⚡ Key Takeaways
- 69% of bipolar patients are misdiagnosed initially, often as depression
- Extended 60-minute initial evaluation to capture your complete picture
- Medical doctor conducting assessment with access to labs and imaging when needed
- Same-day diagnostic impressions with clear treatment recommendations
- Family history and collateral information incorporated for accuracy
- Most insurance accepted — Premera, Regence, Aetna, Cigna, and more
Conditions I Evaluate
Psychiatric diagnosis is rarely simple. Symptoms overlap, conditions co-occur, and what looks like one thing often turns out to be another. I’m trained to distinguish between:
Mood Disorders
Major depression, Bipolar I and II, cyclothymia, persistent depressive disorder, treatment-resistant depression
Anxiety Disorders
Generalized anxiety, panic disorder, social anxiety, specific phobias, OCD and related conditions
Trauma-Related Conditions
PTSD, complex PTSD, adjustment disorders, trauma from childhood and adult experiences
Attention & Executive Function
Adult ADHD (often missed or misdiagnosed as anxiety/depression), executive function difficulties
Psychotic Disorders
Early identification of schizophrenia, schizoaffective disorder, psychotic features in mood disorders
Personality Patterns
Assessment of personality features that impact treatment response and daily functioning
The Misdiagnosis Problem
Here’s something that might sound familiar.
You’ve been treated for depression for years. You’ve tried three, maybe five, maybe ten different antidepressants. Some helped a little. Some made you feel worse. Some seemed to work for a while, then stopped. Your doctor kept adjusting doses, switching medications, adding more pills to the mix.
And you started to wonder: Why isn’t this working? What’s wrong with me?
⚠️ The Numbers Are Staggering
According to research published in Psychiatry (Edgmont), 69% of patients with bipolar disorder are initially misdiagnosed. More than one-third remain misdiagnosed for 10 years or more. That’s a decade of the wrong treatment, the wrong medications, and understandable frustration.
I’m Dr. Cara Erkut, and I’ve seen this pattern repeatedly in my Mercer Island practice. Thoughtful people who’ve been stuck on an antidepressant merry-go-round for years because their underlying condition was never accurately identified.
What Makes My Evaluations Different
Most psychiatric evaluations happen in 15 to 20 minutes. You answer some questions, fill out a checklist, and walk out with a diagnosis and a prescription. That’s not enough time to understand anyone.
My initial psychiatric evaluation takes 60 minutes. Sometimes longer. Here’s why that matters:
💡 Accuracy Requires Context
A precise diagnosis is the foundation of recovery. I take the time to distinguish subtle nuances that others might miss. We build your treatment plan based on rigorous medical accuracy and your unique history. Not assumptions. Not checklists. Your actual story.
During that extended time, I’m not just checking boxes. I’m listening for the patterns that reveal what’s actually happening. I ask about your “good” periods, not just your bad ones. I explore your family history, because genetics play a significant role in psychiatric conditions. I want to know what happened when you tried previous treatments.
Training with Dr. David Dunner
I was fortunate to train with Dr. David Dunner, founder of the Center for Anxiety and Depression. Dr. Dunner developed the term “rapid cycling bipolar disorder” that is now part of the DSM diagnostic criteria. He has taught me a great deal about bipolar diagnosis and management, including the critical importance of distinguishing between true bipolar disorder and other mood patterns.
One thing I want to be clear about: we try not to overdiagnose bipolar disorder. I have commonly seen many people overdiagnosed with bipolar disorder when what they’re experiencing is actually mood instability or affective dysregulation. These conditions may still respond well to a mood stabilizer rather than an SSRI, but they are not bipolar disorder. Getting this distinction right matters for treatment.
And because I’m a medical doctor, not just a therapist, I can order labs to rule out thyroid problems, vitamin deficiencies, hormonal imbalances, and other medical conditions that masquerade as psychiatric disorders. About 10% of patients I evaluate have a medical condition contributing to their symptoms that was never identified.
“A patient once told me she’d seen four different providers over eight years and been given three different diagnoses. When I took a thorough history and asked about patterns the other providers had missed, we were able to get the diagnosis right, adjust her medication, and within two months she felt better than she had in a decade.”
— Dr. Cara Erkut, MDWho Needs a Comprehensive Evaluation
Everyone!
It’s always good to get a second opinion, to get a fresh set of eyes on your situation. Many people have been seeing their mental health provider or primary care provider for years and have gotten stuck in a rut of repetitive habits or ways of doing things. Try something new—even if you decide to stay with your current provider, it never hurts to get a second opinion.
What to Expect During Your Evaluation
Here’s what you’re walking into:
Before Your Appointment
You’ll receive intake paperwork to complete in advance. This includes detailed questionnaires about your symptoms, medical history, family history, and previous treatments. Take your time with these. The more information you provide upfront, the more productive our time together will be.
During the Evaluation
We’ll spend about 60 minutes together. I’ll ask about your current symptoms in detail, including when they started, what makes them better or worse, and how they affect your daily life.
I’ll ask more diagnostic questions, details about your health, medications you have tried in the past, your life, your background, your family, your work. I really want to hear your story and understand you, what makes you tick, what makes you happy, and how we can get you back to that.
After the Evaluation
You won’t leave wondering what just happened. By the end of our session, I’ll share my diagnostic impressions and explain my reasoning. You’ll leave with a clear plan, not just a prescription.
Insurance & Payment
Most patients use their insurance benefits for psychiatric evaluation. I’m in-network with several major carriers:
What will I pay? Your cost depends on your specific plan’s deductible and coinsurance. Call us at (206) 312-8457 and we’ll verify your benefits before your appointment so you know what to expect. Many patients are surprised to find their out-of-pocket costs are lower than expected.
What if my insurance isn’t listed? Please contact my office for information about out-of-network benefits or self-pay options.
Your Provider
Cara J. Erkut, M.D.
Board-certified psychiatrist and psychoanalyst with training from Mayo Medical School and residency at the University of Washington, where I served as Chief Resident. I founded the Advanced Psychotherapy Studies track during residency and completed full psychoanalytic training at the Seattle Psychoanalytic Society & Institute. My approach to diagnosis combines medical rigor with the understanding that comes from truly listening to patients.
Serving Washington State
My practice is located on Mercer Island, easily accessible from Seattle, Bellevue, and surrounding communities.
Mercer Island
Practice locationSeattle
Capitol Hill, Madison Park, Central DistrictBellevue
Downtown, Factoria, NewportEastside Communities
Kirkland, Redmond, IssaquahStop Guessing. Start Knowing.
A comprehensive psychiatric evaluation could be the turning point you’ve been waiting for. Let’s figure out what’s actually happening and build a treatment plan that makes sense.
BOOK A CONSULTATIONSources & References
- Singh T, Rajput M. Misdiagnosis of Bipolar Disorder. Psychiatry (Edgmont). 2006;3(10):57-63.
- Hirschfeld RM, et al. Perceptions and impact of bipolar disorder. J Clin Psychiatry. 2003;64(2):161-174.
- Ghaemi SN, et al. Diagnosing bipolar disorder and the effect of antidepressants. J Clin Psychiatry. 2000;61(10):804-808.
- Psychiatric News. Bipolar Disorder II—Frequently Neglected, Misdiagnosed. American Psychiatric Association. 2023.
⚠️ Medical Disclaimer
The information on this page is intended for educational purposes and should not be considered medical advice. Psychiatric conditions require professional evaluation for accurate diagnosis and treatment. If you are experiencing a mental health crisis or thoughts of self-harm, please contact the 988 Suicide and Crisis Lifeline by calling or texting 988, or go to your nearest emergency room.
For Psychiatrists & Mental Health Practices: This advanced AI-powered website is built and maintained by Staffingly Inc. Comprehensive psychiatric evaluations require significant front-end coordination, including intake paperwork collection, insurance verification for extended evaluation codes, patient history gathering, and detailed documentation. If you’re a psychiatrist or practice owner looking to streamline your diagnostic evaluation workflow, Staffingly Inc offers HIPAA-compliant healthcare virtual assistants specializing in psychiatric intake coordination, prior authorization for evaluation services, patient communication, and EMR documentation support.