PSYCHIATRISTS ENJOY TIME TO COLLABORATE — Dr. Richard Bermudes and Dr. Rachael Smith specialize in depression and anxiety treatment at their El Dorado Hills office. Photo by Roberta Long


Mindful Health Solutions brings new therapy for depression, anxiety

By March 16, 2011

PSYCHIATRISTS ENJOY TIME TO COLLABORATE — Dr. Richard Bermudes and Dr. Rachael Smith specialize in depression and anxiety treatment at their El Dorado Hills office. Photo by Roberta Long

Richard Bermudes, MD – Family physician and psychiatrist

Richard Bermudes, MD, is well aware of the stigma surrounding mental health treatment and psychotherapy. “For a lot of people, it’s just not cool,” he said.

What’s even more not cool is experiencing serious neurological disorders that reduce people’s ability to accomplish what they want and enjoy life.

Now a board-certified family physician and psychiatrist, Dr. Bermudes specializes in depression and anxiety treatment in adults and adolescents. In 2010 he opened Mindful Health Solutions, a practice in the El Dorado Hills Business Park, where he offers the latest in therapeutic treatments and uses a collaborative approach.

Whatever the problem, “We’ll figure it out together,” he said.

“I got into psychiatry by surprise,” explained Bermudes, who grew up in Sonoma County. During rotations as an intern at University of California San Diego Medical School, where future doctors spend several weeks working in different fields of medicine, Bermudes said he became attracted to psychiatry.

“I resisted at first,” he added. “But I found myself fascinated by conditions of the mind.”

He went to the University of Cincinnati for a double residency in psychiatry and family medicine. From there, Bermudes accepted a fellowship at the Beck Institute for Cognitive Therapy and Research near Philadelphia, Pa. Then he moved back to California with his family. “My wife picked El Dorado Hills,” he said. “After moving to Cincinnati for my residency without complaining, I thought she should select where we live next. She found El Dorado Hills online.”

Before opening his practice in El Dorado Hills, Bermudes was director of Cognitive Behavioral Therapy Training for Sacramento County Adult Mental Health Services Division and Sutter Center for Psychiatry. He also founded Sacramento TMS, now a division of Mindful Health Solutions, a private psychiatry group that specializes in Cognitive Behavioral Therapy.

Rachael Smith, MD  Child and adolescent psychiatrist

Rachael Smith, MD, met Bermudes at UC Davis Medical Center, where she did her residency in general psychiatry, plus a fellowship in child and adolescent psychiatry. “We had the same approach, and we’ve kept in touch ever since,” she said.

Smith has been working at Heritage Oaks, an acute psychiatric hospital with inpatient and outpatient services. “That’s where I see the Sacramento kids,” she said. She also sees patients at a clinic in Galt one day a month. Her practice in Sacramento brings her in touch with children from many different cultures.

“I’ve worked with kids my whole life,” said Smith. “Originally, I wanted to be a pediatrician.” She did two international stints working with children: two months of pediatric emergency medicine in Lima, Peru, and three months in Guatemala treating infectious diseases, as well as taking care of pediatric emergencies. She is fluent in Spanish.

Smith recently joined Mindful Health Solutions and has been seeing young patients in the El Dorado County-Folsom area.

“I like treating teenagers and I like doing therapy,” she said. She emphasizes strengthening the relationship and communication between parents and their children.

Depression and anxiety are common problems, she said. Depression is often masked as irritability, and anxiety can be behind panic attacks and rage. Eating disorders are also symptoms of depression and anxiety.

“Early therapy is best for better relationships in life,” she said.

Smith said she’s is highly concerned about the message young people are getting about marijuana. “They got the message that cigarettes are bad for their health,” she said. “Today teenagers are smoking more marijuana than cigarettes. They don’t see it as harmful.”

Young people are experiencing more early psychotic breaks and evidence points to marijuana use as having a role, she explained. A psychotic break is when a person has radical change in personality, seriously reduced ability to function and a distorted or nonexistent sense of objective reality.

“Wellness for your mind,” is the motto at Mindful Health Solutions. Both Bermudes and Smith tailor treatment for the individual, using a combination of therapy and medication as needed. In addition, Bermudes may use a new technique call trans-cranial magnetic stimulation, or TMS.

Cognitive Behavioral Therapy

Cognitive Behavioral Therapy, or CBT, is an approach used by both doctors. It is an evidence-based treatment for problems with relationships, self-esteem, anger, depression, bipolar disorder, anxiety, obsessive-compulsive disorder, post traumatic stress disorder, panic disorder and similar conditions. It involves a series of 20 sessions, followed by a maintenance program.

In the first meeting Dr. Bermudes aims to establish a sense of hope and work out a plan based on structured learning experiences. At the end of the sessions the patient should experience a sense of accomplishment and confidence that the condition can be improved.


As medical physicians, both Bermudes and Smith are licensed to prescribe medication.

“Some problems are the result of over-reaction to medication,” said Bermudes.

Smith has several mutual cases where she will be in charge of medication management for a young person who is seeing someone else for therapy.

Bermudes is aware that many people who are seen as mental patients also have physical diseases. Adults with depression are more prone to heart disease and diabetes, he said. The medications that may be prescribed to treat depression need to be integrated with any medication prescribed for other conditions.

Transcranial Magnetic Stimulation

The use of Transcranial Magnetic Stimulation, or TMS, first came to Bermudes’ attention when he was a resident in Cincinnati. “Patients were going to Canada for treatment,” he said. In 1985 neurologists at a TMS lab at UC Davis used it to map the brain. During the 1990s neurologists noticed that the technique had mood-enhancing effects. It has recently become another tool for treating severe depression, approved for clinical use by the U.S. Federal Drug Administration in October 2008.

TMS works somewhat like an MRI. The device, about the size of a small hair dryer, is handheld.  It emits electromagnetic pulses to the prefrontal lobe, stimulating neurotransmitters to strengthen transmission of nerve impulses in that part of the brain.

The procedure involves no needles, shots, anesthesia, sedation or IVs, and no side effects from medications. The patient sits in a chair for a treatment that lasts about 37 minutes, and can read, watch videos, listen to music, sleep or meditate. A typical course is five treatments a week for a total of 20 to 30 treatments.

Bermudes is the first certified TMS provider in the Sacramento area. His case manager, Christy Tebler, is a certified TMS technician, and staff member Fara Elizalde is in training.

“Our patients who have gone through this treatment have seen encouraging improvement,” said Bermudes.

Smith is not using TMS on adolescents as, she said, “The studies are not conclusive on the benefits for young patients.”

Contact information

For both Bermudes and Smith, helping patients make lasting changes that give them greater control and enjoyment in their lives is the payoff for everyone. Not to mention, less stigma.

At Mindful Health Solutions, longer appointment times and smaller caseloads allow the physicians to offer personalized service.

The office is located at 1020 Suncast Lane, Suite 108, El Dorado Hills. To make an appointment call (916) 932-0380. For more information visit

Roberta Long

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