected resulting in excessively high or low levels of medications can produce unanticipated responses to medication.
My approach to your question and treating patient in general is as follows: Understanding the various agents and each of their side effect profiles; the chief complaint of my patient and all aspects of their chief complaint; their co-morbid medical problems and the underlying psychodynamic issues and psychology of their life. Then carefully choosing the right agent or agents in conjunction and discussion with my patient and putting together a treatment plan. Providing a truly informed consent, still with the possibility there may be an unanticipated side effect and being available to my patient to help manage the side effect as part of a collaborative team with my patient and any other providers involved.
I wish you the best of luck and thank you for your question.
Sincerely,
Renee S. Kohanski, M.D.
I find this site to have very knowledgeable readers, so I don't want to give a simple answer because I believe you seek more. The answer is complex. First, many antidepressants are actually approved to treat anxiety in addition to depression; in many ways, the term "antidepressant" is misnomer for some molecules. With this in mind, there are some antidepressants that are very activating and the experience of this activation often feels like anxiety. This is especially true if there isn't a "protective" agent already on board to soften the activation.
For medication naive patients, bupropion is one such agent. However, I wouldn't necessarily not use this medication because of this. If this is the correct medication, there are strategies to mitigate or minimize the possibility of anxiety being a side effect and these can be deployed. The most basic one is telling your patient this might happen and proceeding with low-dose on-boarding and using the appropriate formulation (for example immediate vs. intermediate or long-acting release formulation). Layering of medications or perhaps an alternate first line medication might be an option for someone with a chief complaint of anxiety and depression. It all depends on the clinical situation.
On the other hand, there are some other antidepressants classes for which anxiety is not typically an anticipated side effect. However, these agents may have other side effects that would need to be considered in the treatment to see if they are an appropriate first line agent.
Anxiety can also occur because of uncommon or unusual side effects that are not the primary action of the anti-depressants and often are easily be managed by providing specific information to your health care provider about the specific symptoms you are experiencing.
Anxiety also can be experienced in the context of unanticipated drug-drug interactions. It is for this reason I maintain a very close contact with my patients when initiating any new medication and carefully review all their current medications and ask they reach out to me if they have any concerns what-so-ever and being available to receive their calls.
Unusual gene expression causing metabolism of medication to be different than expected resulting in excessively high or low levels of medications can produce unanticipated responses to medication.
My approach to your question and treating patient in general is as follows: Understanding the various agents and each of their side effect profiles; the chief complaint of my patient and all aspects of their chief complaint; their co-morbid medical problems and the underlying psychodynamic issues and psychology of their life. Then carefully choosing the right agent or agents in conjunction and discussion with my patient and putting together a treatment plan. Providing a truly informed consent, still with the possibility there may be an unanticipated side effect and being available to my patient to help manage the side effect as part of a collaborative team with my patient and any other providers involved.
I wish you the best of luck and thank you for your question.
Sincerely,
Renee S. Kohanski, M.D.
What happens in the brain during depression?
This is a pretty sophisticated question. My guess is you are someone that could easily research and read about serotonin receptors, dopamine receptors, up-regulation, down-regulation, READ MORE
This is a pretty sophisticated question. My guess is you are someone that could easily research and read about serotonin receptors, dopamine receptors, up-regulation, down-regulation, etc. I could provide you with a neurobiological explanation involving fMRI scans of folks treated and untreated depression. Certainly, the very definition of depression is all brain/mind. From cognitive, mood and even perceptual issues at times to name but a few. I'm most interested in what information do you really seek? Do you want to understand does all depression need medication? Not necessarily, but sometimes it is essential Does psychotherapy help? Yes! Psychotherapy alone actually causes positive changes at the receptor level in the brain. Is the combination of medication and therapy useful? Absolutely. Do you need both? Not always, but it's a powerful combination. Does depression cause functional changes to the brain? Yes, as mentioned above. And the good news is, it's reversible and treatable!
Sincerely,
Renee S. Kohanski, M.D.
Sincerely,
Renee S. Kohanski, M.D.
What helps insomnia anxiety?
I’d really like to understand exactly what you mean by “insomnia anxiety.” I’m going to assume you’re having anxiety about going to sleep but you might have an entirely different READ MORE
I’d really like to understand exactly what you mean by “insomnia anxiety.” I’m going to assume you’re having anxiety about going to sleep but you might have an entirely different question. If you were in my office, I would start by clarifying this completely. Interestingly what happens in these cases is that folks get into vicious cycles. So, it might start innocent enough but by the time people end up in my office, there’s a whole negative conversation in your head and all kinds of “what ifs” and catastrophizing situations. Truly, it’s no wonder your poor brain can’t get any rest. We would start first with some simple reassurance. Disconnecting the anxiety about falling asleep is not all that hard to do. Just a little rewiring of some thinking, some relaxation exercises, maybe guided meditation. Might need to excavate and debride some other troubling thoughts swimming around inside your very busy mind, eluding you from that peaceful place at night, but I assure you it’s all very doable. If there’s more going on perhaps, we’d tease that out as well.
Hope this helps.
Sincerely,
Renee S. Kohanski, M.D.
Hope this helps.
Sincerely,
Renee S. Kohanski, M.D.
Can depression make you have insomnia?
Thank you for the question and being involved enough to ask! As the parent of an adolescent, you are no stranger to the difficulties of navigating this very difficult transition READ MORE
Thank you for the question and being involved enough to ask! As the parent of an adolescent, you are no stranger to the difficulties of navigating this very difficult transition period. Raging hormones, difficult social dynamics, complicated by a lost year due to COVID isolation and conflicting environmental messages, it's no wonder all 13-year-olds aren't struggling to some degree. And in fact, many are. Perhaps for all of time, to varying degrees? It would be very important to determine if your child does in fact have a "mild depression." Depression is a symptom constellation and can present differently in adolescents than adults.
As to insomnia and depression: Insomnia can be a variant of normal behavior (during times of stress) or a symptom of any number of psychiatric illnesses including depression, so contextual meaning is important. Since you are concerned enough to ask the question, you might want to consider professional consultation; you might consider your pediatrician as a starting point.
Sincerely,
Renee S. Kohanski, M.D.
As to insomnia and depression: Insomnia can be a variant of normal behavior (during times of stress) or a symptom of any number of psychiatric illnesses including depression, so contextual meaning is important. Since you are concerned enough to ask the question, you might want to consider professional consultation; you might consider your pediatrician as a starting point.
Sincerely,
Renee S. Kohanski, M.D.
Which antidepressant is effective in treating insomnia in a patient with depression?
While this seems like an innocent, easy question, there are many factors to consider. One has to ascertain if it's a true depression, previous response to medication, comorbid READ MORE
While this seems like an innocent, easy question, there are many factors to consider. One has to ascertain if it's a true depression, previous response to medication, comorbid conditions. So I always recommend a full assessment. There's no single, one right answer. The biggest consideration is the side-effect profile of the candidate molecules and I would also strongly consider non-pharmacologic interventions. So for example, a wonderful anti-depressant, anti-anxiety medication is mirtazapine, which has a very interesting and unique dosing profile. Which antidepressant is effective in treating insomnia in a patient with depression? It also has hypnotic (sedative), NON addictive properties that make it ideal for insomnia. That, being said, it has a very good chance of causing weight gain (!!!!) in certain populations, though.... this can be mitigated. So, as you can see, the answer is not a simple one.
Brain hyperactivity?
Dear Brian,
Lots of positives in the question you asked, the most important is, "It doesn't seem to affect most of my day-to-day activities," but it is impairing your sleep READ MORE
Dear Brian,
Lots of positives in the question you asked, the most important is, "It doesn't seem to affect most of my day-to-day activities," but it is impairing your sleep and you're curious about what's going on. You also mentioned, "I do like to talk a lot about subjects that interest me, but I can occasionally become extremely socially awkward which concerned me that it may be due to a form of autism." Without examining you and speaking in broad strokes not specific to you, there are certainly mild forms of autism spectrum disorder, what used to be referred to as "Asperger disorder" that is highly undiagnosed in the population. The good news is that many social skills that are not innate can actually be taught. This is something that can be remediated. No magic pills, just learning a new skill set. Now, as to the "hyperactive brain," that means many different things to different people. So, I'd need to understand more about that. You can certainly call my office at 609.366.0669 and we could speak briefly to determine if my practice is a good fit for an evaluation. The other direction you could move is neuropsychological testing.
Best of luck!!
Sincerely,
Renee S. Kohanski, M.D.
Lots of positives in the question you asked, the most important is, "It doesn't seem to affect most of my day-to-day activities," but it is impairing your sleep and you're curious about what's going on. You also mentioned, "I do like to talk a lot about subjects that interest me, but I can occasionally become extremely socially awkward which concerned me that it may be due to a form of autism." Without examining you and speaking in broad strokes not specific to you, there are certainly mild forms of autism spectrum disorder, what used to be referred to as "Asperger disorder" that is highly undiagnosed in the population. The good news is that many social skills that are not innate can actually be taught. This is something that can be remediated. No magic pills, just learning a new skill set. Now, as to the "hyperactive brain," that means many different things to different people. So, I'd need to understand more about that. You can certainly call my office at 609.366.0669 and we could speak briefly to determine if my practice is a good fit for an evaluation. The other direction you could move is neuropsychological testing.
Best of luck!!
Sincerely,
Renee S. Kohanski, M.D.
