VERMONT TELEPSYCHIATRY
Specialized Psychiatric Care in Vermont
Verigrate Health provides physician-led psychiatric consultation and comprehensive psychiatric care by secure telemedicine to eligible patients who are physically located in Vermont at the time of care. Christian S. Monsalve, M.D., a board-certified psychiatrist and Founder & Medical Director, personally provides diagnostic clarification, complex medication review, individualized psychiatric medication tapering and deprescribing, and related psychiatric services.
Care is provided directly by Christian S. Monsalve, M.D. — one physician-led practice, with recommendations grounded in evidence, safety, the patient’s treatment history, and the particular circumstances of the individual.
Scope of Consultation
Clinical Areas of Consultation
Diagnostic uncertainty, difficult treatment histories, complex psychopharmacology, and focused specialist review.
Individualized tapering when medication reduction requires more than a routine dose schedule.
Careful assessment and tapering of benzodiazepines where reduction is clinically appropriate.
Structured reconsideration of medication burden, benefits, adverse effects, interactions, and ongoing indication.
Psychiatric treatment considered alongside relevant metabolic and physical-health factors.
Physician assessment of alcohol-related psychiatric and medical complexity, evidence-based treatment, and appropriate level of care.
Medication Stewardship
Psychiatric Medication Tapering in Vermont
For eligible patients located in Vermont, psychiatric medication tapering is considered when it is clinically appropriate — not assumed. Consultation begins with careful review of diagnosis, treatment response, medication history, previous withdrawal experiences, current evidence, concurrent care, and the patient’s goals before individualized recommendations are made. Representative medication classes reviewed during consultation include, but are not limited to:
Antidepressants
SSRIs, SNRIs, tricyclic antidepressants, MAOIs, serotonin modulators, NDRIs, and other atypical antidepressants — including escitalopram (Lexapro), sertraline (Zoloft), fluoxetine (Prozac), paroxetine (Paxil), citalopram (Celexa), fluvoxamine (Luvox), vilazodone (Viibryd), venlafaxine (Effexor XR), desvenlafaxine (Pristiq), duloxetine (Cymbalta), levomilnacipran (Fetzima), bupropion (Wellbutrin XL, SR), mirtazapine (Remeron), trazodone (Desyrel), vortioxetine (Trintellix), amitriptyline (Elavil), nortriptyline (Pamelor), clomipramine (Anafranil), doxepin (Silenor, Sinequan), phenelzine (Nardil), tranylcypromine (Parnate), isocarboxazid (Marplan), and selegiline transdermal (Emsam).
Benzodiazepines
alprazolam (Xanax), clonazepam (Klonopin), lorazepam (Ativan), diazepam (Valium), oxazepam (Serax), temazepam (Restoril), chlordiazepoxide (Librium), clorazepate (Tranxene), and triazolam (Halcion).
Hypnotic and sleep medications
Orexin receptor antagonists, non-benzodiazepine hypnotics, and other prescription sleep medications — including zolpidem (Ambien), eszopiclone (Lunesta), and zaleplon (Sonata).
Other psychiatric medication classes
ADHD medications, antipsychotic medications, mood stabilizers, anxiolytic and adjunctive psychiatric medications, medications for opioid use disorder, and medications for alcohol use disorder are also reviewed when relevant to the consultation.
Individualized by Design
Consultation begins with the person — not a protocol. Recommendations are individualized based on diagnosis, treatment response, medication history, previous withdrawal experiences, medical history, current evidence, and the patient’s goals.
How Care Works
Specialized Psychiatry Throughout Vermont by Telemedicine
Verigrate provides physician-led psychiatric consultation and comprehensive psychiatric care by secure telemedicine to eligible patients who are physically located throughout Vermont at the time of care. The work may include diagnostic clarification, complex medication review, individualized medication tapering or deprescribing, and coordination with another treating clinician when appropriate. The practice is not structured for urgent or emergency psychiatric needs.
Practice Structure
Common Questions
Is this a private-pay psychiatric practice?
Yes. Verigrate Health is a private, out-of-network membership practice, structured for depth, discretion, and physician continuity rather than volume.
What does an initial psychiatric consultation involve?
An unhurried, comprehensive evaluation: longitudinal history, prior treatment response, medication and withdrawal history, relevant medical factors, and the patient’s own goals — followed by individualized recommendations.
Is telepsychiatry available throughout Vermont?
Yes. Secure telepsychiatry is available to eligible patients who are physically located in Vermont at the time of their visit, subject to clinical appropriateness and practice availability.
Are second opinions and medication tapering offered?
Yes. Psychiatric second opinions, diagnostic clarification, and physician-guided medication tapering and deprescribing are central areas of the practice.
Who may not be well served by this model of care?
Patients requiring urgent or emergency psychiatric care, frequent crisis support, or in-network insurance-based treatment. Individuals in crisis should contact emergency services or local crisis resources.