Free consult
A 15-minute phone call to decide whether psychiatric medication management fits. No card required.
§ 01 Trauma & PTSD
The threat ended. The alarm didn't.
I work with Washington adults whose nervous systems are still working a job that ended: scanning rooms, sleeping light, bracing for the next thing. Psychiatric evaluation and medication management that treats those symptoms as logic, not defects.
No card required for the consultation request. We use the call to decide whether medication management is appropriate.
At a glance
Trauma and PTSD psychiatry here means telehealth medication management for adults physically in Washington State: a 60-minute evaluation ($250), then 30-minute follow-ups ($150), starting with a free 15-minute phone call. Medication lowers the biological alarm so trauma therapy and daily life become workable; it does not replace therapy, and this practice does not prescribe controlled substances.
§ 02 What this care is
Medication management that respects the adaptation.
The evaluation maps what your system is actually doing: how you sleep, what you scan for, what sets off the surge, where the numbness sits, what the nightmares take from the next day, and which medications have already been tried on you, and how carefully.
Medication does not erase memory, and it is not the cure for trauma. It is support for the real work: lowering the biological noise enough that trauma therapy, relationships, sleep, and ordinary days 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: history, medication review, a working formulation, and an initial plan.
$150 follow-up
Thirty-minute visits to track sleep, arousal, nightmares, mood, side effects, and response.
§ 03 Symptoms as logic
Every symptom was once a job.
PTSD is not a system malfunctioning. It is a protective system that does not know its contract ended. Read your symptoms that way, and treatment stops being about what is wrong with you.
HypervigilanceScanning exits, watching hands, sitting with your back to the wall
Threat detection. In the environment that built it, noticing the wrong detail too late had a real cost. The system learned to notice everything. It still does, in the grocery store, on the same budget, and it bills you in exhaustion.
StartleJumping at doors, brakes, a hand on the shoulder
Rapid response. The body's fastest circuit, tuned by repetition to fire before thought. That was once exactly the point. Now it fires at noises that carry no information, and the adrenaline takes an hour to drain each time.
AvoidanceSkipped drives, declined invitations, subjects steered around
Exposure control. If certain places, dates, or conversations detonate the alarm, routing around them is rational resource management. The cost is gradual: the map of where you can comfortably live keeps shrinking.
NumbingFeeling far away from people you love, even in the same room
Emotional triage. When feeling everything was not survivable, the system learned to feel less. But it cannot mute selectively; it takes the warmth and the grief together, and the people around you feel the distance.
Nightmares and thin sleepWaking braced at 3 a.m., dreading the bed
Night watch. Sleep is the most vulnerable state there is. A system that does not believe the danger has passed will not let you fully off duty, so it keeps the sleep shallow and replays the briefing.
None of this means you are broken. It means a system did its job too long. Treatment is not deleting the system; it is recalibrating the threshold, so protection switches on when it is needed and stands down when it is not.
§ 04 Where medication fits
Lowering the alarm enough to do the work.
Medication targets specific biological burdens. It does not numb the whole person, and it is never the whole plan.
Hyperarousal
SSRIs and SNRIs, the best-studied medications for PTSD, lower the baseline alarm that shows up as scanning, panic, tension, and feeling permanently braced.
Nightmares
Prazosin, a non-controlled blood-pressure medication, can blunt the adrenaline surge behind trauma nightmares and middle-of-the-night waking. It is one of the most targeted tools in trauma psychiatry.
Mood and reactivity
Irritability, anger spikes, depressive weight, and the crash after prolonged stress all have medication options worth weighing carefully against their costs.
One commitment, stated plainly: medication here is support for trauma therapy, not a substitute for it. If you are not in therapy and want to be, I will help you find someone. And this practice does not prescribe controlled substances, so nothing I start will create a dependence problem you have to solve later.
§ 05 What this is not
Boundaries are part of good care.
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 management coordinates with trauma-focused psychotherapy; it does not stand in for it.
Not controlled substances
I do not prescribe controlled substances: no benzodiazepines, no stimulants, no zolpidem (Ambien) or other controlled sleep medications. This boundary holds for every patient.
Not legal documentation
I do not provide custody evaluations, disability determinations, VA claim letters, or compensation exams.
§ 06 Related reading
Understanding Post-Military Hypervigilance
The decommissioning gap, invisible armor, and why the mission can end before the nervous system stands down.
Read the articleDecoding Veteran Trauma
A practical look at specialized telehealth care for PTSD, complex grief, hypervigilance, and medication management.
Read the articleVeterans services
A dedicated page for veterans: post-service adjustment, sleep disruption, trauma symptoms, and grief, from a provider who served.
Explore veterans careAnxiety and sleep
When the night-waking and rumination run without a trauma history behind them, the anxiety-insomnia loop may be the better frame.
Explore anxiety careDepression overlap
Trauma, grief, shutdown, and threat physiology can overlap with persistent low mood and loss of motivation.
Explore depression careGrief and bereavement
When the trauma is a loss, and the loss will not resolve, grief-focused care may sit closer to the center.
Explore grief care§ 07 Questions
Do I need a PTSD diagnosis to start?
No. Diagnosis matters, but the first step is understanding what is actually happening: sleep, threat response, mood, grief, anxiety, and what treatments you have already tried. The label, if one fits, comes from the evaluation rather than before it.
Can medication replace trauma therapy?
No. Medication is support for trauma therapy, not a substitute. It can lower the biological alarm enough that therapy becomes tolerable and useful, and it coordinates well with trauma-focused psychotherapy and peer support.
Is there anything that helps with trauma nightmares?
Often, yes. Prazosin, a non-controlled blood-pressure medication, can blunt the adrenaline surge that drives trauma nightmares and middle-of-the-night waking. It is one of the most targeted tools in trauma psychiatry, and it is part of my regular prescribing.
Will medication flatten me or take my edge?
That is not the goal, and it is something we watch for explicitly. The aim is to lower unnecessary alarm, not to mute the person. Dosing is adjusted with your feedback at every visit, and a medication that costs you more than it gives gets changed.
Can you coordinate with my therapist or primary care clinician?
Yes, with your permission. Collaborative care is often the strongest arrangement when medication management is one part of a broader recovery plan.
What if I am in crisis?
This practice is not an emergency service. If you are in immediate danger or may harm yourself or someone else, call or text 988, call 911, or go to the nearest emergency department.
Standing down is a process. It can start with a call.
Fifteen minutes, free, by phone. Enough to decide together whether this kind of care fits what you are carrying.
Book a free 15-minute consultation