Diagnostic clarification

If you're not sure what you're dealing with, you're not alone. A careful second look can help when:

• Your symptoms seem to fit more than one condition
• Treatment has helped only partly, or not at all
• Different providers have given you different diagnoses
• Your symptoms have changed over the years
• You've had depression, and also times of unusually high energy or little need for sleep
• You have trouble focusing and wonder whether it's ADHD, anxiety or depression
• Sleep problems, irritability or feeling on edge started after something frightening happened

These situations are a general guide, not a checklist for diagnosis.

Trouble concentrating can be part of generalized anxiety disorder, depression, bipolar disorder, PTSD and ADHD. Sleep problems show up in most of them too. Conditions also often come together: many people with bipolar disorder also have an anxiety disorder or ADHD, for example.

Some patterns are easy to miss. People with bipolar II disorder may seek help only when they're depressed, so the high periods go unnoticed. That matters, because treating depression with an antidepressant alone can sometimes trigger a manic episode in someone with bipolar disorder. Some health conditions, such as thyroid problems, and some medications can also cause symptoms like depression or mood swings.

Diagnostic clarification is part of a comprehensive psychiatric evaluation. It looks at the course of your symptoms over time, not just a snapshot:

• When each symptom started, how long it lasts, how often it comes back, and what it affects
• Periods when your mood, energy or sleep were very different from usual
• Past diagnoses and treatments, including medications, doses, how long you took them and how they worked
• Your physical health, current medications, alcohol or substance use, and family history
• Stressful or traumatic experiences, at whatever pace feels right for you

Records from past providers help, but they aren't required. Sometimes the picture is clear after the first visit; sometimes it becomes clearer over follow-ups. Your first evaluation is up to 90 minutes in length. Some people need more time, some less, and we take the time you need. Follow-up visits are typically 20 to 30 minutes, and extended follow-ups are available.

We don't offer formal ADHD or autism testing (such as neuropsychological testing), or disability, forensic, custody or court evaluations. If you need one of those, the person or organization asking for it can usually tell you what kind of evaluation they require.

A clear explanation. We tell you what we think is going on and why, what we've ruled out, and what we're still unsure about. If more than one condition is involved, your plan covers all of them.

Treatment that fits the pattern. When medication is appropriate, the right choice depends on the diagnosis. For example, bipolar disorder is treated differently from depression. We explain every option, its side effects and what to expect, and decide together.

Support in every visit. Visits include real conversation, education about your diagnosis and practical strategies. We don't offer standalone weekly therapy, but we're happy to help you find a therapist and, with your permission, we'll coordinate with them.

Regular follow-ups. We check how things are going and adjust carefully. If your symptoms change, we look at the diagnosis again.

Already have a diagnosis and want a fresh look? Read about our second-opinion evaluations.