Free consult
A 15-minute phone call to decide whether psychiatric medication management fits what is happening. No card required.
§ 01 Bipolar psychiatry
The pattern is the diagnosis.
Bipolar disorder cannot be read off a single bad week. I work with Washington adults by telehealth to map mood across months, depressive stretches, activated climbs, the sleep changes that announce both, and to build a medication plan that protects the baseline.
No card required for the consultation request. We use the call to decide whether medication management is the right next step.
At a glance
Bipolar psychiatry here means private telehealth evaluation and medication management for Washington adults with mood cycling, depression with activation history, irritability, sleep-driven shifts, or genuine uncertainty about whether the bipolar spectrum applies. The evaluation reads your history across months rather than judging a snapshot, and the plan emphasizes mood stability, sleep protection, careful antidepressant decisions, and collaborative follow-up.
§ 02 What this care is
Longitudinal care for a longitudinal illness.
A snapshot of you today, in this appointment, in this mood, is the least useful data I will ever collect. So the intake works differently here: we reconstruct the record. When the depressions came and how long they held. Whether there were stretches of needing less sleep and feeling better than well. What every antidepressant actually did, especially if one made you faster instead of better. Family history, substance effects, hospitalizations if any.
From that record we build a plan whose first job is protecting your baseline: mood stabilization chosen for your pattern, sleep treated as a vital sign, labs when the medication calls for them, and follow-ups close enough together to catch a shift while it is still small.
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: longitudinal mood history, medication review, activation screening, and an initial plan.
$150 follow-up
Thirty-minute follow-ups tracking sleep, cycling, side effects, labs when needed, and early signs of a shift.
§ 03 Why history beats snapshots
Episodes have shapes.
Seen day by day, a mood episode is chaos. Seen across months, it has a recognizable arc, and the arc is what we treat. This is why I ask about your last two years, not just your last two weeks.
Baseline
Your actual self: sleep steady, judgment yours, range intact. The whole plan exists to defend this ground.
The climb
Often pleasant at first: less need for sleep, more ideas, more speed. The most commonly missed phase, because it rarely feels like a problem.
Activation
Hypomania or mania, or an irritable mixed state: racing thoughts, agitation, impulsive decisions, spending, conflict. Sleep collapses further.
The crash
The depression that follows is frequently the only phase that reaches a clinician, which is exactly how the wrong diagnosis gets made.
Return
Back toward baseline, until the next cycle. Treatment aims to make this stretch longer, the swings shallower, and the warnings audible.
A note on antidepressants.
If your history includes activated periods, an antidepressant prescribed by itself deserves real caution: in bipolar-spectrum depression it can speed the system up rather than settle it, thinning sleep, sharpening agitation, sometimes tipping a switch into hypomania or a mixed state. This is not a reason to fear the medication class. It is a reason to take the history first, stabilize mood where stabilization is needed, and add an antidepressant only when the foundation can hold it.
§ 04 Common presentations
What brings people here.
Few people arrive saying "I have bipolar disorder." They arrive with one of these, and a history that deserves a longer look.
01
Recurrent depressions that keep returning despite treatment that "should" work.
02
Stretches of needing little sleep while feeling energized, fast, or unusually confident.
03
An antidepressant that made things faster, more agitated, or strangely worse.
04
Irritability and anger spikes that feel chemical rather than circumstantial.
05
Mood that tracks sleep loss, shift work, travel, or a disrupted body clock.
06
An existing bipolar diagnosis and a medication regimen that needs a careful, unhurried review.
§ 05 What treatment protects
Defend the baseline. Then stay watchful.
Every medication in the plan has a named job. If we cannot say what a drug is protecting, it does not belong in the regimen.
Mood stability
Reducing the amplitude of both poles: the destabilizing highs, the mixed states, the crash that follows activation, and the depressions in between.
Sleep, as a vital sign
Tracked at every visit, because a shrinking need for sleep is often the earliest measurable warning that a climb has started.
Tolerability
Stabilization that costs you your sharpness, your weight, or your emotional range is a bad trade. We monitor side effects and labs, and we adjust.
§ 06 What this is not
Clear boundaries reduce risk.
Not crisis care
If you are in acute danger, a manic crisis, or thinking of harming yourself or someone else, call 988, 911, or go to the nearest emergency department.
Not antidepressant-only care
Depression with an activation history is not treated like depression without one. Mood stabilization comes first when the pattern calls for it.
Not therapy replacement
Medication management coordinates with therapy, routine, and the people around you, but it does not substitute for them.
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
Depression care
When the low pole dominates and activation has been ruled out, the depression page describes that work in depth.
Explore depression careAnxiety and sleep
Sleep disruption destabilizes mood from below. When insomnia is the loudest symptom, start there.
Explore anxiety and sleep careUnsure where you fit?
That is precisely what the free consultation is for. Fifteen minutes, no card, and an honest answer about whether this practice can help.
Free 15-min consult§ 08 Questions
What if I am not sure whether I have bipolar disorder?
You do not need to arrive certain; most people do not. The evaluation reads your history across months and years: depressive stretches, activated periods, sleep changes, family history, how antidepressants behaved, substance effects, and prior medication trials. The pattern decides, not a single day.
Why are you so careful with antidepressants?
In people with an activation history, an antidepressant prescribed alone can speed things up rather than settle them: less sleep, more agitation, sometimes a switch into hypomania or a mixed state. That is why I take a longitudinal history before prescribing, and why depression with activation history is treated differently from depression without it.
Why does sleep matter so much?
In bipolar care, sleep is both a trigger and an early warning. A few short nights can start a climb, and a shrinking need for sleep is often the first measurable sign that one has begun. Protecting sleep is treatment, not lifestyle advice, so we track it at every visit.
Can you coordinate with my therapist or primary care clinician?
Yes, with your permission. Bipolar care works best as a team effort, especially when medication management is one part of a broader support plan that includes therapy, family, and primary care.
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.
Bring me the whole pattern. That is where the answer is.
Fifteen minutes by phone, free, no card. Enough to decide whether this kind of psychiatric care fits your history.
Book a free 15-minute consultation