The evaluation process
Depression in adults rarely arrives as a clean clinical picture. It overlaps with anxiety, sleep disturbance, ADHD, perinatal mood changes, grief, and burnout. Treatment that ignores those overlaps tends to disappoint — which is why our first visit is built to look at the whole picture rather than reach for a prescription first.
A full unhurried intake covers a structured DSM-5 symptom review, the PHQ-9 for baseline severity, a careful look at sleep, substance use, medication history, and prior treatment responses. We screen for conditions that often travel with depression: generalized anxiety, panic, ADHD, PTSD, postpartum mood, and bipolar-spectrum signals that change which medications are safe.
A treatment plan is discussed before you leave. If medication is the right next step, we usually start that day or within a few days — and we follow up on a clear interval (2 weeks during a start or change, 4–6 weeks while dialing in, every few months once stable). PHQ-9 tracking between visits keeps us honest about whether what we're doing is actually working.
Medication options
Medication choice depends on your symptom pattern, side-effect profile, prior responses, and what you're willing to live with. We prescribe across all major antidepressant classes:
- SSRIs: Sertraline (Zoloft), escitalopram (Lexapro), fluoxetine (Prozac), citalopram, paroxetine — first-line for most patients
- SNRIs: Duloxetine (Cymbalta), venlafaxine (Effexor), desvenlafaxine — useful when anxiety, pain, or significant fatigue are prominent
- Atypicals: Bupropion (Wellbutrin) for low energy and motivation; mirtazapine (Remeron) for sleep and appetite
- Augmentation: Adding aripiprazole, lithium, or a thyroid agent when monotherapy isn't quite getting there
For treatment-resistant patients, we discuss next-step options including TMS (transcranial magnetic stimulation), esketamine (Spravato), and referral to in-person specialty providers — and we coordinate care if you pursue them.
Serving Portland and Multnomah, Washington, and Clackamas counties County
Portland sits in the Portland metro area, served by I-5, I-205, I-84, and Highway 26. We see adults from Portland as well as Northwest Portland, Southeast Portland, Northeast Portland, St. Johns, Sellwood, Hillsdale, Multnomah Village, Lake Oswego, Milwaukie, and Gresham — mostly by secure-video telehealth. Our patient base in the area skews toward tech professionals from Intel, Nike, Adobe, and the smaller PDX startup scene; healthcare workers across the major systems; creative-industry professionals; government employees; and graduate students.
Patients who'd prefer to be seen in person can book at our nearest office: Vancouver, WA — about 15–20 minutes across the river from Portland.
Coordination with primary care is routine. We send a visit summary to your PCP at OHSU, Providence Portland, Legacy Good Samaritan, Kaiser, Adventist Health, and Doernbecher (or your independent provider) within one business day when you request it.
Insurance & self-pay
We are in-network with ten major plans: Moda, PacificSource, Regence BlueCross BlueShield, Cigna / Evernorth, Aetna, Providence, MultiPlan / Claritev, First Health, First Choice, and Optum. Most Portland patients pay a specialist copay ($20–$60 typical) per visit.
We do not accept Medicaid or Oregon Health Plan (OHP). Self-pay rates are available by phone. Superbills available for out-of-network reimbursement. Good Faith Estimates provided before your first visit.
Frequently asked questions
How do I get started with depression treatment in Portland?
Book a new-patient telehealth visit online or by phone. Most patients are seen within about a week. The first visit is a comprehensive evaluation; if medication is appropriate, we usually start that day or within a few days.
Will I need to see someone in-person?
Not for most patients. Antidepressant medications are not controlled substances, which means they can be prescribed by telehealth without special restrictions. In-person visits are also available at our Vancouver, WA office (about 15–20 minutes across the river) if you'd prefer that.
What happens if the first medication doesn't work?
It's common — only about 60% of patients respond to their first antidepressant. We use measurement-based care (PHQ-9 tracking) to see whether the medication is actually helping, and we switch or augment on a clear, evidence-based timeline rather than guessing.
Do you accept insurance for depression treatment?
Yes — we are in-network with Moda, PacificSource, Regence BCBS, Cigna / Evernorth, Aetna, Providence, MultiPlan / Claritev, First Health, First Choice, and Optum. Medicaid and Oregon Health Plan are not accepted.