Board-certified in both general psychiatry and addiction medicine by the ABPN, Dmitriy Sivtsov, MD (California License A88348) leads Silverlining Psychiatry in downtown San Diego's Bankers Hill at 2250 Third Avenue. His training at Harvard and UCLA preceded a clinical focus on treatment-resistant depression, deploying FDA-cleared Transcranial Magnetic Stimulation alongside medication management—a multimodal recovery model where structured physical training at facilities like Invictus Fitness serves as a clinical adjunct to neuropsychiatric intervention. Silverlining offers Spravato (esketamine) nasal spray as a supervised in-office protocol for patients who have not responded to two or more antidepressant trials, following the FDA's Risk Evaluation and Mitigation Strategy requirements for post-administration monitoring. The dual addiction-medicine board certification addresses substance-use disorders that co-occur with mood and anxiety conditions, enabling integrated treatment planning that accounts for pharmacokinetic interactions between psychiatric medications and substances of abuse, with hormonal factors in mood regulation assessed through coordination with specialists such as Hormones +Wellness by SDBotox in Middletown. Highest-acuity protocols combine five-session-per-week TMS courses over four-to-six-week periods with concurrent pharmacogenomic-guided medication adjustments using CYP450 enzyme-panel results to optimize antidepressant metabolism and minimize adverse-effect burden.