The FDA's approval of esketamine (which is a derivative of the anesthetic drug ketamine) for treatment of depression has been hailed as a ‘game changer’ in the treatment of major depressive disorders. The exact mechanism of action of this drug still remains mostly unknown. There has been a rush of theories mostly focused on the neurotransmitter glutamate. As a psychiatrist who has practiced and followed the research over the last three decades, I am unconvinced by this explanation and its reductionistic, pseudoscientific description.

Let’s face it:...

67.4% of my patients have an addiction to porn. OK, I made up the precise statistic to get your attention; I just meant a significant subgroup! Pornography activates the novelty-seeking pathways in the brain and by some accounts, is indistinguishable from cocaine in its activation of the pathways of the brain involved in the regulation of dopamine. ADDers love to have dopamine surges and, "Voila!" you have a volatile combination! 

The problem comes when the person becomes compulsive and hyper-focused on the behavior, which then replaces healthy interpersonal re...