Precision Psychiatric Medication Management | Seattle

Board-certified psychiatrist Dr. Cara Erkut provides evidence-based medication management for depression, anxiety, bipolar disorder, and ADHD on Mercer Island, serving Seattle, Bellevue, and the greater Eastside.

Treating Complex Conditions

Some of the patients I find most rewarding to work with are those with conditions that don’t respond to simple solutions. Depression that doesn’t lift with standard antidepressants. Anxiety that seems immune to conventional treatment. Mood patterns that suggest something more complicated than garden-variety depression.

These conditions often require more than just picking a medication from a list. They require understanding how different symptoms interact, how your life circumstances affect your mental health, and how to sequence treatments for maximum benefit with minimum side effects.

My Medication Management Philosophy

I’m Dr. Cara Erkut, and I’ve spent my career developing a systematic, evidence-based approach to psychiatric medication management. My treatment protocols were developed in collaboration with Dr. David Dunner at the Center for Anxiety and Depression, one of the Pacific Northwest’s leading experts in mood and anxiety disorders.

One Medication Change at a Time

I select one medication change at a time. This approach lets us understand what’s actually working and what isn’t. When you’re making multiple changes simultaneously, it becomes impossible to know which intervention is responsible for improvement or side effects.

No “Cocktail of Meds” Approach

I refrain from using the “cocktail of meds approach” unless I feel each medication is targeting a specific symptom. A little bit of this and a little bit of that does not make sense to me. If you’re taking multiple medications, there should be a clear rationale for each one.

Adequate Therapeutic Trials

I try to get the most out of each medication. This means giving it an adequate trial at a therapeutic dosage based on the research—usually 8 weeks. Too often, patients are switched off medications before they’ve had a chance to work at an appropriate dose.

After that trial period, we decide together whether to keep it, maximize it, augment it, or move on to something else.

Stimulants for ADHD: A Different Story

I believe stimulant medications for a well-established diagnosis of ADHD are incredibly helpful as long as there are no contraindications. These medications have strong evidence supporting their use, and when prescribed appropriately, they can be genuinely life-changing.

Bipolar Disorder: More Than Just Mood Swings

If you’ve been diagnosed with bipolar disorder, you’ve probably already discovered that managing it is complicated. What works for the depressive episodes might trigger mania. What controls the highs might leave you feeling flat. And the research shows that 20-60% of bipolar patients struggle with medication adherence, often because they haven’t found a regimen that lets them feel like themselves.

I approach bipolar management with several principles in mind.

First, we need to get the diagnosis right. Bipolar disorder is frequently misdiagnosed as unipolar depression, sometimes for years. This matters because giving antidepressants to someone with unrecognized bipolar disorder can actually make things worse.

Second, we match the treatment to the phase. International guidelines give us clear direction here. Quetiapine, for instance, has evidence for all phases of bipolar disorder. Lithium offers unique protection against suicide. Lamotrigine works particularly well for bipolar depression but not acute mania. Understanding these nuances lets me build a regimen that addresses your specific pattern.

Third, we plan for the long term. Bipolar disorder is chronic. I want to find medications you can stay on, that protect against future episodes while allowing you to function well day to day.

Feeling Like Your True Self, Not a Sedated Version

Here’s what I tell patients who’ve been burned by psychiatric medications before: the goal isn’t to make you numb. It’s to help you feel like yourself again.

Some psychiatric medications do cause emotional blunting. Some cause weight gain, sexual dysfunction, cognitive fog, or other side effects that make people wonder if the cure is worse than the disease. I take these concerns seriously.

When I’m choosing a medication, I’m not just thinking about efficacy. I’m thinking about what matters to you. Are you a writer who needs cognitive clarity? An athlete who can’t afford weight gain? Someone whose libido is already suffering? These factors influence which medications we try and in what order.

Sometimes the answer is finding a different medication. Sometimes it’s adjusting the dose. Sometimes it’s adding something to counteract side effects. And sometimes it’s combining medication with other treatments like psychotherapy or TMS therapy.

What to Expect at Your First Visit

Your initial appointment lasts about 60 minutes.

We’ll review your psychiatric history, including any medications you’ve tried and how they worked. We’ll discuss your medical history, family history, and current life circumstances. I’ll want to understand not just your symptoms but how they affect your daily functioning, your relationships, your work.

Based on this evaluation, I’ll share my diagnostic impressions and discuss treatment options. If medication seems appropriate, I’ll explain why I’m recommending what I’m recommending, what side effects to watch for, and what timeline to expect.

Medication Management Visits

Once we’ve completed your initial evaluation and started treatment, you’ll transition to medication management visits. These appointments are structured differently from the comprehensive initial assessment.

Visit Format

Medication management appointments are 20 minutes in length. During these focused visits, we’ll:

• Review how the current medication is working
• Assess any side effects or concerns
• Monitor your symptoms using standardized measures when appropriate
• Make dosage adjustments or medication changes as needed
• Discuss any new issues or changes in your circumstances

Visit Frequency

I see patients once every 1-3 months depending on what medications I am prescribing and your clinical stability. The frequency depends on several factors:

Every month when starting a new medication, making dosage adjustments, or managing controlled substances like stimulants.

Every 2-3 months for patients on stable medication regimens who are doing well. This allows us to maintain continuity of care while respecting your time and schedule.

The specific interval we establish will be based on your individual needs, the complexity of your medication regimen, and regulatory requirements for certain medications.

Insurance

I accept several major insurance plans.

Please contact my office for detailed information about fees and out-of-network reimbursement options.

I believe good psychiatric care shouldn’t require endless appointments. My goal is to get you stable and then see you only as often as clinically necessary.

Serving Washington State

My practice is located on Mercer Island, easily accessible from Seattle, Bellevue, and surrounding communities.

Meet Dr. Erkut

Common Questions