Depression and anxiety care · Telehealth across Washington
Depression and anxiety treatment that fits your life
Medically reviewed by Dr. Iman Yunis, DNP, PMHNP-BC · Last reviewed October 31, 2026
Evaluation and medication management by secure video with a doctorate-trained, board-certified psychiatric nurse practitioner, plus a clear plan when standard treatment has not worked.
New patients typically seen within 2–3 days
- ✓ Ages 13 and up
- ✓ Secure video visits
- ✓ Most major insurance
The short answer
Effective help is available, and it starts with a careful evaluation
Depression and anxiety are among the most common and most treatable mental health conditions. At Peak Psychiatry and Wellness, Dr. Iman Yunis, DNP, PMHNP-BC, evaluates your symptoms by video, explains what is going on, and builds a step-by-step plan that may include medication, therapy, lifestyle changes, or a combination. We see teens 13 and up and adults anywhere in Washington, and new patients are typically seen within 2–3 days.
This page is our complete guide. It covers how depression and anxiety show up, how evaluation and treatment work, what to expect from medication, and where to go next. Every section is based on national guidelines and peer-reviewed research, listed at the bottom of the page.
Understanding depression
More than a bad week
Depression is a medical condition that affects mood, thinking, sleep, appetite, and energy. A diagnosis of major depression generally requires symptoms most of the day, nearly every day, for at least two weeks.[1]
- Persistent sadness, emptiness, or feeling numb
- Loss of interest or pleasure in things you used to enjoy
- Changes in sleep or appetite
- Fatigue, slowed thinking, or trouble concentrating
- Feelings of guilt, worthlessness, or hopelessness
- Thoughts of death or suicide. If this is you right now, call or text 988.
Types of depression we treat
- Major depressive disorder: episodes that disrupt daily life.
- Persistent depressive disorder: lower-grade depression that lasts two years or more.
- Perinatal and postpartum depression: depression during pregnancy or after birth. See our postpartum depression page.
- Depression with a seasonal pattern: symptoms that return at the same time each year, common in Washington winters.
- Treatment-resistant depression: depression that has not improved after two or more adequate medication trials.
Some people who have depression also have periods of unusually high energy or little need for sleep. That can signal bipolar disorder, which is treated differently, so we screen for it before recommending an antidepressant.
Understanding anxiety
When worry takes over
Anxiety becomes a disorder when worry or fear is persistent, hard to control, and gets in the way of daily life. Generalized anxiety disorder, for example, involves excessive worry on most days for at least six months.[2]
- Generalized anxiety: constant worry, muscle tension, restlessness, and trouble switching your mind off.
- Panic disorder: sudden waves of intense fear with a racing heart, shortness of breath, or dizziness, often followed by fear of the next attack.
- Social anxiety: intense fear of being judged that leads to avoiding work, school, or social situations.
- Health-related and situational anxiety: worry that grows around illness, pregnancy, work stress, or major life changes.
Depression and anxiety often occur together, and one can make the other worse. Treating both at the same time usually works better than treating them one at a time.
Your evaluation
What happens at your first visit
Your first appointment is about 60 minutes by secure video. Dr. Yunis will ask about your symptoms, history, sleep, substance use, medical conditions, current medications, and what you have already tried. You may complete brief rating scales such as the PHQ-9 and GAD-7. Guidelines recommend these scales because they make it easier to track progress over time.[3]
- Medical causes: thyroid problems, anemia, sleep apnea, and some medications can mimic depression or anxiety. We may coordinate lab work with your primary care provider.
- Safety: we ask directly about thoughts of self-harm, because it helps us keep you safe and choose the right level of care.
- Your goals: what you want to feel and do differently, and your preferences about medication and therapy.
You leave with a diagnosis explained in plain language and a written plan. Use our first visit checklist to prepare.
Treatment options
A step-by-step plan, adjusted as you improve
Medication
For moderate to severe depression and for many anxiety disorders, medication is an evidence-based option. A large analysis of 522 trials found that all 21 antidepressants studied worked better than placebo for adults with major depression, with differences in how well people tolerated them.[4] For generalized anxiety, SSRIs and SNRIs such as escitalopram, sertraline, and duloxetine are well-supported first-line choices.[6]
Dr. Yunis chooses a medication based on your symptoms, past responses, side effects you want to avoid, other health conditions, and possible interactions. Learn more about common options: escitalopram (Lexapro), sertraline (Zoloft), and bupropion (Wellbutrin).
Therapy, and why the combination matters
Therapy such as cognitive behavioral therapy is effective on its own, especially for anxiety. For depression, a review of more than 100 trials found that therapy and medication together led to better response than either one alone.[5] Dr. Yunis provides medication management with supportive counseling. If you would benefit from structured therapy, we help you find a therapist and coordinate with them. Not sure which you need? Read psychiatry vs. therapy.
Measuring progress
We repeat brief rating scales at follow-up visits so decisions are based on how you are actually doing, not guesswork. This approach is recommended by the American Psychiatric Association.[3]
Lifestyle support
Regular aerobic or strength exercise, consistent sleep, and limiting alcohol can meaningfully improve mood and anxiety, and the APA guideline recognizes exercise as a helpful addition to treatment.[3] We build these into your plan in realistic, small steps.
When the first medication does not work
Not responding to the first medication is common and does not mean treatment will fail. In the large STAR*D study, many people who did not improve with their first antidepressant got better after a change or an added medication.[7] Options include adjusting the dose, switching to a different class, adding a second medication, GeneSight® testing, and advanced treatments.
- Medication managementCareful selection and adjustment. Learn more
- GeneSight® testingA cheek-swab genetic test that may help guide medication choices. Learn more
- Spravato® (esketamine)Coming soon. For adults with treatment-resistant depression. Learn more
- Coordinated therapyWe can recommend therapists and coordinate care with yours.
What to expect
Your first months of treatment
- 01Weeks 1–2Some people notice better sleep, appetite, or energy first. Mild side effects, if any, often fade.
- 02Weeks 4–8The fuller effect on mood and worry usually appears with a steady dose.
- 03Follow-upsVisits every 2–4 weeks at first, then every 1–3 months once you are stable.
- 04Staying wellContinuing treatment for several months after you feel better lowers the risk of relapse.
For a first episode of depression, the APA guideline recommends continuing medication for about four to nine months after symptoms improve, and longer for people with repeated episodes.[3]
Safety
Side effects and safety, explained honestly
- Common side effects: upset stomach, headache, sleep changes, or sexual side effects. Many improve in the first weeks. Tell us about any side effect, because there is usually a fix.
- Young people: antidepressants carry an FDA boxed warning because a small number of people under 25 may have increased suicidal thoughts when starting or changing a dose. We monitor closely and involve parents for teens.[1]
- Stopping medication: do not stop suddenly. Stopping some antidepressants abruptly can cause withdrawal-like symptoms. When it is time to come off a medication, we taper gradually with you.[8]
- Sedatives: medications like benzodiazepines can relieve anxiety quickly but carry risks of dependence and are generally used only short-term, if at all.[2]
- Crisis: if you have thoughts of suicide, call or text 988 any time, or call 911 in an emergency.
Special situations
Pregnancy, postpartum, and teens
Pregnancy and breastfeeding. Untreated depression and anxiety during pregnancy and after birth carry real risks for parent and baby. ACOG guidance supports treating these conditions and notes that many medications, including several SSRIs, can be used during pregnancy and breastfeeding after a careful discussion of risks and benefits.[9] Never stop a medication on your own if you become pregnant. Talk with Dr. Yunis and your OB or midwife. Visit our women’s mental health guide.
Teens 13 and up. We work with parents and, with permission, schools and therapists. Read our guide for parents.
Depression and anxiety guide
Everything in this guide
- ScreenerFree depression test (PHQ-9) →A 2-minute screening you can take privately.
- ScreenerFree anxiety test (GAD-7) →A 2-minute screening for anxiety symptoms.
- Medication guideEscitalopram (Lexapro) →Uses, side effects, and what to expect.
- Medication guideSertraline (Zoloft) →Uses, side effects, and what to expect.
- Medication guideBupropion (Wellbutrin) →Uses, side effects, and what to expect.
- ArticleTreatment-resistant depression →What it means and when to ask about Spravato.
- TreatmentGeneSight® testing →How genetic testing may guide medication choices.
- TreatmentSpravato® (esketamine) →Coming soon for treatment-resistant depression.
- GuidePsychiatry vs. therapy →Which one do you need?
- ArticleYour first psychiatric evaluation →What happens and how to prepare.
- Related conditionPostpartum depression →Care during pregnancy and after birth.
- GuideWhat it costs →Insurance, self-pay, and no surprise bills.
Insurance and cost
Covered by most major Washington plans
We are in network with these plans and verify your benefits before your first visit. Tap your plan to learn more:
Self-pay: $300 initial evaluation · $150 follow-ups
FAQ
Common questions
How do I know if I need a psychiatric provider?
If low mood, worry, or panic has lasted more than two weeks and is affecting sleep, work, school, or relationships, an evaluation can help. You do not need a referral to book with us.
How long do antidepressants take to work?
Some people notice better sleep or energy within one to two weeks, but the full effect on mood and anxiety usually takes four to eight weeks at a steady dose. That is why we check in often during the first months.
How long will I need to stay on medication?
For a first episode of depression, guidelines recommend continuing treatment for several months after you feel well, because stopping early raises the risk of relapse. People with repeated episodes may benefit from longer treatment. We decide this together and review it at every visit.
Can I stop my medication if I feel better?
Please do not stop on your own. Stopping some antidepressants suddenly can cause withdrawal-like symptoms and raises the risk of relapse. If you want to come off a medication, we plan a gradual, supervised taper with you.
What if antidepressants have not worked for me?
You are not out of options. We review what you have tried, the doses, and side effects, then consider adjustments, a different medication class, adding a second medication, GeneSight testing, or referral for advanced treatments. Spravato® is coming soon to Peak for adults with treatment-resistant depression.
Do you provide therapy?
Dr. Yunis provides psychiatric evaluation and medication management with supportive counseling. For structured therapy such as CBT, we help you find a therapist and, with your permission, coordinate care with them.
Can anxiety be treated without medication?
Often, yes. Therapy such as cognitive behavioral therapy is a first-line treatment for many anxiety disorders. Medication can help when symptoms are moderate to severe or when therapy alone has not been enough. We talk through the options and your preferences before recommending anything.
Is this covered by insurance?
In most cases, yes. We verify your benefits before your first visit. Self-pay is $300 for the initial evaluation and $150 for follow-ups.
What if I am in crisis?
Peak is not an emergency service. Call or text 988, the Suicide and Crisis Lifeline, any time, or call 911 if you are in immediate danger.
Sources
References
This page was written and medically reviewed by Dr. Iman Yunis, DNP, PMHNP-BC, using the sources below. It is for education and is not a substitute for personal medical advice.
- National Institute of Mental Health. Depression. www.nimh.nih.gov/health/topics/depression
- National Institute of Mental Health. Anxiety Disorders. www.nimh.nih.gov/health/topics/anxiety-disorders
- American Psychiatric Association. Practice Guideline for the Treatment of Patients With Major Depressive Disorder, 3rd edition. 2010. psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/mdd.pdf
- Cipriani A, et al. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. Lancet. 2018;391(10128):1357-1366. doi.org/10.1016/S0140-6736(17)32802-7
- Cuijpers P, et al. A network meta-analysis of the effects of psychotherapies, pharmacotherapies and their combination in the treatment of adult depression. World Psychiatry. 2020;19(1):92-107. doi.org/10.1002/wps.20701
- Slee A, et al. Pharmacological treatments for generalised anxiety disorder: a systematic review and network meta-analysis. Lancet. 2019;393(10173):768-777. doi.org/10.1016/S0140-6736(18)31793-8
- Rush AJ, et al. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. Am J Psychiatry. 2006;163(11):1905-1917. doi.org/10.1176/ajp.2006.163.11.1905
- Horowitz MA, Taylor D. Tapering of SSRI treatment to mitigate withdrawal symptoms. Lancet Psychiatry. 2019;6(6):538-546. doi.org/10.1016/S2215-0366(19)30032-X
- American College of Obstetricians and Gynecologists. Clinical Practice Guideline No. 5: Treatment and Management of Mental Health Conditions During Pregnancy and Postpartum. Obstet Gynecol. 2023;141(6). www.acog.org/clinical/guidance/clinical-practice-guideline/2023/06/treatment-and-management-of-mental-health-conditions-during-pregnancy-and-postpartum/
Take the first step today
New patients typically seen within 2–3 days. Book online or call (425) 477-9272.
Book a Visit