confluence-psychiatry

ADHD in Children and Teens: When to See a Psychiatrist in Denver

Tue, 20 Oct 2026 09:56:55 GMT

Quick Answer: Consider a psychiatric evaluation when attention or impulsivity problems show up in more than one setting, have been going on for months rather than weeks, and are getting in the way of school, friendships, or home life. A child and adolescent psychiatrist can diagnose ADHD, rule out the conditions that imitate it, and manage medication if it's needed. You don't need a diagnosis before you book.

Every child loses focus, forgets things, and acts without thinking. That's childhood. What makes ADHD different isn't the behavior itself, it's how persistent it is, how many parts of life it touches, and how much it costs your child.

Most parents arrive at this question after a teacher comment, a run of difficult school reports, or a growing sense that their child is working harder than their classmates for worse results.

What ADHD Actually Looks Like

ADHD doesn't always look like a child who can't sit still. There are two broad presentations, and many children have features of both.

Inattentive presentation. Loses track mid-task, forgets instructions, misplaces things constantly, avoids work that requires sustained mental effort, seems not to listen when spoken to directly, makes careless errors. This is the presentation that gets missed for years, particularly in girls and in bright children who compensate until the workload grows.

Hyperactive and impulsive presentation. Can't stay seated, fidgets, talks over people, interrupts, acts before thinking, struggles to wait. This one gets noticed early, because it's disruptive in a classroom.

In teenagers, visible hyperactivity often fades into restlessness, while the organizational problems get worse as school demands more independent planning. A teen who coped fine in elementary school can hit a wall in high school, and it's easy to read that as laziness or attitude.

Ordinary Behavior or Something More?

Three questions separate typical childhood behavior from ADHD worth evaluating.

Does it show up in more than one place?

ADHD doesn't switch off at the school gate. If the problems appear at school, at home, and at activities, that's meaningful. Difficulties in only one setting usually point to something about that setting.

How long has it been going on?

ADHD is a long-running pattern, not a reaction to a recent event. A child who became distracted and irritable two months ago may be dealing with something else entirely.

Is it costing them something?

This is the question that matters most. Grades, friendships, confidence, family relationships. A child who is slightly scattered but happy and doing fine is in a different position from one whose self-esteem is eroding year on year.

Who to See, and When

Your pediatrician is a reasonable first stop and can handle straightforward cases.

A school psychologist can assess learning difficulties and arrange classroom support, but they don't diagnose medically or prescribe.

A child and adolescent psychiatrist is the right call when the picture is complicated, when other conditions may be involved, when medication is being considered or isn't working as expected, or when previous attempts at treatment haven't helped.

Book directly with a psychiatrist if any of these apply:

Anxiety, low mood, or irritability alongside the attention problems
A previous ADHD diagnosis where treatment isn't working well
Sleep problems that nobody has got to the bottom of
Behavior that has changed sharply rather than built up over years
Your instinct that something more is going on, even if you can't name it

Why the Evaluation Matters More Than the Label

A great many things look like ADHD. Anxiety fragments attention. Depression in a teenager can present as poor concentration and lost motivation . Sleep problems, including sleep apnea, produce exactly the symptoms people associate with ADHD. Learning disorders, hearing and vision problems, and significant family stress all affect focus.

Some children have ADHD plus one of the above, which is why a thorough evaluation matters more than getting a label quickly. Treating only half of what's going on usually disappoints everyone.

A comprehensive psychiatric evaluation covers developmental history, school performance over time, behavior at home and elsewhere, sleep, mood, medical history, and family history. Input from teachers is valuable, so bring recent school reports and any teacher comments you have.

At Confluence Psychiatry, Dr. Shankar Nandakumar is board certified in psychiatry and specializes in child, adolescent, and adult mental health, with fellowship training at the University of Colorado and Children's Hospital of Colorado.

What Treatment Involves

Treatment is not automatically medication, and when it does involve medication, that's rarely all of it.

Behavioral and organizational support. Structure, routines, and systems that work with how your child's attention actually operates rather than against it. For teenagers, this means building skills they'll take into adulthood rather than parents managing everything for them.

School accommodations. Extra time, seating changes, assignment chunking, and similar adjustments. A diagnosis provides the documentation to request these.

Therapy. Useful where ADHD has knocked a child's confidence, or where anxiety or low mood sit alongside it.

Medication. Stimulant and non-stimulant options exist, and they work differently for different children. Starting medication means monitoring: how it's working, side effects, appetite, sleep, growth, and whether the dose still fits as your child grows. That follow-up is the part that makes medication work well or badly.

The Worries Parents Usually Have

"Will medication change who they are?" Well-matched ADHD medication at the right dose shouldn't flatten a child's personality. If your child seems dulled or unlike themselves, that's information for the psychiatrist, not something to accept. It usually means the medication or the dose needs adjusting.

"Does treating ADHD lead to substance problems later?" This is a common and reasonable worry, and it's worth raising directly at the evaluation. Dr. Charles Shuman is board certified in addiction psychiatry, so questions about substance risk are answered by a specialist rather than brushed aside.

"Are we just medicating normal childhood?" It's a fair question to ask out loud. A proper evaluation is how it gets answered, in either direction. Sometimes the honest conclusion is that this isn't ADHD.

Cost and Insurance

A comprehensive evaluation is $320 and runs about an hour. Follow-up visits are $160 for 25 minutes, or $280 for 55 minutes with therapy.

Insurance coverage for office visits depends on your plan. We verify your benefits before your first visit, so you know where you stand before anything is booked.

Frequently Asked Questions

Will my child be put on medication?

Not automatically. The evaluation comes first, and medication is one option among several. If it's recommended, you'll hear why, what to expect, and what the alternatives are.

Is a school assessment the same as a psychiatric evaluation?

No. School assessments identify learning needs and set up classroom support. A psychiatric evaluation diagnoses medically and can lead to treatment including medication. They work well together.

My teen was diagnosed years ago but nothing is working. Is it worth starting again?

Yes. Medication that worked at nine often doesn't fit at fifteen, and conditions that were invisible in a younger child can become clear later. A fresh evaluation is a reasonable step.

What if my child refuses to go?

Come anyway. Frame the first visit as a conversation rather than a commitment, and be clear that nobody will make them take anything they haven't agreed to. A first appointment where your teen says little is still more useful than no appointment.

What ages do you see?

Dr. Nandakumar sees children, adolescents, and adults.

Do I need a referral?

No. You can book an evaluation directly.

Not sure what the right next step is?

Every patient starts with a full evaluation with one of our board-certified psychiatrists. We look at what you’ve already tried and what makes sense now.

TMS vs Ketamine vs Spravato: How to Choose

Tue, 20 Oct 2026 09:56:54 GMT

Quick Answer: All three treat depression that hasn't responded to medication , and they work in completely different ways. TMS uses magnetic pulses, involves no drug, and runs as a course of sessions. Spravato is a nasal spray given in the office and covered by several insurers. Ketamine works fastest but is self-pay everywhere and used off-label. The right one depends on your medical history, how quickly you need relief, what your schedule allows, and what your insurance covers.

If medication hasn't worked, you've probably come across all three names and found it hard to tell them apart. They get grouped together because they're all used for treatment-resistant depression, but the day-to-day experience of each is very different.

The Short Version

TMS uses magnetic pulses rather than medication. It's FDA-approved for depression and OCD, improvement is gradual over a course of sessions, and you can drive yourself home. It's in network with several insurance plans.

Spravato is an esketamine nasal spray , FDA-approved for treatment-resistant depression and given in the office under supervision. Many people respond within weeks. You can't drive afterward. It's in network with several insurance plans.

Ketamine is used off-label for depression and acts fastest, sometimes within hours or days. It's given in the office, you can't drive afterward, and it isn't covered by any insurer.

TMS: No Medication, No Drowsiness

Transcranial magnetic stimulation delivers magnetic pulses to the area of the brain involved in mood regulation. You sit in a chair, fully awake, and feel a tapping sensation on your scalp.

Because nothing enters your bloodstream, TMS avoids the side effects that make people give up on antidepressants. There's no sedation, no monitoring period, and no restriction on driving. You come in, have your session, and carry on with your day.

The trade-off is time. The standard course runs daily over six to eight weeks, which is a real commitment. Accelerated schedules compress the same course into five days or two days for people who can't do daily appointments or who travel in from outside Denver.

The most common side effects are scalp discomfort and mild headache in the first week. TMS isn't suitable if you have metal implants in or near your head, and a history of seizures needs careful review.

Spravato: Covered, Supervised, In the Office

Spravato is esketamine, delivered as a nasal spray. It's FDA-approved specifically for treatment-resistant depression, and it's given in the office under supervision rather than taken at home.

You self-administer the spray while a clinician is present, then stay to be monitored afterward, so plan for the appointment to take a couple of hours. You can't drive for the rest of the day, so you'll need someone to take you home.

Appointments are frequent at first and become less so over time, following the schedule your psychiatrist sets. Because Spravato holds FDA approval for this use, it's covered by a number of insurance plans, which often makes it the most affordable of the three.

Ketamine: Fastest, but Self-Pay

Ketamine has been used as an anesthetic for decades. At much lower doses it's used off-label for depression, and it's associated with the fastest response of the three. Some people notice a change within hours or days rather than weeks.

As with Spravato, you're monitored in the office and can't drive afterward. We also offer ketamine-assisted therapy, where a therapist is in the room during treatment to help you work with what comes up. That option doesn't exist with the other two.

The limitation is cost. Ketamine is not covered by any insurer, anywhere, so it's self-pay by definition rather than by choice.

The Questions That Actually Decide It

Most people find the decision gets much easier once they answer these.

Do you want to avoid medication altogether? That points to TMS. It's the only one of the three with no drug involved.

How quickly do you need to feel different? Ketamine is fastest, Spravato next, TMS most gradual. If the situation is urgent, that ordering matters a great deal. If it isn't, it matters less than the other factors.

What does your schedule allow? Daily appointments for two months is impossible for some people and perfectly manageable for others. If it's impossible, accelerated TMS or one of the medication options fits better.

Can you arrange rides? Spravato and ketamine both rule out driving on treatment days. TMS doesn't.

What's covered? TMS and Spravato are both in network with several insurers here. Ketamine isn't covered anywhere. For many people this is the deciding factor, and there's nothing wrong with that.

What Rules Each One Out

TMS: metal implants or devices in or near the head. Dental fillings and braces are fine. A seizure history needs review.

Spravato and ketamine: uncontrolled high blood pressure, certain heart conditions, a history of psychosis, current pregnancy, or unaddressed substance misuse.

These are reviewed properly during your evaluation rather than guessed at from a list.

How the Decision Gets Made Here

You don't choose between these on your own, and you shouldn't have to. Every option starts with a comprehensive psychiatric evaluation: what you've tried, how it went, your medical history, and what you actually need from treatment.

What matters is that the recommendation isn't shaped by what the clinic happens to own. TMS, Spravato, ketamine, medication management, and therapy are all provided here by the same psychiatrists, so the answer can be "none of these three yet, let's revisit your medication first" when that's the honest one.

We verify your insurance benefits before your first visit, so cost is a known quantity rather than a surprise.

Frequently Asked Questions

Can I have more than one of these?

Sometimes. They're not mutually exclusive, and some people move from one to another over time. Your psychiatrist will advise on sequencing.

Is Spravato just ketamine with better insurance coverage?

Not quite. Esketamine is a closely related compound, given differently and approved specifically for treatment-resistant depression. The coverage difference follows from that approval.

Will I have to stop my antidepressant?

Usually not. All three are often used alongside existing medication. Your psychiatrist will review what you're taking.

Which one works best?

There's no single answer, which is the honest response rather than an evasive one. Response varies between individuals, and the best choice depends on your history and circumstances rather than a ranking.

What if the one I choose doesn't help?

You switch. Because everything is offered here, changing direction means a conversation, not starting again somewhere new.

How do I find out what I'd pay?

Ask us to verify your benefits before your first visit. For TMS, ketamine, or Spravato, you can also book a free 10-minute call with one of our physicians.

Not sure what the right next step is?

Every patient starts with a full evaluation with one of our board-certified psychiatrists. We look at what you’ve already tried and what makes sense now.

When Antidepressants Aren't Working: Your Options in Denver

Mon, 12 Oct 2026 15:14:54 GMT

Quick Answer: If two or more antidepressants haven't helped enough, that's called treatment-resistant depression, and it's common. The next step isn't necessarily another prescription. It's a thorough review of whether the diagnosis is correct, whether the doses and durations were adequate, and whether something else is getting in the way. From there, the options include changing or combining medications, adding therapy, or moving to TMS, Spravato, or ketamine.

Being on your third antidepressant and still feeling the same is demoralizing. It can start to feel like the problem is you rather than the treatment. It usually isn't. Depression is not one condition with one mechanism, and the first medication someone tries is an informed guess, not a precision match.

Here's how a psychiatrist approaches it when the usual approach hasn't worked.

First: Has the Treatment Actually Had a Fair Trial?

Before concluding that antidepressants don't work for you, it's worth checking that they were given a real chance.

Dose. Many people stay on a starting dose that was never increased. A starting dose is a starting point.
Duration. Antidepressants take weeks, not days. Stopping at three weeks tells you very little.
Consistency. Missed doses, or stopping and restarting, change the picture.
Side effects. If side effects meant you quietly took it less often, that's worth saying out loud. It's extremely common and nobody will be annoyed with you.

None of this is a telling-off. It's the first thing we look at, because a medication that was never properly trialed isn't a medication that failed.

Second: Is the Diagnosis Complete?

This is where a lot of stuck cases turn out to be stuck for a reason.

Bipolar disorder. The depressed phase of bipolar disorder looks like depression, but antidepressants alone often don't help and can sometimes make things worse. The diagnosis depends on a history of elevated or hypomanic periods, which people rarely bring up unprompted.
ADHD. Untreated ADHD can produce low mood, demoralization, and exhaustion. Treating the depression without addressing the ADHD leaves half the problem in place.
Alcohol or substance use. Alcohol in particular works directly against antidepressant treatment, and it's often the part of the history people most want to skip over.
Medical contributors. Thyroid problems, sleep apnea, chronic pain, and some medications can all sustain depressive symptoms.
Trauma. Depression that follows unprocessed trauma often needs a different approach than medication alone.

See more: Conditions Treated

A comprehensive psychiatric evaluation exists to find these things. Dr. Charles Shuman is board-certified in both general and addiction psychiatry , which matters when substance use is part of the picture rather than a side issue.

Medication Options That Haven't Been Tried Yet

If the diagnosis holds and the trials were adequate, there's still room in medication before moving on.

Antidepressants come in different classes that work on different systems. Not responding to two drugs in the same class says less than it appears to. Beyond switching, there's augmentation, where a second medication is added to strengthen the first, which is a standard approach in treatment-resistant depression and often more effective than yet another switch.

Pairing medication with psychotherapy also tends to outperform either alone. We provide both here, including cognitive behavioral therapy, acceptance and commitment therapy, mindfulness-based approaches, and existential therapy. You don't need to arrange this with a separate provider.

TMS: Treatment Without Medication

Transcranial magnetic stimulation uses magnetic pulses to stimulate the area of the brain involved in mood regulation. It's FDA-approved for depression and OCD. There's no medication involved, so none of the medication side effects apply, and you stay awake and drive yourself home.

A standard course runs daily over six to eight weeks. Accelerated options compress the same course into five days or two days, which suits people who can't commit to daily appointments or who travel in.

TMS is a strong option specifically for people who responded poorly to medication or couldn't tolerate the side effects.

Spravato and Ketamine: Faster-Acting Options

Spravato (esketamine) is a nasal spray that's FDA-approved for treatment-resistant depression and given in the office under supervision.

Ketamine is used off-label for depression and works through a different system than standard antidepressants. Rather than taking weeks, it's associated with a rapid response, and some people notice change within hours or days. We also offer ketamine-assisted therapy, where a therapist is in the room during treatment.

These aren't first-line treatments, and they're not right for everyone. Both start with a full evaluation that covers blood pressure, cardiac history, psychosis history, and substance use history.

What About Insurance?

This is usually the next question, so here it is plainly.

We're in network for TMS and Spravato with Aetna, UnitedHealthcare and Rocky Mountain Health Plans, Medicare through Novitas, TriWest and VA Community Care, and SBA. Some plans, including Cigna, are covered for office visits only. Ketamine is not covered by any insurer and is self-pay everywhere, not just here.

We verify your benefits before your first visit, so you know where you stand before anything is booked.

How to Decide Between Them

You don't have to work this out alone, and you shouldn't try to. The decision depends on your history, what's already been tried, your medical background, what your schedule allows, and what you're willing to take on.

What it shouldn't depend on is which treatment a clinic happens to offer. Because medication management, therapy, TMS, Spravato, and ketamine are all provided here by the same psychiatrists, the recommendation can follow your situation rather than the equipment in the building.

Frequently Asked Questions

How long should I give an antidepressant before deciding it isn't working?

Generally several weeks at an adequate dose, but this is a conversation to have with your prescriber rather than a decision to make alone. Don't stop a medication abruptly.

Does trying TMS or ketamine mean stopping my antidepressant?

Usually not. Both are often used alongside existing medication. Your psychiatrist will review what you're taking.

I've tried everything. Is there any point?

"Everything" usually turns out to mean several medications from a narrow range, without augmentation, without therapy alongside, and without TMS or Spravato. A full review is worth having before concluding that nothing works.

Do I need a referral?

No. You can book an evaluation directly.

How quickly can I be seen?

Request an appointment and we'll reply the same day, Monday to Friday, with the current availability.

Every patient starts with a full evaluation with one of our board-certified psychiatrists. We look at what you’ve already tried and what makes sense now.

Not sure what the right next step is?

What Psychiatric Care Costs in Denver (Self-Pay Explained)

Thu, 24 Sep 2026 16:29:01 GMT

Quick Answer: Confluence Psychiatry is a self-pay practice. A comprehensive evaluation is $320, follow-up visits are $160 for 25 minutes or $280 for 55 minutes with therapy, ketamine treatment starts at $360 including the first session, and TMS is charged as one all-inclusive rate from $2,800 to $5,500 depending on the schedule. We aren't currently in network with insurance. Every fee is discussed with you before you book.

Most psychiatry websites won't tell you what anything costs. You call, you leave a message, and you find out the price after you've already invested time in the process. We'd rather put the numbers in front of you now, along with an honest explanation of what self-pay means and when it isn't the right choice.

What "Self-Pay" Actually Means

Self-pay means you pay the practice directly rather than the practice billing your insurance company.

We aren't in network with insurance plans at present, though we intend to be. Until then, every fee on this page is what you pay, and there's no separate bill arriving weeks later from someone you've never heard of.

There's a trade-off here, and it's worth being straight about it. Self-pay costs more out of pocket than an in-network copay. What you get in exchange is appointment length set by what your care needs rather than by billing rules, continuity with the same psychiatrist rather than whoever is available, and no prior authorization deciding what treatment you can have.

Psychiatry Appointment Fees

Comprehensive psychiatric evaluation (about an hour): $320

Follow-up visit (25 minutes): $160

Follow-up visit with therapy (55 minutes): $280

The first appointment is always the comprehensive evaluation. It covers your symptoms and history, previous treatments and how they went, medical background, and where things stand now. Everything that follows is built on it.

After that, how often you come in depends on what you're being treated for and how stable things are. Someone starting a new medication will be seen more often at first. Someone stable on a long-term plan may need only occasional visits.

Ketamine Treatment Costs

Initial comprehensive evaluation, including your first ketamine treatment: $360

Follow-up ketamine treatments: $250 each

Insurance does not cover ketamine treatment. That's true across the board, not a quirk of this practice.

Spravato (esketamine) is also available here. Coverage for Spravato works differently from ketamine, so ask us directly about it when you call rather than assuming either way.

TMS Pricing

TMS is charged as a single all-inclusive rate. There are no per-session fees added later, and follow-up visits and touch-up sessions are already in the price.

Standard TMS: $3,800. Includes the evaluation, 36 sessions delivered daily over six to eight weeks, follow-up visits, and free touch-up sessions within six months if you need them.

Accelerated TMS, five days: $5,500 . Includes the evaluation, 50 sessions during the treatment week, follow-up visits, and free touch-up sessions within six months.

Accelerated TMS, two days: $2,800. Includes the evaluation, 20 sessions over two days, a follow-up visit, and free touch-up sessions within six months.

The touch-up sessions matter more than they might appear. If symptoms return within six months of finishing a course, you're covered rather than facing a new bill. s

Medical-Legal Work

Court-ordered evaluations, expert witness testimony, and evaluations required by a regulatory body are priced individually. These fall outside standard clinical care, and the fee depends on what's involved. Contact us to discuss.

Insurance, HSA, and FSA

Insurance. We aren't in network yet. We do plan to accept private insurance in future, and we'll update our pricing page when that changes.

Out-of-network benefits. Some plans reimburse part of what you pay for out-of-network care. Whether yours does, and what paperwork it needs, is a question for your insurer. Ask us what documentation we can provide.

HSA and FSA. Psychiatric care is generally an eligible expense for health savings and flexible spending accounts. Check with your plan administrator, since rules vary between plans.

Is Self-Pay Right for You?

Self-pay works well if you want longer appointments, continuity with one psychiatrist, and treatment decisions made between you and your doctor without an insurer in the middle. It also suits people who've found that in-network waiting lists mean months before a first appointment.

It's the wrong choice if the cost would genuinely strain your finances. Care you can't sustain isn't care. If that's the position you're in, say so when you call. We'd rather point you toward something workable than start a course of treatment you can't continue.

Our physicians are available for a phone consultation before you schedule, to talk through which option makes sense for your situation and your budget.

Learn More : Pricing

Every patient starts with a full evaluation with one of our board-certified psychiatrists. We look at what you’ve already tried and what makes sense now.

Not sure what the right next step is?

Finding a Psychiatrist for Your Teen in Denver

Wed, 23 Sep 2026 16:51:15 GMT

Quick Answer: A child and adolescent psychiatrist is a medical doctor with extra fellowship training in how mental health conditions present in young people. They can diagnose, prescribe, and provide therapy. If your teen's mood, anxiety, or focus is affecting school, sleep, or friendships, and it's been going on for weeks rather than days, that's the point at which a psychiatric evaluation is worth arranging.

Most parents start searching after something has been building for a while. The hard part isn't deciding to get help. It's working out who to call, when every website says something slightly different and no one explains the difference between the titles.

Psychiatrist, Psychologist, Therapist: Who Does What?

A psychiatrist is a medical doctor (MD or DO) who completed medical school, a psychiatry residency, and often a fellowship. Psychiatrists diagnose, prescribe and manage medication, and many also provide therapy.
A child and adolescent psychiatrist is a psychiatrist who completed an additional fellowship specifically in treating children and teenagers.
A psychologist holds a doctorate in psychology. They provide therapy and psychological testing. In Colorado, psychologists don't prescribe medication.
A therapist or counselor (LPC, LCSW, LMFT) provides talk therapy and is often the right first step on their own for many teens.
A psychiatric nurse practitioner can also diagnose and prescribe, with training that follows a nursing rather than a medical path.

Not every teen needs a psychiatrist. If the question is "my teen is struggling and needs someone to talk to," a therapist may be exactly right. A psychiatrist matters most when there's a diagnostic question, when medication is on the table, or when something hasn't responded to therapy alone.

Why Child and Adolescent Training Matters

Teenagers aren't small adults. Depression in a 15-year-old often looks like irritability, exhaustion, and withdrawal rather than sadness. ADHD frequently gets missed in teens who did well academically until the workload grew. Anxiety can arrive as stomachaches and school refusal. Bipolar disorder, in its early stages, can look a great deal like depression.

Fellowship-trained child and adolescent psychiatrists spend those extra years learning how these conditions actually present at this age, how they differ from ordinary adolescence, and how medication works differently in a developing brain.

At Confluence Psychiatry, Dr. Shankar Nandakumar is board certified in psychiatry and specializes in child, adolescent, and adult mental health. Dr. Nandakumar completed medical training at UT Health San Antonio, a residency at Baylor College of Medicine, and a fellowship at the University of Colorado and Children's Hospital of Colorado.

Learn More: About Us

When to Consider a Psychiatric Evaluation

Consider booking an evaluation if, over several weeks, you've noticed:

A lasting change in mood, irritability, or withdrawal from friends and family
Grades slipping, or school becoming a fight
Sleep or appetite changes that aren't explained by anything else
Anxiety that's stopping your teen from doing things they used to do
Focus problems affecting schoolwork, especially if they've worsened as demands increased
Something you can't quite name, but which you know isn't how your teen usually is

You don't need a diagnosis before you call. Working out what's going on is the psychiatrist's job, not yours.

If your teen has talked about harming themselves or about suicide, don't wait for an appointment. Call or text 988, the Suicide and Crisis Lifeline, or go to your nearest emergency department. Colorado Crisis Services is also available at 1-844-493-8255.

What the First Appointment Looks Like

The first visit is a comprehensive evaluation, usually around an hour. The psychiatrist will take a full history: symptoms and how long they've been present, school, sleep, friendships, family history, any past treatment, and medical background.

Expect part of the appointment to be with your teen alone. That isn't about excluding you. Teenagers tell a doctor things they won't say in front of a parent, and that information matters. You'll usually be brought back in to talk through what comes next.

Medication is not a foregone conclusion. Sometimes the recommendation is therapy. Sometimes it's a combination. Sometimes it's more information before deciding anything. Ask how the practice handles confidentiality and what gets shared with you, so everyone knows the rules up front.

Questions Worth Asking

Are you fellowship-trained in child and adolescent psychiatry?
Who conducts the evaluation, and how long is it?
Do you provide therapy as well as medication management, or will we need a separate therapist?
How do you approach medication decisions with teenagers?
How does confidentiality work with my teen, and what will you share with me?
How quickly can we be seen, and how often are follow-ups?

At Confluence, psychiatric evaluation, medication management, and psychotherapy are all provided by the same doctors, so nothing gets lost between providers.

What It Costs in Denver

Our standard fees:

Comprehensive evaluation (about an hour): $320
Follow-up visit (25 minutes): $160
Follow-up visit with therapy (55 minutes): $280

We aren't currently in network with insurance, so these are self-pay rates. All fees are discussed with you before you schedule.

An evaluation is where those questions get answered, by a psychiatrist who specializes in this age group.

Wondering if it's time to get your teen seen?

TMS for Depression: What to Expect and Who It Helps

Wed, 23 Sep 2026 10:51:10 GMT

Quick Answer: TMS (transcranial magnetic stimulation) uses magnetic pulses to stimulate the part of the brain involved in mood regulation. It's FDA-approved for depression and OCD, involves no medication and no anesthesia, and you stay awake and drive yourself home afterward.

If antidepressants haven't worked for you, or the side effects made them not worth it, TMS is usually the next option a psychiatrist raises. It's been available for years, but most people know little about it beyond the name. Here's what it involves.

What Is TMS?

TMS stands for transcranial magnetic stimulation. A coil is placed against your scalp and delivers magnetic pulses to a specific area of the brain involved in regulating mood . The pulses are similar in strength to those used in an MRI scan.

It isn't a medication, so it doesn't circulate through your body. That's why TMS avoids the side effects people most often quit antidepressants over: weight gain, sexual side effects, and feeling emotionally flat.

TMS is FDA-approved for depression and OCD. You stay fully awake; there's no anesthesia and no sedation, and you can drive yourself home and go back to work straight afterward.

Who Does TMS Help?

TMS is mainly used for adults with treatment-resistant depression, which means depression that hasn't improved enough after trying antidepressants. It's also used for OCD.

It's often a good fit if:

You've tried one or more antidepressants without enough benefit
Medication side effects have been hard to tolerate
You want a treatment that doesn't involve daily medication
You can commit to attending appointments on a set schedule

TMS isn't suitable for everyone. It may not be an option if you have metal implants or devices in or near your head, such as aneurysm clips or cochlear implants. Dental fillings and braces are fine. A history of seizures also needs careful review, because seizure is a rare risk with TMS.

Your psychiatrist will work through all of this during your evaluation.

What Happens Before You Start

A free 10-minute call. Talk to one of our physicians about whether TMS is worth exploring. No obligation.

A comprehensive psychiatric evaluation. Every patient has a full evaluation with a psychiatrist before starting. We'll go through your symptoms, the treatments you've already tried, your medical history, and anything that would rule TMS out. This is also where we decide whether a standard or accelerated course suits you better.

Your first session includes mapping. Before treatment begins, your psychiatrist finds the right spot on your scalp and works out the right level of stimulation for you. This is personalized to you, not a standard setting, and it's what the rest of your sessions are based on.

What a Session Feels Like

You sit in a chair, awake, in your normal clothes. The coil rests against your head, and you'll hear a clicking sound and feel a tapping sensation on your scalp while the pulses are delivered.

Most people describe it as odd at first rather than painful. Scalp discomfort and mild headache are the most common side effects, and they usually settle within the first week as you get used to it. You can read, listen to music, or talk to the technician during treatment.

Session length depends on the protocol your psychiatrist recommends, and they'll tell you what to expect at your evaluation. Afterward you get up and carry on with your day. There's no recovery time and no restriction on driving.

How Long Does a Course Take?

At Confluence, there are three options:

Standard TMS. 36 sessions, one a day over six to eight weeks.
Accelerated TMS , five days. 50 sessions delivered across a single treatment week.
Accelerated TMS, two days. 20 sessions across two days.

Accelerated schedules suit people who can't commit to daily appointments for two months, or who travel in from outside Denver. Standard TMS spreads the same course over a longer period and is easier to fit around a regular work schedule.

Improvement is usually gradual rather than sudden. Many people notice change partway through a course, and some notice it after the course has finished. Individual responses vary, and TMS doesn't work for everyone.

What Does TMS Cost in Denver?

Every option here is an all-inclusive rate. No per-session charges are added later.

Standard TMS: $3,800. Includes the evaluation, 36 sessions, follow-up visits, and free touch-up sessions within six months if you need them.
Accelerated TMS, five days: $5,500. Includes the evaluation, 50 sessions, follow-up visits, and free touch-up sessions within six months.
Accelerated TMS, two days: $2,800. Includes the evaluation, 20 sessions, a follow-up visit, and free touch-up sessions within six months.

We aren't currently in-network with insurance, so these are self-pay rates. All fees are discussed with you before you schedule or pay for anything.

Book with one of our physicians. Ask your questions and find out whether an evaluation makes sense before you commit to anything.

Not sure if TMS could work for you?

Ketamine-Assisted Therapy in Denver: What to Expect

Tue, 22 Sep 2026 15:54:53 GMT

Quick Answer: Ketamine-assisted therapy combines a low-dose ketamine treatment with psychotherapy. It's mainly used for adults whose depression hasn't improved enough with other treatments. At Confluence Psychiatry, you start with a free 10-minute call and a full evaluation with a psychiatrist , and you can choose to have a therapist in the room during treatment. Below is what happens before, during, and after a session, and what it costs.

If you've tried more than one antidepressant and you're still struggling, you've probably read about ketamine. Much of what's online either oversells it or makes it sound frightening. This guide explains what ketamine-assisted therapy at our Denver office actually involves.

What Is Ketamine-Assisted Therapy?

Ketamine has been used as an anesthetic for decades. At much lower doses, it has been studied as a treatment for depression, particularly depression that hasn't responded to standard medications.

Most antidepressants take weeks to work. Ketamine acts on a different brain chemical system, glutamate, and it's associated with a rapid response. Some people notice a change within hours or days. Individual responses vary, and it doesn't work for everyone.

Ketamine-assisted therapy pairs the treatment with psychotherapy. At Confluence, a therapist can be with you in person during the treatment. Ketamine can loosen stuck patterns of thinking for a short time, and a therapist helps you make use of that time.

Ketamine is FDA-approved as an anesthetic, and its use for depression is off-label.

Esketamine (Spravato), a related nasal spray, is FDA-approved for treatment-resistant depression. We offer both.

Learn more about ketamine and Spravato at Confluence.

Who Is It For?

Ketamine is usually considered for adults with treatment-resistant depression , which means depression that hasn't improved enough after trying other treatments. It isn't a first-line option.

It may not be suitable if you have:

Uncontrolled high blood pressure or certain heart conditions
A history of psychosis
A current pregnancy
A history of substance misuse that hasn't been addressed

The evaluation is where we work through these questions. Dr. Charles Shuman is board-certified in addiction psychiatry, so questions about substance use history are reviewed by a specialist.

What Happens Before Your First Treatment?

A free 10-minute call. Speak with one of our physicians, ask your questions, and find out whether an evaluation makes sense. There's no obligation.

A comprehensive evaluation. You'll meet with a psychiatrist, a medical doctor with specialist training in psychiatry. We'll review:

Your symptoms and how long they've lasted
The medications and therapies you've already tried
Your medical history, current medications, and blood pressure
Any history of substance use

If ketamine is a good fit, the evaluation fee includes your first treatment. If it isn't, we'll say so and talk through other options, such as TMS , Spravato, or changes to your medication plan.

What Happens on Treatment Day?

Before you arrive

Arrange a ride home. You can't drive for the rest of the day.
Follow the eating instructions you're given ahead of your appointment.
Keep the rest of your day light.

During the treatment

We'll check your blood pressure and vital signs first. If you've chosen to have a therapist present, you'll spend a few minutes with them before starting.

Most people describe the experience as dreamy or detached. You may feel like you're floating, sounds and colors may seem different, and time can feel stretched. This is called dissociation. You stay awake throughout, and the effects fade soon after the treatment ends. You're monitored the whole time.

Afterward

You'll rest in the office until you feel clear-headed, then head home with your ride. Feeling tired or foggy for the rest of the day is common.

How Many Sessions Will I Need?

Ketamine is usually given as a series rather than a single session. Your psychiatrist will recommend a plan and check how you're responding along the way.

If it isn't helping, you won't be kept on it for the sake of it. Because TMS, Spravato, and medication management are all offered here, we can change course without sending you somewhere new.

What Are the Side Effects?

During or shortly after a session, some people experience:

Nausea or dizziness
A temporary rise in blood pressure and heart rate
Blurred vision or headache
Tiredness

These usually pass quickly. Ketamine can be misused, and frequent unsupervised use carries real risks, including dependence and bladder problems. That's why screening and medical supervision matter.

How Much Does Ketamine Therapy Cost in Denver?

Initial evaluation, including your first treatment: $360
Follow-up treatments: $250 each

Insurance doesn't cover ketamine treatment. We go over all fees with you before you schedule or pay for anything.

Book with one of our physicians. Ask your questions and find out whether an evaluation makes sense before you commit to anything.

Wondering if ketamine is right for you?