OUR CLINICAL PHILOSOPHY

Our Approach

How Solana Psychiatry treats adult ADHD and anxiety, and how your provider decides your dose

The Enough Principle

We raise your dose until it's enough. Then we stop.

Rating scales track your symptoms and functioning. They show you and your provider when you've reached your minimum effective dose: the lowest dose that removes the barrier.

0 24 48 72 ASRS symptom score (lower = fewer symptoms) Dose step 1 2 3 4 5 0 4 8 12 16 Weeks on treatment Score improving: dose steps up Score stopped improving: dose holds Enough 0 24 48 72 ASRS symptom score (lower = fewer symptoms) Dose step 1 2 3 4 5 0 4 8 12 16 Weeks on treatment 1 2 3
Illustrative example of finding enough. Not real patient data.

Your first visit

You're capable, and something specific is in the way. The initial evaluation finds out what. Never diagnosed? Your provider can diagnose you at this visit. No psychological testing first. No charge if we can't help.

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THE PROCESS

How You and Your Provider Work Together

What treatment looks like, from first appointment to stable maintenance

Your provider is Robert Beukema, DNP, PMHNP-BC.

1

Stage 1: What Actually Needs Treating?

Diagnosis, baseline metrics, and your treatment plan

The first step is figuring out what's going on. Your provider will ask about your symptoms, what you've tried before, and what's blocking your performance right now. If you've never been diagnosed, this is the visit where that happens, based on standard diagnostic criteria and your provider's clinical judgment. You don't need a prior diagnosis or psychological testing first.

You'll also complete rating scales. They don't decide the diagnosis. They give you and your provider real numbers to track against later.

By the end, you'll know whether medication makes sense for your situation, what your provider recommends trying first, and what to expect over the next few weeks. If we can't help, you don't pay for the visit.

2

Stage 2: Finding Your Dose

Monthly follow-ups track progress; weekly check-ins keep you supported between

Your provider starts medication at a reasonable dose and adjusts it based on how you respond. At monthly appointments, the two of you review your scores and side effects and make systematic changes. Between those visits, you'll have weekly check-ins with your provider at no charge. These aren't courtesy calls. They catch problems early, so you're not stuck with the "wait six weeks and hope it works" approach.

3

Stage 3: Confirming It's Working

When your scores stabilize, that's your dose

Once you and your provider land on a medication that works, the next job is making sure it holds. Maybe the morning dose is solid but you're fading by 3pm. Maybe appetite suppression is manageable but sleep needs adjusting. Your provider works through these at follow-up appointments until everything is dialed in.

Most people reach stable maintenance within two to three months. If your provider is still making significant adjustments after that, it's time to reconsider whether treatment is on the right track.

4

Stage 4: Staying Stable

Ongoing care with minimal disruption to your life

When treatment is working and stable, care shifts to maintenance. For controlled substances, that means monthly video appointments (federal requirement, not our preference). For non-controlled medications, we can move to quarterly visits. Either way, follow-ups are $125 per visit.

Between appointments, you can message your provider with questions. If something changes, we schedule sooner. The goal is keeping you functioning well without unnecessary appointments.

What Drives Medication Decisions

Dose changes aren't based on "I feel like it's wearing off" or "I think I need more." They're driven by your symptom scores and how you're functioning.

Prescribing can go wrong in two directions: too much, to keep patients happy, or too little, out of caution about controlled substances. The Enough Principle is how we avoid both. More medication isn't better. The right amount is better.

What the Scales Track

ADHD Symptoms

Task completion, focus duration, impulsivity control

Functional Domains

Work performance, time management, home responsibilities, social engagement

Anxiety Severity

Avoidance behaviors, physical symptoms, performance interference

Depression Symptoms

Mood, energy levels, sleep quality, interest in activities

When your scores improve and you're functioning better in daily life, you and your provider have found your dose. When scores plateau or don't change after 4-6 weeks on a stable dose, your provider tries a different medication or adjusts the approach.

What Doesn't Trigger a Dose Increase

  • Feeling like medication isn't as strong as when you started (that's normal adaptation, not tolerance)
  • Wanting dull work to feel engaging (no dose does that)
  • A rough week due to life stress (context matters, and not every struggle is a medication problem)
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Sometimes you might feel like you need more even when your scores say things are working. That gap is worth exploring together. It might mean the scales are measuring the wrong things. It might mean there's something else going on that medication can't address. Or it might just mean recalibrating what "working" looks like for you.

Why the Data Matters

Hope isn't a treatment plan. Data is. Your treatment uses six rating scales, and each one answers a different question about how it's going.

Select a scale below to learn how it guides your treatment:

How Fast Does Medication Work?

Different medications work on different timelines. Here's what to expect from each in the first weeks.

Stimulants

You'll know the same day whether stimulants help. Effects show up within hours of your first dose. Here's what throws people off: the initial effects often feel strong, then seem to fade over 1-2 weeks. That's your brain adapting, not the medication failing. Finding your optimal dose takes 4-8 weeks of adjustments based on symptom scores.

Onset Hours
Duration Daily

Non-Stimulants for ADHD

Non-stimulants like atomoxetine and clonidine work more like antidepressants. You won't feel an immediate change. Full effects take 4-6 weeks at a stable dose. The tricky part: improvement shows up in your symptom scores before you consciously notice it, so tracking matters more than your subjective sense of "working."

Onset 4-6 weeks
Duration Daily

Beta-Blockers

Beta-blockers like propranolol work on the body, not the mind. Performance anxiety often shows up as physical betrayal: racing heart, shaky voice, sweating through situations you're fully prepared for. Propranolol blunts those physical symptoms. Without your body feeding the anxiety loop, the mental component becomes manageable.

Take one 30-60 minutes before a presentation, interview, or high-stakes meeting, and the physical symptoms quiet down. They don't treat the underlying anxiety. They just keep your body from betraying you when it matters.

Onset 30-60 min
Duration As-needed

SSRIs for Anxiety

SSRIs take patience. Physical symptoms might ease within 1-2 weeks, but full anxiety relief needs 4-6 weeks. The tricky part: side effects (nausea, jitteriness) show up in weeks 1-2 and typically fade by weeks 3-4, right as the actual benefits kick in. It's worth pushing through if you can tolerate it.

Onset 4-6 weeks
Duration Daily

What You Get Beyond Appointments

The appointments are just the visible part. Here's what happens between them.

✓

Weekly Check-ins While Your Provider Finds Your Dose

During the first weeks of treatment, you'll have brief phone check-ins with your provider at no extra charge. If you're on a controlled medication like a stimulant, any dose change happens at a video visit per DEA requirements.

These are 5-15 minutes where you and your provider talk through how you're responding, catch side effects early, and make dose adjustments in real time. This is how treatment works: close contact during the critical phase, not prescribing and hoping for the best.

✓

Ongoing Symptom Tracking

You'll repeat your rating scales periodically throughout treatment, not just at the evaluation, so every dose decision has current numbers behind it.

✓

Side Effect Support

Most side effects are predictable: appetite changes, sleep disruption, initial jitteriness with SSRIs. Your provider tells you what to expect before you experience it and helps you strategize around what's manageable. Some side effects fade with time. Others are deal-breakers that mean switching medications. Together you'll figure out which is which so you're not suffering through something that won't improve.

✓

Cardiovascular Monitoring for Stimulants

If you're taking stimulants, you'll track your blood pressure and heart rate periodically. Pharmacy kiosks, your PCP, urgent care, or a home monitor all work. Your provider reviews these readings to make sure stimulants aren't affecting your heart. If your numbers stay elevated, your provider will talk with you about whether you need a cardiology check before continuing.

✓

Federal Requirements (The Non-Negotiables)

Controlled substances like stimulants come with federal oversight. That means video appointments for prescribing and dose changes, not phone-only. It means your provider checks Arizona's prescription monitoring database to see what controlled substances you're receiving from other providers. These aren't our preferences. They're DEA requirements that apply to every prescriber. We mention them here so you're not surprised.

What's Not Part of This Practice

A few things we want to be upfront about:

  • × Conditions outside our scope. We treat ADHD, performance anxiety, and social anxiety, plus mild depression or insomnia that comes with them. We don't treat PTSD, OCD, eating disorders, personality disorders, moderate-to-severe depression, bipolar disorder, psychosis or schizophrenia spectrum disorders, or addiction or substance use disorders. If that's what you need, we'll tell you directly and refer you to someone who does it better.
  • × Emergency services. If you're in crisis, call or text 988, or go to your nearest emergency room. This practice isn't equipped for emergencies.
  • × After-hours crisis support. We respond during business hours. Urgent needs outside that window need emergency resources.
  • × Therapy or counseling. We do medication management, not talk therapy. If you need it, your provider can point you to therapist directories.
  • × Continuing a prescription written elsewhere, as is. Already diagnosed and on medication? You start with the initial evaluation like every new patient, and your provider decides your treatment and doses there. Nothing carries over automatically.

Ready to Start?

Two ways to start.

Schedule Initial Evaluation

$250 | About an hour

You and your provider will talk through what's going on and what you've tried before, and figure out whether medication makes sense for your situation. You'll leave knowing the plan and what to expect over the next few weeks.

If we can't help, you don't pay for the visit. We don't charge for an evaluation that ends with "we're not the right practice."

After that, follow-ups are $125 per visit.

Schedule Initial Evaluation

Not Sure Yet?

Free | 15 minutes

Schedule a consultation first. We'll talk through your symptoms, confirm whether we treat what you're dealing with, and you can ask how treatment works here. No pressure. Just clarity.

Book Free Consultation

You'll know pretty quickly whether this approach fits. If we're a good match, we'll get started. If not, we'll point you toward someone whose practice aligns better with what you need.

Let's Work Together

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