Antidepressants work considerably better when someone is actually paying attention to how they are working. Ongoing management by secure video, anywhere in Oregon.
Book a Telehealth Appointment →The usual pattern is a prescription and a six-month gap. If it half worked, it stays at the same dose forever. If it did not work, the person concludes antidepressants are not for them and stops. Both outcomes are avoidable, and both come down to nobody checking in during the weeks that mattered.
An adequate trial means an adequate dose for an adequate duration, usually six to eight weeks at a therapeutic dose. A great many people who believe they failed three antidepressants actually received three subtherapeutic trials. That distinction changes what happens next entirely.
Follow-ups ask what is genuinely better and what is not. Sleep, appetite, energy, concentration, and interest tend to improve before mood does, which is useful to know so that real progress is not mistaken for none. Sexual side effects, emotional blunting, and weight changes are asked about directly, because people rarely volunteer them and they are among the most common reasons people quietly stop.
Six to eight weeks at a therapeutic dose before calling something a failure. Anything less is not a real test.
Sexual side effects, emotional flatness, and weight change are asked about directly rather than waited for.
When one medication is not enough there are well-established next steps, including changing class or adding a second agent.
Many people stop after a well-treated episode. Done on a taper with a relapse plan, that is a good outcome rather than a risk.
For a first episode, commonly six to twelve months after you feel well, since stopping too early is the single biggest predictor of relapse. Recurrent depression may warrant longer. It is a shared decision.
Emotional blunting is a real side effect and a common reason people stop without saying why. It is asked about directly, and it is usually addressable through dose or a change of medication.
Worth examining closely. Frequently the doses were too low or the trials too short. It is also worth rechecking the diagnosis, since bipolar depression, thyroid disease, and untreated sleep apnea all masquerade as treatment-resistant depression.
Not abruptly, and usually not immediately. Feeling well is the medication working, not proof it is no longer needed. When the time is right it is tapered with a plan for what to watch for.
Usually within one to two weeks. There is no waitlist and no referral requirement.
By secure video, anywhere in Oregon. The initial evaluation is up to 60 minutes and follow-ups are 30 or 45 minutes. You need to be physically located in Oregon during the visit.
Oregon care is self-pay only. $400 for the initial evaluation, $200 for a 30-minute follow-up, $250 for 45 minutes. Nothing is billed to a health plan.
Start here
Psychiatric care across OregonPortlandVietnamese-speaking careTelehealth visitsSelf-pay ratesWhat it costsHow to find careCities
PortlandBeavertonHillsboroGreshamSalemEugeneBendConditions
AnxietyDepressionAdult ADHDADHD diagnosisBipolar disorderOCDPTSD and traumaInsomniaMedication management
ADHD medicationAnxiety medicationSecure video across Oregon. Self-pay only. Usually seen in one to two weeks.
Book Now →Or call/text: (703) 791-9099