Marilyn Vache, MD

I went to Dr. Marilyn Vache a number of years ago. She was horrible. She didn’t seem to care much about me as a person nor did she care about how to treat me.
I had to get her records about me for disability and was shocked to see what she had written. She said I had borderline personality disorder, but never once did she ever talk to me about that.
I was finally properly diagnosed years later by another psychiatrist and my therapist as having Bipolar II Disorder.
See someone else. Don’t see her.

It’s been a year and a half since I saw Dr. Vache, but I finally realized that I had to describe my experience with her just so I could start to move on with my life.
First, let me say there is a chronic shortage of psychiatrists in Austin, and I assume that nothing I say will make much difference. Last year, her office told me she was not taking new customers.
I think she is the worst medical professional I’ve met in my life. That’s counting my childhood family doctor in Germany, who it was discovered lacked a medical license and never attended medical school.
I only saw Dr. Vache two and a quarter times. The second meeting completely traumatized me. Then she called me at home on her own initiative and blind-​sided me with accusations about my defects.
I was so upset that I scheduled a phone session with my former psychiatrist I saw for 28 years while living in Los Angeles to discuss her diatribes.
My previous psychiatrist was horrified, called her unprofessional and repeatedly asked me in person and in writing (I still have these as pdfs) to report her to the Texas Medical Board. He is a noted psychiatrist affiliated with UCLA who has testified as an expert for the Supreme Court.
At the beginning of the third and final meeting, I recounted to her verbatim the things she said to me in our previous meeting. I think she was shocked to hear that I met with my previous highly respected psychiatrist in California to deal with what she told me. She immediately closed our doctor patient relationship and didn’t charge me for the 10 minutes or so I saw her that day.
Later she sent me a poison pen letter that my husband, friends and I interpreted as threatening to violate HIPAA privacy laws relevant to me at any time. She referred to so-​called information she might use against me that she knew of that I did not, making clear that supposed information was really terrible. My husband and I interpreted her letter as a blatant attempt to blackmail me. I’d be happy to post her letter on this thread as a pdf if she disputes what I say.
At that point, I felt that I could under no circumstances see any psychiatrist in Texas, that she would always poison the well. Those into Carl Jung may understand what I mean when I say that she became my shadow, my dark side I couldn’t bear to face.
Much later, my regular Austin doctor pointed out that I didn’t need to see a psychiatrist at all, a neurologist can diagnose my problems and prescribe medications as needed.
Thank goodness. The fabulous neurologist I have been seeing, Dr. Das from the Neurology and Sleep Disorders Center of Central Texas gave me a series of neurological tests that found spiking in the temporal and frontal lobes of my brain that put me at risk of seizures. She thought I must have been having them all along, though I don’t know about that.
She has me on new medications that control the problem. Some of the medications are what you might expect, but other medications are more commonly used in Europe, reflecting the medical literature. (Keep in mind we can’t get a lot of medicaitons because US pharmaceutical companies won’t bother with medications where the patents expired).
Seeing a neurologist also cost about one-​tenth as much as it did to see Dr. Vache after insurance. Dr. Vache does not take insurance or provide psychological therapy.
On reflection, I should mention there was one useful thing I got from Dr. Vache. She had me take a blood test that indicated that my thyroid was a bit low. My GP doctor should have caught it during my annual checkups, but he missed it. I should also have noticed since I always request hard copies of blood tests.
However, she instructed me improperly on its use — she told me to take it only in the morning though the research indicates the medication is dramatically more effective when taken at night (see some of these studies below).
+ Bolk et al (2010) Effects of evening vs morning levothyroxine intake: A randomized double-​blind crossover trial. Archives Internal Med. 70(22) p 1996 – 2003.
+ Bolk et al (2007) Effects of evening vs morning thyroxine ingestion on serum thyroid hormone profiles in hypothyroid patients. Clin Endocrinol. 66(1), 43 – 48.
+ Rajput et al (2011) Can levothyroxine be taken as evening dose? Compar evaluation of morning versus evening dose of levothyroxine in treatment of hypothyroidism. J Thyroid Res. 2011(505 239).
Followup — Unilocal indicates the Neurologist center I mentioned (as a possible alternative) is closed, but they only moved to a new address. This is their new location:
Dr. Rani Das
4407 Bee Caves Road
Building 3, Suite 301
Austin, TX 78 746
Dr. Das (512) 458‑2600
Fax: (512) 454‑2292

I have been seeing Dr, Vache for over a year. She is very thorough, open to try different things and has a passion for what she does that is clearly evident. She has both my trust and my respect.
You will be in good hands with her.

Dr. Vache is a Psychiatrist but not the kind that you talk to– she focuses on brain chemistry and different levels of specific things in your brain that could affect your mood etc. The main focus of her practice is for depression related issues but I saw her for anxiety related issues.
As the other reviewer mentioned– Dr. Vache is a huge fan of note taking and will be typing a mile a minute for literally the entire duration of your visit stopping briefly to ask questions and rarely making eye contact with you. She is a big fan of expensive blood work tests etc. and in my experience will always determine you are low on specific vitamins and supplements which she happens to sell herself and urge you to purchase before you leave her office. She insisted I see her once a month the entire year or so that I was her patient so she could monitor my anxiety… she wouldn’t give refills on even basic meds like Paxil and in my opinion this was at least partially to insure that I needed to come back every month and pay her fees. About a year into my «treatment» when I politely told her I didn’t expect to see her any more and would be looking for another Psychiatrist she refused to prescribe refills on any of the meds she had put me on (Paxil, Xanax) knowing full well that this would put me in a situation where I would be forced to suddenly stop taking my medications rather than taper off as is recommended. I truly feel she tried to take advantage of my medical condition for her own financial gain and from what I have seen of her treatment of other patients I believe this is pretty much her standard MO.
She doesn’t accept insurance of any kind and you must pay in full at every visit.
Her office staff is a stark contrast to her in personality and efficiency and among the best I have ever encountered. I hope she pays them well with all that vitamin money she makes.

Dr Vache isn’t the worst out there. She is pretty cold, but competence means more to me than bedside manner. She listens and doesn’t rush to change your current medication regimen. On the other hand, after only a few months of working with medications, she told me I needed $ 10,000 dollar TMS treatment, which is not covered by insurance and which doesn’t have a proven track record. Since she does those treatments in her office, it seemed a little too convenient.