Why the first visit runs 60 to 90 minutes
A genuine psychiatric evaluation is long for a clinical reason, not a billing one. Across the research, a careful history and medication review is the single highest-yield diagnostic tool in psychiatry — in one analysis it identified the cause of a presentation about 15% of the time, versus roughly 1% for routine lab panels ordered without that history. The conversation is the instrument; everything else confirms what it surfaces. A fifteen-minute visit cannot run that instrument, which is why so much gets missed in care built around the quick refill.
What a thorough evaluation actually covers
The first visit works through your current concerns and how they affect daily life; your full psychiatric history and what treatments have and haven't worked; your complete medical history; every medication and supplement you take, with doses; sleep, substance use, and stress; relevant family history; and your own goals for care. None of this is box-ticking — each thread changes what a diagnosis and a plan should be. The same symptom of 'low energy' points in completely different directions depending on what the rest of the picture holds.
Why the medical side matters more than people expect
This is where a dual-trained evaluation earns its time. In published studies, up to a third of people presenting with depressive symptoms have an underlying medical condition contributing to the picture. Obstructive sleep apnea affects roughly 36% of people with major depression and is routinely missed, because its daytime signs — fatigue, poor concentration, irritability — look purely psychiatric. Thyroid disease is one of the best-established mimics of both depression and anxiety. Vitamin B12 and folate deficiency, and the perimenopausal transition (which more than doubles the risk of a depression recurrence), all belong in the same conversation.
Your medicine cabinet is part of the diagnosis
More than 200 commonly prescribed medications list depression as a possible adverse effect, and the likelihood of depressive symptoms climbs with each additional one — from about 7% on a single such medication to roughly 15% on three or more. Blood-pressure medications, corticosteroids, hormonal agents, acid reducers, and others can all shape mood, sleep, and cognition. That's the reason a careful evaluation asks for every medication and supplement, with doses and a pharmacy — and why an evaluator trained in both medical and psychiatric care reads that list differently than a prescriber who only treats the symptom in front of them.
What testing does — and doesn't — do
Consensus guidelines support a baseline set of labs for new presentations when indicated: thyroid function, a complete blood count, a metabolic panel, and B12 and folate. But the evidence is consistent that the history finds more than routine bloodwork does. Labs confirm and refine what the conversation raises; they are not a substitute for it. Tests are ordered because something in the picture points to them, not as a reflex.
What you leave the first visit with
By the end you have a working clinical picture — an honest read of what is going on and why — and the beginning of a plan you understand. If medication is clinically appropriate, prescribing can begin once the evaluation supports it; if the picture isn't clear yet, the next step is named rather than guessed. The aim is a plan, not just a prescription: one that may include medication, therapy-informed care, attention to sleep and medical factors, and coordination with your other clinicians.
How to prepare
A few things make the first visit far more useful: a current list of medications and supplements with doses, plus your pharmacy; your primary-care clinician's contact information; any prior psychiatric records or medication history you can lay hands on; and the questions you actually want answered. You don't need to organize your whole history — that's the clinician's job — but the medication and supplement list genuinely changes what the evaluation can see.
Safety and scope
This guide is general education, not medical advice. It does not create a treatment relationship, diagnose a condition, promise medication, or replace crisis care. For immediate danger use 911, 988, or the nearest emergency department.
Related service
Comprehensive psychiatric evaluation
A comprehensive psychiatric evaluation is the starting point for care at Foundry, reviewing current concerns, psychiatric history, medical history, medications, prior treatment response, sleep, substance use, family history, relationships, functioning, safety, and goals.