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 seven major plans, including Moda, Regence BlueCross BlueShield, PacificSource, Providence, First Choice Health Network, MultiPlan, and select Kaiser Permanente plans (PPO, Added Choice, and Dual Choice). If you don’t see your plan listed, call our office and we’ll verify your benefits. 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 telehealth patients are seen within a few days. 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, Regence BlueCross BlueShield, PacificSource, Providence, First Choice Health Network, MultiPlan, and select Kaiser Permanente plans (PPO, Added Choice, and Dual Choice). Medicaid and Oregon Health Plan are not accepted.