I am a medical doctor with a background in obstetrics and gynecology in addition to board certification in psychiatry.  When I meet patients, I work to understand them as wholly as possible by looking at their family history and health, THEIR SUPPORTS AND STRESSORS, and the way they make meaning of themselves and their life.  My treatment tools include talk therapy, psychiatric medications and helping patients build resources including Improved sleep, nutrition, exercise, and contemplative practice.  I coordinate my care with other caregivers including a patient's  therapist, primary care doctor, ob/gyn or other medical specialist and will happily meet with a patient's family members for help with education or relationship conflicts.

 

 

OFFICES

My main office is in Arvada, Colorado located just off of Interstate I-70 at Wadsworth Blvd.

On Wednesdays I see patients in Boulder, Colorado at the Postpartum Wellness Center, located at 2300 Canyon Boulevard.

Please see the Contact page for maps.

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Undergraduate Education:

Yale University, Philosophy, B.A., 1987

Medical Education:

Baylor College of Medicine, M.D., 1997

Internship:

Baylor College of Medicine, Ob/Gyn, 1998

Residency:

Baylor College of Medicine, Psychiatry, 2003

Board Certification:

American Board of Psychiatry and Neurology, 2005

Memberships:

American Psychiatric Association, Colorado Psychiatric Association, National Association of Psychosocial Obstetrics and Gynecology, Marcé Society, Postpartum Support International

ADDITIONAL TRAINING IN PSYCHODYNAMIC PSYCHOTHERAPY: 

Houston-Galveston Psychoanalytic INstitute & Denver institute for psychoanalysis

MEDICATION

The thoughtful use of medication can make a huge difference by relieving symptoms and helping patients focus on other mental health tools including psychotherapy and self-care.  When using medications, I work closely with patients assessing for effectiveness and side effects and minimizing the number of medications needed.  I also counsel regarding complementary medicine approaches including supplements, acupuncture, bodywork and developing or strengthening spiritual practice.  

 

PSYCHOTHERAPY

Psychotherapy is the act of talking through thoughts and feelings in order to change the way you think and feel.  No one specific technique works for everyone.  My approach is patient-centered, using insight from multiple methods depending on individual needs and including cognitive-behavioral, mindfulness, psychodynamic and somatic techniques.  

 

REPRODUCTIVE PSYCHIATRY CONSULTATION

I have a special interest in the overlap of psychiatry and women's health and am a specialist in reproductive psychiatry.  Sex hormones change the way our brain cells work and some women are particularly sensitive to the fluctuations naturally occurring throughout the menstrual cycle, pregnancy and menopause.  

I frequently give presentations to other medical personnel including obstetricians and gynecologists, family practice doctors, nurse-midwives and labor and delivery and NICU nurses on subjects such as perinatal depression in mothers and the safety of psychiatric medications during pregnancy and breastfeeding.  

I meet with patients who would like one-on-one guidance on issues including whether to continue a psychiatric medication during a hoped-for pregnancy or support during the postpartum period for someone who experienced postpartum depression with a prior pregnancy.  I can either act as a consultant for a patient's current caregivers, or become the primary caregiver for a patient.

 

Genetic Testing

For patients with a history of non-response to medication, I now offer genetic testing through a company called Genomind.  I chose this company for testing because they do a comprehensive panel of testing specific to psychiatric illness and will bill your private insurance, but not ask for payment from you.  They also are doing research on the data (you can authorize to be part of this research, or opt out), to continue to build this new tool in psychiatric treatment.  The testing looks at three categories of genes: 

  1. Genes identified with clinical psychiatric conditions such as depression, anxiety and mood instability.  The results of this testing can help direct medication or supplement choices.
  2. A gene called MTHFR that codes for an enzyme that metabolizes folic acid.  People with low production of this enzyme will have a deficiency of the form of folic acid that crosses the blood-brain barrier.  As a result of this vitamin deficiency, they are thought to be low producers of some of the key neurotransmitters in the brain such as serotonin, norepinephrine and dopamine.  People with low enzyme activity can take a supplement, L-methylfolate, and build up their levels of those neurotransmitters which can lead to a remission in symptoms.
  3. Genes that code for liver metabolism pathways called CYP 450.  Many medications are broken down by the liver through these pathways and some people are either slow metabolizers or very rapid metabolizers which results in higher or lower drug levels than anticipated.  Higher drug levels often leads to more side effects and lower drug levels leads to lack of efficacy.
 

Do you take insurance?

I am not on insurance panels, Medicaid or Medicare.  I ask for payment at the time you see me and will give you a receipt that has the information needed to submit to your insurance for out-of-network reimbursement.  You may call your insurance company to find out whether you have coverage for out-of-network psychiatric visits.

I wish that I could take insurance, but to do that would change the way I practice.  It would require me to hire staff to spend the time insurance companies require for negotiation and communication, and I would be encouraged to visit with patients for 10-15 minutes rather than 30-50 minutes.  Finally, insurance companies can request private information regarding our treatment that some patients may consider an invasion of privacy.

What do you charge?

Initial visits are long and in-depth and take, on average, 1 ¼ hours (I allow for up to 1 ½ hours depending on the complexity of a patient's history and presenting problem.)  Follow-up appointments may be 30 minutes for medication-focused treatment or 50 minutes for more psychotherapeutically-oriented treatment.

Rate Schedule: 

  • Initial Evaluation $400
  • Follow-up (30 min.) $160
  • Follow-up (50 min.) $220

I do not charge for time spent in short communication with patients (such as phone calls less than 15 minutes).  I will communicate with patients in the unlikely and infrequent circumstance that I feel they may be taking advantage of this policy.

 

What conditions do you treat?

(click on highlighted items to take screening tests or be directed to references.)

Anxiety

Obsessive-Compulsive Disorder

Generalized Anxiety Disorder

Panic Attacks

Social Anxiety

Depression

Attention-Deficit Disorder

Insomnia

Pregnancy-related Mood Disturbances

Peri-menopause related Mood Disturbances

Relationship Issues

Difficulties around parenting

Grief process

 

FREQUENTLY ASKED QUESTIONS SPECIFIC TO MEDICATION TREATMENT: 

Question: How long are medication visits? 

Answer: An initial medication evaluation is scheduled for 90 minutes. At the end of this appointment we will discuss a treatment plan which includes the frequency of subsequent visits. Medication monitoring visits are 25 minutes long and are spaced apart depending upon how often we need to get together to review your medication treatment and make decisions about any changes that may be called for. If your medication is working well and your condition stable, I will ask you to see me every 6 months at a minimum. These checkup visits must be face to face and cannot be held over the phone. 

Question: What information do you need from me before our first appointment? 

Answer: It is helpful to me if you complete the Initial Patient Form and bring it with you to our first appointment.  If you are currently in treatment with a psychotherapist, please bring a completed Authorization to Release Information form to your appointment since this will allow me to contact your therapist to provide him or her with feedback about our appointment and to discuss a shared treatment plan as needed. 

Question: What if I have a question about my medication (e.g. side effects) in between appointments? 

Answer: I encourage you to call me with questions about your medication. I try to return calls the day they are received unless you call after business hours. I feel that time spent on the phone can be essential for good treatment and I do not routinely charge for time spent with you on the phone. However, if I see that we are spending extended periods of time on the phone, I will discuss with you the need to charge for that time as if it were an office visit. 

Question: What if I am running low on my medication? 

Answer: If I am prescribing medication for you, I ask that you keep track of your medication supply so that you can call for a refill at least a few days before you will run out. It is helpful to me if you always call your pharmacy for a refill rather than contacting me directly as this enables the pharmacy to have your records prepared when they call me.  This applies even if your bottle indicates that there are no additional refills available.

 

Books:

 

PERINATAL MENTAL HEALTH:

This Isn't What I Expected by Karen Kleiman, LCSW and Valerie Raskin, MD

The Postpartum Husband by Karen Kleiman

Dropping the Baby and Other Scary Thoughts by Karen Kleiman & Amy Wenzel

When Words Are Not Enough by Valerie Raskin, MD

 

Relationships

Boundaries, by Henry Cloud, PhD & John Townsend, PhD

How To Be An Adult in Relationships, by David Richo

Seven Principles for Making Marriage Work, by John Gottman, PhD  (poster link)

Hold Me Tight, by Sue Johnson, PhD

Wired for Love, by Stan Tatkin, Psy.D.

Your Brain on Love (audiobook), by Stan Tatkin, Psy.D.

 

Cultivating well-being

Thoughts Without A Thinker, by Mark Epstein, MD

Going To Pieces Without Falling Apart, by Mark Epstein, MD

Full Catastrophe Living, by Jon Kabat-Zinn, PhD and Guided Mindfulness Meditations by Jon Kabat-Zinn (available on CD)

When Things Fall Apart: Heart Advice for Difficult Times, by Pema Chödrön

 

Parenting

Everyday Blessings: The Inner Work of Mindful Parenting, by Jon Kabat-Zinn & Myla Kabat-Zinn

Touchpoints series, by T. Berry Brazleton, MD

Your ____ Year Old series, by Louise Bates Ames, PhD

Get Out of My Life, but First Could You Drive Me & Cheryl to the Mall: A Parent's Guide to the New Teenager, by Anthony E. Wolf

Masterminds and Wingmen: Helping Our Boys Cope with Schoolyard Power, Locker-Room Tests, Girlfriends, and the New Rules of Boy World, by Rosalind Wiseman

Queen Bees and Wannabes: Helping Your Daughter Survive Cliques, Gossip, Boyfriends, and the New Realities of Girl World, by Rosalind Wiseman

Video interview with Rick Hanson, PhD on navigating conflict with your teenager/young adult child: http://www.rickhanson.net/countdown-2017-day-5/

 

 

 


Links on the web:

Perinatal Mental Health:

Link to a blog I recently wrote on Perinatal Mood and Anxiety Disorders: https://genomind.com/genetic-testing-maternal-mental-health/

Postpartum Depression Screening Tool: EPDS

Postpartum Support International: www.postpartum.net

Massachusetts General Hospital Center for Womens Mental Health: www.womensmentalhealth.org

FDA's New Pregnancy and Lactation Medication Guidelines Announcement and Interpretation

PPD Act, an Apple-platformed app-based study of perinatal depression: see http://www.pactforthecure.com

 

Breastfeeding and Medications:

Lactmed: http://toxnet.nlm.nih.gov/newtoxnet/lactmed.htm

Mother to Baby: http://www.mothertobaby.org

 

cultivating well-being

Depression

Podcast: OnBeing (favorite episodes of mine: Brené Brown on vulnerability, Jennifer Michael Hecht on suicide, Thupten Jinpa translator for the Dalai Lama, Sylvia Boorstein on what we nurture)

 

BIPOLAR DEPRESSION

National Institute of Mental Health page

Depression & Bipolar Support Alliance page

Screening questionnaire

Mood Chart Apple Store App: Optimism

 

 

Office Documents to Prepare Before Your Visit: 

New Patient Form

Current Medical Providers and Pharmacy Information

EPDS (please print and fill out this mood questionnaire IF you are pregnant or are a postpartum parent.)

Informed Consent

Electronic Agreement

Release of Information

Privacy Policy HIPAA (for reference only, no signature required)

Acknowledgement of Receipt of Privacy Policy

Contact Information

Office phone: 720.379.4386

Fax number: 720.379.6316

Scheduler (only for existing patients, not new patients): 303.975.6142

Patient Portal link: https://valantmed.com/Portal/klh

 

Main Office (Mondays, Tuesdays & thursdays)

5601 Olde Wadsworth Boulevard, Suite 200
Arvada, CO 80002

 

Parking for Arvada office: there is a reserved parking spot located in a parking lot accessed at the intersection of Grandview Avenue and Yukon Street.  The parking spot sign reads "Dr. Karen Horst, Management".  You are welcome to park there.

 

 

Boulder (Wednesdays)

The Postpartum Wellness Center: http://www.pwcboulder.com

2300 Canyon Boulevard, Suite 5

Boulder, CO 80303

303-955-6809

 

Parking is directly behind building.
 

Payment On-line

30 minute session ($160)

50 minute session ($220)

Initial Consultation ($400)

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