Free consult
A 15-minute phone call to decide whether psychiatric medication management fits what is happening. No card required.
§ 01 Adjustment psychiatry
When coping runs out before the change does.
Leaving the service. A diagnosis that redrew the map. A loss, a retirement, a move that took more than it gave. I work with Washington adults by telehealth when a transition has outlasted their reserves, and sleep, mood, or the nervous system is paying the bill.
No card required for the consultation request. We use the call to decide whether medication management is the right next step.
At a glance
Adjustment psychiatry here means private telehealth evaluation and medication management for Washington adults when major transitions (post-service life, medical illness, disability, caregiving, retirement, relocation, or loss) overlap with insomnia, anxiety, depression, traumatic stress, irritability, or impaired functioning. Medication does not erase the transition; it can reduce the biological noise that makes carrying it harder.
What you are crossing is a threshold, not a disorder.
Human beings are built for change, but not for unlimited change at unlimited speed. After twenty years in uniform, after a diagnosis, after a death, after the job that structured your days ends, it is normal for sleep, mood, and patience to strain. That strain is not weakness and it is not pathology. It is load.
Psychiatry earns a place at that threshold in one specific situation: when the load has started breaking things. Nights that no longer restore you. Alarm that will not switch off. A mood that has gone flat or heavy enough to take functioning with it. My job is to tell you honestly which side of that line you are on, and I will say so plainly if what you need is time and support rather than a prescription.
When short-term medication support earns its place
- Sleep has been broken for weeks and is dragging everything else down with it.
- Anxiety or physiological alarm is constant, not just situational.
- Depressive weight has settled in: flat mood, low energy, work and relationships slipping.
- Trauma physiology (vigilance, startle, nightmares) followed the event and has not stood down.
- You are doing the work of adapting, and the symptoms keep undoing it.
When it is not the right tool
- The pain is proportionate, recent, and moving; what it needs is time, people, and room.
- The real problem is a situation that has to change: a job, a living arrangement, an unsafe relationship.
- You are looking for something to make the transition not have happened. Nothing prescribable does that.
- What you want most is to talk it through; that is therapy's ground, and I will help you find it.
§ 03 What this care is
Steadying the body while the life rebuilds.
The evaluation starts with what actually changed and what it took with it: sleep, appetite, anxiety, mood, concentration, the medications you already take, the medical realities in play, and what an ordinary day looks like now compared to a year ago.
I am not trying to rush you back to a "normal" that no longer exists. I am trying to find out whether medication can hold sleep, mood, or arousal steady enough that the real work, therapy, rebuilding routine, showing up for the people who matter, stays possible.
This is a private cash-pay practice for adults physically located in Washington State. I do not accept or bill insurance. Superbills are available for possible out-of-network reimbursement when applicable.
$250 intake
A 60-minute psychiatric evaluation: history, transition context, medication review, target symptoms, and an initial plan.
$150 follow-up
Thirty-minute follow-ups reviewing sleep, mood, anxiety, functioning, side effects, and whether support is still needed.
§ 04 The thresholds I see most
Different doors, similar strain.
After serviceLeaving the uniform
The structure, mission, and identity end on a date certain; the nervous system did not get the memo. Vigilance, broken sleep, irritability at civilian pace, and the strange grief of missing something difficult. As an Air Force veteran, I know this threshold from the inside.
After illnessA diagnosis, a treatment, a changed body
Serious illness and medical trauma redraw what your days can hold. Sleep, mood, and threat sensitivity often shift along with the body, and the people around you may expect relief just as the weight actually lands.
After lossA person, a role, a future
Not only bereavement in the narrow sense. The end of a marriage, a career, fertility, mobility, a version of the future you had already moved into. Loss of any of these can outstrip coping without being a disorder.
After the structure endsRetirement, relocation, an empty house
Transitions that are supposed to be good can still dismantle the scaffolding your days stood on. When the routine, the place, or the role goes, sleep and mood sometimes go with it, and the guilt of struggling with a "good" change makes it harder to ask for help.
§ 05 Medication can help with
Lightening what makes adapting harder.
Medication is considered only after the target is named: sleep, alarm, mood, or the trauma physiology underneath. No target, no prescription.
Sleep disruption
Restoring rest when the transition has turned nights into rumination, vigilance, or repeated waking, using non-controlled options only.
Anxiety and alarm
Turning down the physiological dread and threat-scanning that can follow service, illness, or loss and refuse to switch off.
Depressive weight
Addressing energy, motivation, appetite, and cognitive slowing when the mood has become biologically heavy rather than situationally sad.
§ 06 What this is not
Major change deserves clear boundaries.
Not crisis care
If you are in acute danger or thinking of harming yourself or someone else, call 988, 911, or go to the nearest emergency department.
Not a bypass
Medication does not remove grief, medical reality, moral injury, or the human work of rebuilding after loss or service. It makes room for that work.
Not therapy replacement
Medication can support therapy, peer support, spiritual care, and community, but it does not replace them, and I will say so when therapy is the better first move.
Not controlled substances
I do not prescribe controlled substances: no stimulants, no benzodiazepines, no controlled sleep medications. That prescribing is not part of this practice.
§ 07 Related paths
Veterans services
For Washington veterans when post-service adjustment, hypervigilance, sleep, and transition stress are the center of gravity.
Explore veterans careTrauma and PTSD
When the event left more than strain: intrusive memories, nightmares, a body that will not stand down.
Explore trauma careGrief and loss
When the transition is a death, mourning has its own page, and its own rules about what medication can and cannot do.
Explore grief careFrom the journal
"Decommissioning": on post-military hypervigilance and why the alarm system outlasts the mission it was built for.
Read the essay§ 08 Questions
Is every life transition a psychiatric diagnosis?
No, and I will not treat yours as one by default. Adjustment is human. Psychiatric care earns its place when the transition drives severe insomnia, panic, depression, traumatic stress, or impaired functioning, not because struggling with a big change is wrong.
Will medication remove the need to adapt?
No. Medication does not erase grief, identity change, or medical reality, and it does not do the human work of rebuilding a life. What it can do is reduce specific biological burdens, broken sleep, physiological alarm, depressive weight, so that you have the capacity to do that work yourself.
How long does medication support usually last?
It depends on the person and the symptoms, and I will not pretend otherwise. For some people, adjustment-related symptoms need support for a season rather than indefinitely; for others, the evaluation uncovers something longer-standing that deserves ongoing treatment. Either way, the question is reviewed openly at follow-ups, and any taper is planned deliberately rather than left to drift.
Can you coordinate with my therapist or primary care clinician?
Yes, with your permission. Adjustment often goes best when medication management is one part of a broader support system that includes therapy, primary care, and the people around you.
What is the first step?
Request a free 15-minute phone consultation. No card is required for that call, and we use it to decide together whether a full psychiatric evaluation makes sense.
If the transition is living in your sleep, your body, or your mood, start there.
Fifteen minutes by phone, free, no card. Enough to decide together which side of the threshold you are standing on.
Book a free 15-minute consultation