Medication Management with Dr. Yeganeh "Anna" Jalaeian

I am often asked about psychiatric medications as part of a mental health treatment plan. In this blog, I ask some of the most common questions I receive to Yeganeh "Anna" Jalaeian, DNP, MS, FNP-BC, PMHNP-BC, CARN-AP, CAS, who is licensed in Virginia and who I collaborate with for medication management.

Why is it important to seek thorough clinical assessment for ADHD or ADD prior to seeking a prescription to treat it?

Difficulties with focus and concentration can come from many places — not just ADHD. Depression, anxiety, and PTSD can all mimic or worsen attention problems.

With depression, people often feel drained and low on mental energy. With anxiety, the brain goes into “threat-scanning mode.” In modern life, that doesn’t mean danger in the jungle — it means constant worry, overthinking, or feeling on edge. The brain tries to be efficient, so if something feels stressful, it focuses all its energy there instead of on day-to-day tasks. That’s why concentrating becomes so difficult.

PTSD works in a similar way. The brain becomes vigilant and keeps checking the environment to avoid anything that feels like past trauma. When the brain is busy making sure you’re “safe,” it’s much harder to sit down and focus.

Because these conditions can look like ADHD from the outside, a careful evaluation is really important. We want to rule out and treat anything else that could be interfering with focus first. Once those areas are addressed, if true ADHD symptoms remain, then we can confidently treat them.

As with any medication, we consider the benefits, possible side effects, and how it fits with your overall health. The goal is to treat what’s actually causing the difficulty — not just put a Band-Aid on the symptoms.

I am an adult who was diagnosed with ADHD in childhood but wonder now if that was accurate. Should I be assessed again as an adult? Will I have to come off of the medication to be adequately assessed? I fear withdrawal symptoms and that it may look like ADHD when it is really from withdrawal of medication I have taken for so long.

This is a very reasonable concern. ADHD usually begins in childhood and often continues into adulthood, but the way symptoms show up can change. Kids tend to look more hyperactive, while adults may mainly struggle with focus, organization, and forgetfulness. Sometimes the symptoms feel different simply because adult life doesn’t require the same level of structured attention as school did.

If you’re questioning your diagnosis, an adult reassessment can definitely be helpful. For the most accurate results, it’s ideal to be off stimulant medication during testing, because the medication can mask symptoms. You don’t have to stop suddenly — tapering slowly or taking “drug holidays” on low-demand days can make the process much more comfortable.

Withdrawal from stimulants is usually mild and short-term. The main symptom is fatigue, which passes after a week or two and is not the same as ADHD returning.

If you choose to pursue formal testing, there are FDA-approved tools like the QB Check that objectively measure attention and concentration.

Overall, the goal is simple: understand how your brain functions now as an adult and decide whether medication still supports your daily life, or whether the demands on your attention have changed enough to try life without it.

What is Naltrexone and how can it help me with abstaining from alcohol?

Naltrexone is a medication used to treat alcohol use disorder, opioid use disorder, and certain behavioral conditions. It works by blocking the brain’s opioid receptors, which are indirectly involved in the experience of reward and pleasure.

When someone drinks alcohol, part of the “reward” comes from stimulating these natural opioid receptors. Naltrexone blocks that pathway and helps the brain unlearn the association between drinking and feeling rewarded. As a result, alcohol simply doesn’t feel as reinforcing or compelling.

Across studies, people taking naltrexone tend to show:

• longer periods of sobriety

• fewer drinks on days they do drink

It’s important to know that naltrexone does not block the physical effects of alcohol. It simply reduces the rewarding loop that keeps alcohol use going.

People vary in how strongly they respond to naltrexone due to genetics. For many, it becomes a useful tool for supporting abstinence or reducing heavy drinking because it takes away the “pull” or “hook” that alcohol usually has on the brain.

I smoke marijuana daily. What effect will that have on my mental health medications?

Daily marijuana use can affect how your mental-health medications work and can impact your mood, thinking, and overall functioning.

Key points:

·        Modern marijuana is much stronger and poorly regulated, so THC levels vary widely. Even CBD products may contain THC.

·        The American Psychiatric Association reports no evidence that marijuana helps any psychiatric condition — and it may worsen them.

How it can affect mental health and medication response:

·        Can worsen anxiety, depression, irritability, and mood swings over time

·        Can trigger or worsen psychosis (paranoia, hallucinations), especially in daily or long-term users

·        Impairs memory, focus, motivation, and decision-making, which can make it harder to see whether medications are helping

·        Can blunt or interfere with the positive effects of psychiatric medications

·        Long-term use is linked to lower motivation, poorer work/school performance, and reduced life satisfaction

·        About 1 in 10 adults (and 1 in 6 teens) develop marijuana addiction

Bottom line: Daily marijuana use can reduce the effectiveness of mental-health medications and may worsen mood, anxiety, psychosis risk, and cognitive functioning. It’s important to discuss your use openly so treatment can be adjusted safely and effectively.

If I have a security clearance that requires me to disclose any mental health treatment and I fear disclosing that I take medication for a mental health issue will mean that I won’t be allowed to perform my job, what advice would you offer?

Taking care of your mental health is usually viewed as a sign of reliability, not a liability. Simply having a diagnosis or taking medication does not disqualify someone from holding a security clearance. What matters is whether your symptoms are well-controlled and you’re functioning safely and effectively.

It’s also important to know that failing to disclose required information can be seen as dishonesty — and that is taken far more seriously than receiving mental-health treatment.

If needed, your provider can document that your condition is treated, stable, and does not impair your ability to perform essential duties. This type of documentation often helps reassure security reviewers that you are responsible and able to carry out your role.

How does your education and experience in toxicology set you apart from other prescribers?

My training in toxicology gives me an additional layer of understanding about how medications interact with the body. Because toxicology focuses on biochemistry, physiology, and pharmacology, it has helped me develop a stronger grasp of how medications move through the body, how they act on different receptors, and how they influence symptoms.

In mental health care, this translates into a clearer understanding of how psychiatric medications work, which symptoms they’re likely to help, and how to manage treatment safely — especially when someone takes multiple medications or has complex conditions. Overall, it allows me to make medication decisions that are thoughtful, safe, and tailored to each person’s needs.

What is your favorite part of your work?

My favorite part of this work is watching people change in ways they didn’t think were possible — when symptoms finally make sense, when treatment begins to work, or when someone reconnects with parts of themselves that were buried under anxiety, trauma, or addiction. I love understanding a person’s story, their biology, and their patterns, and helping them put it all together in a way that brings clarity and relief. The trust, the honesty, and being part of someone’s growth is truly meaningful to me.

If you are in Virginia and looking for assistance with mental health medication, contact Anna by going to https://novamjhealth.com/