Walsh Approach Telemedicine and Functional Biochemical Assessment
Second Opinion Physician is a telemedicine practice founded by David Epstein, D.O., focused on the Walsh Approach, lab-guided nutrient therapy, methylation analysis, copper-zinc regulation and functional medicine strategies for mood, behavior, neurodevelopmental and cognitive concerns.
Symptoms, treatment history, medication response and laboratory findings are organized into a practical clinical strategy. The aim is to identify biochemical factors that may be driving symptoms or limiting recovery rather than simply adding another medication or another generic supplement list.
Functional Medicine, Biochemical Psychiatry and the Walsh Approach
More than 35 years of clinical experience in general, osteopathic, nutritional and functional medicine provide the foundation for a practice increasingly devoted to biochemical psychiatry, methylation and the Walsh Approach.
Before developing Second Opinion Physician, the practice included an Atlanta medical clinic emphasizing nutritional medicine, EDTA chelation, IV nutrients, oxidative therapies, heavy-metal burden and antioxidant support.
Since 2014, the Walsh Approach developed by William J. Walsh, Ph.D. has been applied closely in patients with depression, anxiety, obsessive-compulsive symptoms, insomnia, ADHD, autism, behavioral problems, bipolar and psychotic disorders, and cognitive decline. Physician education and clinical implementation have also become part of that work.
Clinical Emphasis
Particular attention is given to undermethylation and to patients who do not respond fully to a standard nutrient protocol. The assessment may include SAM and SAH, creatine demand, mitochondrial energy, oxidative stress, toxic burden, mineral balance and metabolic buffering.
Dr. Walsh has publicly discussed and supported the importance of reducing elevated SAH before adding SAMe or methionine in appropriate undermethylated patients. View the methylation discussion.
Medication-Cautious Care
The concern is not the appropriate use of psychiatric medication, which can be necessary and lifesaving. It is prolonged polypharmacy without a clear biochemical reassessment of the original problem, treatment fit, side effects and long-term risk.
Care remains grounded in minimally processed food, healthy fats, adequate protein, wild-caught fish, exercise, sunshine, sauna, lower-carbohydrate eating and intermittent fasting when appropriate.
An Updated Application of the Walsh Protocol
The Walsh Approach remains the foundation of the practice. Dr. Epstein uses the original biochemical patterns and laboratory principles, while extending the evaluation when direct methylation testing or functional barriers help explain incomplete response.
More Than Medication Management
Many patients come to Second Opinion Physician after years of medication trials, side effects, incomplete response or uncertainty about whether the diagnosis fully explains the symptoms.
- Multiple psychiatric medications with limited improvement
- Unexpected reactions to antidepressants, stimulants or supplements
- Persistent anxiety, insomnia, obsessive symptoms or irritability
- ADHD, autism or behavior concerns requiring broader assessment
- Questions about copper, zinc, histamine, pyrroles or methylation
- Interest in stabilizing biochemistry before considering medication reduction
Stabilize First
Psychiatric medication should not be stopped abruptly. Patients who are severely unstable, suicidal, psychotic or potentially harmful to themselves or others may require medication and urgent conventional care.
The practical sequence is to test relevant biochemical factors, begin targeted nutrient support, improve medication fit when necessary, normalize deficiencies and imbalances, and only then work with the prescribing clinician on a gradual taper when appropriate.
More information is available in the Walsh Protocol Testing and Consultation FAQ .
Discussion With Dr. William Walsh
Dr. Epstein’s discussion with Dr. William Walsh addresses methylation, elevated SAH, creatine demand, kidney pH and treatment strategy in difficult undermethylation cases.
The interview helps explain how Dr. Epstein’s current work remains grounded in Walsh principles while adding direct methylation and functional assessment where clinically useful.
Questionnaires, Reports and Follow-Up
WalshDoc was developed to make complex history, symptom patterns, laboratory findings and treatment response easier for patients and physicians to organize.
Questionnaire
Patients complete a focused symptom and history intake.
Pattern review
WalshDoc organizes findings into clinically useful domains.
Testing priorities
The assessment helps clarify which labs may be most useful.
Physician report
Clinical impressions and nutrient priorities are added when appropriate.
Follow-up
Symptoms, supplements and laboratory response can be tracked over time.
Mood, Behavior, Neurodevelopment and Cognitive Health
The practice reviews conditions in which nutrient biochemistry, methylation, copper-zinc regulation, oxidative stress or functional health factors may influence symptoms or treatment response.
Not Sure Which Assessment Fits?
Patients who are unsure whether to begin with a Walsh biotype questionnaire, methylation testing, copper-zinc testing, toxic burden review or consultation can begin with the free pre-consultation.