A prescription is a single decision. Medication management is the work after it: watching what the medication actually does, adjusting when it is not enough, and stopping safely when the time comes. Adults across Virginia, by video telehealth or in person in Fairfax.
Book an Appointment →A refill continues what already exists. It answers one question: is this person still on this medication? Medication management asks a longer list. Is this still the right medication for what you actually have? Is the dose high enough to be a fair trial, or low enough to be tolerable? Has anything changed in your health, your other prescriptions, or your life that changes the calculation? Are we treating a target we can both name, and are we measuring whether we are hitting it?
That difference compounds. Plenty of adults in Virginia have been on the same antidepressant for six years because nobody revisited it. Some need it. Some are carrying a side effect they stopped mentioning because they assumed it was permanent. Some are on a starting dose that was never raised, which is a common reason a medication gets written off when it was never really tried.
Alice Tran, PMHNP-BC, FNP-BC is dual board-certified and licensed in Virginia, trained under psychiatrist Dr. Errol Segall, MD, who has over 50 years of clinical experience. She treats adults 18 to 65, in English or Tiếng Việt with no interpreter needed. For the short version of what these visits look like, see what medication management is. This page covers the reasoning underneath it.
The initial visit is 60 minutes and it is a full psychiatric evaluation, not a prescribing consult with a form attached. Before any medication is chosen, Alice needs the picture: when the symptoms started, what they interfere with, the pattern across months and years, current medical conditions and prescriptions, what runs in your family, and what you have already tried.
Prior treatment history is the most useful thing you can bring. If something failed for you before, the important detail is usually why: a side effect, a dose that never went up, a stop after ten days, or a genuine full trial that did not work. Those four answers point in four completely different directions.
Sometimes medication starts at the first visit; for a clear presentation of depression or anxiety, waiting adds nothing. Other times more information is needed first, especially with a question of bipolar disorder, a substance that may be driving the picture, or an ADHD question that deserves a proper evaluation rather than a same-day label.
Follow-ups are 30 minutes, and they are spaced by where you are in treatment rather than by a fixed schedule. While a medication is being started or a dose is being changed, visits are typically every 2 to 4 weeks. Once you are stable, they usually stretch to every 1 to 3 months.
The close spacing at the beginning is not administrative. The first several weeks are when side effects appear and usually settle, when a dose that is too low becomes obvious, and when early response shows up in sleep and appetite before mood shifts. It is also the window when people quietly stop taking something because of a side effect nobody warned them about. Seeing you at week three rather than week twelve keeps a workable medication from being abandoned and a wrong one from being tolerated for a season.
Controlled medications, including stimulants for ADHD, require regular follow-up. They cannot be refilled indefinitely without visits, and that is a fixed part of how they are managed here rather than a matter of preference.
Different medications work on different clocks, and knowing which clock you are on prevents a lot of discouragement. Stimulants for ADHD show their effect within days, sometimes on the first dose. Antidepressants are slower: early change often appears around 2 to 4 weeks, and a fair trial at an adequate dose generally takes 6 to 12 weeks before it is reasonable to say the medication did not work. Mood stabilizers and antipsychotics fall in between.
Response is judged on more than whether you feel happier. Sleep, appetite, energy, concentration, and the ability to do ordinary things you had stopped doing all move before subjective mood does, and they are usually the first honest evidence that something is working. It also helps to define at the start what better would look like in your life: sleeping through the night, getting through a workday without three hours of dread, finishing what you start. Concrete targets make the next decision clearer than a general sense of how the week went.
Worth reading alongside this page: how long you should stay on an antidepressant, which walks through the acute, continuation, and maintenance phases and why the answer depends on your own episode history rather than a standard protocol.
Many people do not respond fully to the first medication they try. That is expected and planned for rather than treated as a dead end. When a trial has been long enough and the response is partial or absent, there are four reasonable moves, and you should always be told which one is being made and why.
The most common fixable problem. Many medications get declared failures at the starting dose, which is chosen for tolerability, not effect. If side effects allow, raising the dose is often the first step.
A different medication, sometimes within the same class and sometimes to a different mechanism entirely. What failed tells us something about what to try next.
Adding a second medication that works differently, when there is a real partial response worth keeping rather than abandoning.
When nothing is working, the question is whether the target is right. Unrecognized bipolar disorder, ADHD, trauma, sleep apnea, thyroid disease, and alcohol use all masquerade as treatment-resistant depression.
The fourth is the one most often skipped and the one that most often changes everything. If two or three trials have failed, the useful move is usually not a fourth medication from the same shelf. It is a step back to ask whether we have been treating the right condition all along.
Condition-specific detail: depression · anxiety · ADHD · bipolar disorder
Almost every psychiatric medication has side effects, and most are manageable if you say them out loud. The pattern matters more than the presence. Nausea, headache, and early jitteriness with an antidepressant are common in the first week or two and usually settle on their own. Appetite suppression and later-day irritability with a stimulant tend to be dose-related and often respond to timing changes. Sexual side effects, weight change, and daytime sedation are the ones people most often endure silently, and they are among the most workable once named, whether by adjusting the dose, changing the time of day, or switching to something with a different profile.
A short list is different. New or worsening thoughts of self-harm, a rash, severe agitation, a rapid shift into unusually elevated or sped-up mood, or anything that feels physically wrong is a call to the office, not a wait-and-see. Those are flagged specifically at the visit where the medication is started so you are not guessing at 9 PM. If you are in crisis, call or text 988; this practice is not a crisis service.
Some psychiatric symptoms are not psychiatric. Thyroid disease can look exactly like depression or anxiety. B12 and folate deficiency can produce fatigue and brain fog. Baseline work such as a complete blood count, a metabolic panel, and thyroid function is often worth drawing before starting treatment for that reason, and to confirm your liver and kidneys can handle what is being prescribed.
Ongoing monitoring depends on the medication. Lithium requires level checks along with kidney and thyroid monitoring, because the gap between a therapeutic level and a toxic one is narrow. Valproate calls for levels, blood counts, and liver function. Second generation antipsychotics call for metabolic monitoring, meaning glucose, lipids, and weight, at baseline and periodically after. Most antidepressants and ADHD medications need no routine bloodwork at all, though blood pressure and heart rate are checked with stimulants. The full picture is in this guide to lab testing in psychiatry. Labs can be drawn near you anywhere in Virginia.
Stopping is a legitimate goal and it comes up in most long treatments. It is also the part most likely to go badly when done alone. Stopping an antidepressant abruptly can produce discontinuation symptoms including dizziness, flu-like aches, insomnia with vivid dreams, nausea, brief electrical sensations often described as brain zaps, and rebound anxiety. These are not dangerous the way alcohol or benzodiazepine withdrawal can be, but they are unpleasant, easily mistaken for relapse, and largely preventable with a gradual taper.
A taper is a stepwise reduction, commonly no more than 10 to 25 percent of the current dose every 2 to 4 weeks, slower for people who have been on higher doses for longer. The final steps are usually the hardest, and going back up to a dose that was working is not a failure. It is information. Timing matters too: tapering in the middle of a job change or a family crisis stacks the deck against you. The mechanics are covered in how to taper off antidepressants safely. Never stop abruptly on your own.
Alice does not provide ongoing weekly psychotherapy, and for most conditions the strongest results come from medication and therapy together rather than either alone. If you already have a therapist, she coordinates with them with your permission, so the two of you are not working from different theories of what is wrong. If you do not have one, she can point you toward therapists in Virginia who fit what you are dealing with.
Coordination with primary care matters just as much, for practical reasons: drug interactions, blood pressure with stimulants, metabolic effects, thyroid results, and pregnancy planning all sit at the border between the two. Records are shared with your primary care provider on request. No referral is needed to be seen here.
Access is the real barrier for most people in this state. Waits of two to four months are normal, and outside the Northern Virginia and Richmond corridors there may be very few prescribers taking new adult patients at all. Telehealth closes that gap. Patients are seen from Richmond, Hampton Roads, Charlottesville, Roanoke, Lynchburg, Harrisonburg and the Shenandoah Valley, Fredericksburg, Loudoun and Prince William, and towns with no psychiatric office within an hour. New patients are typically seen within 1 to 2 weeks.
Two requirements apply. You must be physically located in Virginia at the time of your visit, because that is where Alice is licensed. And visits are conducted by video, never by telephone. Under current DEA telemedicine rules, a real-time audio and video visit is what permits controlled medications such as stimulants to be prescribed by telemedicine, and audio only is not sufficient for those, so video is practice policy for every visit. You need a private space and a working camera. Visits join at doxy.me/alicetran, with nothing to download.
3060 Williams Drive, Suite 300, Fairfax, VA 22031, in the Merrifield area, with free on-site parking. See medication management in Fairfax →
Monday to Thursday, 9:00 AM to 5:00 PM Eastern. Evenings and weekends may be available on request. No referral needed.
Aetna, Anthem, Cigna, Medicare, and Medicaid, verified before your first visit. Self-pay is $400 initial and $200 or $250 for follow-ups. See rates →
Care delivered fully in either language, with no interpreter in the room. Trang tiếng Việt →
Related statewide pages: ADHD treatment in Virginia · anxiety treatment in Virginia · depression treatment in Virginia · all services · about Alice · contact
A refill continues what already exists. Medication management asks whether the medication is still the right one, at the right dose, for the right reason, and whether anything has changed in your health, your other prescriptions, or your life. Every visit re-examines the plan rather than repeating it.
Visits at this practice are conducted by video, never by telephone. A real-time audio and video visit is what permits controlled medications such as stimulants to be prescribed by telemedicine, and audio only is not sufficient for those, so video is practice policy for everyone. Video visits join at doxy.me/alicetran.
No. You need to be physically located in Virginia at the time of your visit. Patients are seen from Richmond, Virginia Beach, Charlottesville, Roanoke, the Shenandoah Valley, and everywhere in between. In-person appointments are available at the Fairfax office if you would rather come in.
It depends on the medication. Stimulants for ADHD can show an effect within days. Antidepressants usually need about 2 to 4 weeks for early change and 6 to 12 weeks at an adequate dose before the trial can be called fair. Sleep, appetite, and energy often improve before mood does, and those early signals are worth tracking.
There are four reasonable moves, and Alice will tell you which one she is making and why: raise the dose if the trial was underdosed, switch to a different medication, add a second medication that works through a different mechanism, or step back and re-examine whether the diagnosis is complete. A partial response is information, not failure.
Closer together at the start, typically every 2 to 4 weeks while a medication is being started or a dose is being changed, then every 1 to 3 months once you are stable. Controlled medications require regular follow-up and cannot be refilled indefinitely without visits.
Sometimes. Baseline labs such as a complete blood count, a metabolic panel, and thyroid function help rule out medical causes of psychiatric symptoms. Some medications, including lithium, valproate, and second generation antipsychotics, need ongoing monitoring. Labs are ordered when the result would change the plan, not as a routine ritual.
Bring it up at a visit rather than stopping on your own. Feeling better usually means the medication is working, not that it is no longer needed, and stopping an antidepressant abruptly can cause discontinuation symptoms such as dizziness, flu-like aches, insomnia, and rebound anxiety. When stopping is the right call, it is done as a planned gradual taper with follow-up along the way.
Yes. Bring your current medication list and whatever records you have. She will review what you are taking, what has been tried before, and what helped or did not, then continue, adjust, or change the plan with you rather than starting from zero.
Aetna, Anthem, Cigna, Medicare, and Medicaid are accepted, and coverage is verified before your first visit. Self-pay is $400 for the 60 minute initial visit, and follow-ups are $200 for a 30-minute follow-up. There are no memberships and no hidden fees.
More questions? Visit the full FAQ →
Video telehealth anywhere in Virginia & in person in Fairfax. English & Tiếng Việt.
Book Now →Or call/text: (703) 791-9099 · info@alicetrannp.com
Not a crisis service. If you are in crisis, call or text 988.
Condition Treatment Across Virginia