Free consult
A 15-minute phone call to decide whether psychiatric medication management fits what is happening. No card required.
§ 01 Depression psychiatry
When the gray stops lifting.
I see Washington adults whose low mood has outstayed every reasonable explanation: the motivation that never came back, the sleep that broke, the concentration that quietly left. Sixty minutes for the first visit, because this history deserves more than a checklist.
No card required for the consultation request. We use the call to decide whether medication management is the right next step.
At a glance
Depression psychiatry here means private telehealth evaluation and medication management for Washington adults with persistent low mood, low motivation, sleep changes, anxiety overlap, or questions about past medication response. The first step is formulation, including screening for bipolar-spectrum patterns when indicated, so that any prescription is aimed at something specific.
§ 02 What this care is
Formulation first. Prescription second.
Before I treat depression, I want to understand yours. Mood, sleep, appetite, energy, concentration, anxiety, grief, trauma history, medical contributors, alcohol and substances, and every medication you have already tried, at what dose, for how long, and what it actually did.
That last part matters more than most people expect. A surprising number of "failed" antidepressant trials were never given an adequate dose or an adequate number of weeks. I would rather find that out in the first hour than repeat it for six months.
The goal is not to reduce a complex life to a prescription. It is to figure out whether medication can lower the biological load enough for the rest of recovery, therapy, movement, connection, daylight, to become possible again.
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: full history, medication review, target symptoms, and an initial plan you understand.
$150 follow-up
Thirty-minute follow-ups that track response with brief standardized measures, not just "how are you feeling?"
§ 03 How it shows up
Less an emotion. More a subtraction.
Sadness is only one face of it. Many of the people I see would not describe themselves as sad at all. They describe a life with things missing.
- Mornings that start defeated, before anything has happened.
- Interest and pleasure thinning out of things you used to choose freely.
- Sleep that will not come, will not stay, or will not stop.
- Concentration and decisions that used to be automatic now costing effort.
- Irritability or numbness standing in where feeling used to be.
- Appetite and energy drifting in either direction.
- A harsh internal narrator with strong opinions about your worth.
- Antidepressant trials that half-worked, quit working, or were never reviewed.
- A history of activated or sped-up periods that makes the diagnosis less simple.
- Holding it together publicly while privately running out of range.
None of these alone is a diagnosis. Together, over weeks, they are a pattern worth a careful hour.
§ 04 The honest version
What getting better tends to look like.
I cannot promise you a result; no honest clinician can. I can tell you what the work usually involves, so the first weeks do not feel like failure.
01
The first weeks
Slower than anyone wants.
Most antidepressants take several weeks at an adequate dose to show their real effect. Early on, side effects often arrive before benefits do. I tell you this up front so a rocky second week reads as expected, not as proof that nothing will ever work.
02
Measurement
We track it, we do not guess.
Depression distorts memory; a bad day can erase a better fortnight. Brief standardized measures at each follow-up give us a record your mood cannot rewrite, so decisions about dose and direction rest on evidence rather than on whichever day the appointment happened to land.
03
Side effects
Named early, taken seriously.
Sleep changes, appetite, sexual side effects, emotional blunting: these are real, common, and worth discussing in plain language before you start, not after you quietly stop taking the medication. There is almost always an adjustment or an alternative.
04
Changing course
A failing trial gets changed.
If a medication has had a fair trial, right dose, enough weeks, and the measures have not moved, we change something. Dose, agent, augmentation, or the formulation itself. What improvement tends to look like is not euphoria; it is ordinary things costing less.
§ 05 What this is not
Boundaries keep the care clear.
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 therapy replacement
Medication can support psychotherapy and behavior change, but it does not replace them. I coordinate with your therapist whenever you permit it.
Not one-size-fits-all
Bipolar-spectrum history, trauma, grief, sleep, and medical contributors all change the plan. The same symptoms do not always get the same prescription.
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.
§ 06 Related paths
Anxiety and sleep
For many people depression travels with insomnia, rumination, panic, or nighttime activation, and the night has to be treated too.
Explore anxiety and sleep careGrief and loss
When the heaviness began with a death or a loss, mourning and depression need to be told apart before either is treated.
Explore grief careTrauma and PTSD
Shutdown, numbness, and threat physiology can wear depression's clothes. The treatment differs when trauma is underneath.
Explore trauma careFrom the journal
On men, modern life, and why so much male depression hides inside overwork, irritability, and withdrawal.
Read the essay§ 07 Questions
What if I am not sure this is depression?
You do not need to arrive with the right label; finding it is my job, not yours. The evaluation looks at mood, sleep, anxiety, grief, trauma, medical contributors, current medications, and whether bipolar-spectrum patterns need to be ruled out before anything is prescribed.
Will you just start an antidepressant?
No. Antidepressants help many people, but the first step is formulation: your history, prior medication response, activation risk, side-effect concerns, and which symptoms we are actually aiming at. A prescription written before that work is a guess.
How long until we know whether a medication is working?
Most antidepressants need several weeks at an adequate dose before they can be judged fairly. We do not wait passively. Follow-ups track sleep, energy, mood, and side effects with brief standardized measures, so a medication that is failing gets changed on evidence rather than on hope.
Can medication help if depression has been present for years?
Sometimes, yes. Long-standing symptoms do not mean the system is fixed in place. Medication can reduce specific burdens around mood, sleep, anxiety, energy, and functioning, and a careful review often finds that past trials were too short, too low, or aimed at the wrong target.
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 weight is not lifting on its own, look at it with me.
Fifteen minutes by phone, free, no card. Enough to decide whether this kind of psychiatric care fits what is happening.
Book a free 15-minute consultation