Anxiety and Depression Treatment in Portland

By Laura Canepa, LCSW and Hilary Duvauchelle, PMHNP

If you're looking into depression treatment or anxiety treatment in Portland, you may already feel tired before you start. There are therapists, psychiatric providers, naturopathic doctors, and a lot of opinions about which one is "right."

Here's the short answer. You usually don't have to pick just one. For many people, the most helpful care comes from a few kinds of support working together, with everyone on the same page. This article explains what each type of care does, how they fit, and how to choose a place to start.

If you're in crisis or thinking about suicide, call or text 988 (988 Suicide & Crisis Lifeline), any time. If you are in immediate danger, call 911 or go to the nearest emergency room.

Anxiety and depression often show up together

Anxiety and depression share a lot of ground. Poor sleep, low energy, trouble focusing, a racing mind, and a heavy feeling that won't lift can belong to either one, or both at once.

They can also overlap with physical health. Thyroid problems, low nutrient levels, hormone shifts and sleep problems can all affect mood. That doesn't mean your symptoms are "just physical." It means a good workup looks at the whole picture before settling on a plan.

What therapy does

Therapy gives you a space to talk through what's happening and practical skills to handle it. Approaches like cognitive behavioral therapy (CBT) help you notice thought patterns and change how you respond to them. Others, like acceptance and commitment therapy (ACT) and dialectical behavior therapy (DBT), focus on living with hard feelings without being run by them.

Therapists don't prescribe medication. Their work is the relationship, the skills, and the steady weekly or biweekly support.

At Origins, counseling is led by Laura Canepa, LCSW, a licensed clinical social worker with over 20 years of experience. She draws from CBT, DBT, ACT and mindfulness, and her work is trauma-informed. She often works with people facing anxiety, depression, grief, life transitions, and the strain of chronic health problems.

What psychiatric care does

A psychiatric provider focuses on diagnosis and, when it's a good fit, medication. That can be a psychiatrist or a psychiatric mental health nurse practitioner (PMHNP).

Psychiatric care is especially important when symptoms are severe, when there are thoughts of suicide, when bipolar disorder is possible, or when earlier treatment hasn't helped enough. Medication for anxiety and depression often takes several weeks to reach its full effect, so follow-up visits matter. They're how your provider checks what's working and adjusts.

Our psychiatric nurse practitioner care is led by Hilary Duvauchelle, PMHNP. She offers full assessments, diagnosis, and medication management through a functional medicine lens. Her plans may also include support for nutrition, sleep and supplements, and she works closely with therapists and other providers.

What naturopathic medicine adds

Naturopathic medicine looks at the body side of mental health. A naturopathic doctor may order labs to check things like thyroid function and nutrient levels, talk through sleep, food, movement and stress, and review any supplements you take.

This is sometimes called naturopathic psychiatry or integrative mental health. It isn't a replacement for psychiatric care. It's another layer of support.

Two points are worth knowing:

Oregon naturopathic doctors can prescribe medication. Licensed NDs here have prescriptive authority and can prescribe when it's clinically appropriate.
Lifestyle support has research behind it, with limits. A large 2024 review in the BMJ found exercise such as walking, yoga and strength training helped with depression. The authors rated their confidence in the findings as low, though, and exercise should never delay psychiatric care for severe symptoms.

Research on whole-person naturopathic care for anxiety is still early. One small 2009 trial found promising results compared with psychotherapy, and the authors said more research is needed. We treat that as a reason for curiosity, not a promise.

Why coordinated care matters

Researchers have studied what happens when mental health providers work as a team, often called collaborative care. A Cochrane review of collaborative care for depression and anxiety found it was linked with better outcomes than usual care. Other studies suggest that for many people, therapy plus medication helps more than either one alone.

There's also a safety reason. Some supplements interact with prescription medication. St. John's wort, for example, can cause a dangerous rise in serotonin when combined with certain antidepressants. When your therapist, psychiatric provider and naturopathic doctor all know what you're taking, that kind of risk is much easier to catch.

So the real question isn't "natural or conventional." It's whether your providers are talking to each other.

What to expect when you start

Your first visit, with any of these providers, is mostly listening. Expect questions about:

What you're feeling, how long it's been going on, and how it affects your days
Sleep, appetite, energy and stress
Your health history, current medications and supplements
What you've already tried, and what helped or didn't
Your goals, in your own words

You may be asked to fill out a short questionnaire, such as the PHQ-9 for depression or the GAD-7 for anxiety. These aren't tests you pass or fail. They give you and your provider a starting point and a way to track change over time.

From there, you build a plan together. It may begin with one provider and add others as needed. It can change as you do.

How to choose a starting point

There isn't one right door. A few general guides:

Start with psychiatric care if your symptoms are severe, you're having thoughts of suicide, you've had periods of very high energy or little need for sleep, or past treatment hasn't helped enough.
Start with therapy if you want space to talk, build coping skills, and work through stress, grief or a big life change.
Start with naturopathic care if you also have physical symptoms like fatigue, hormone changes or digestive trouble, or you want a closer look at labs, sleep and nutrition.

If you're not sure, that's normal. Reach out to our team and we can help you figure out where to begin. [Confirm with Heather: how new mental health patients are usually routed between Hilary, Laura and the NDs at intake.]

Frequently asked questions

Do I have to take medication?

No one is required to take medication. Some people find it helpful, and others focus on therapy and lifestyle support. The decision is yours to make with a prescriber, based on your symptoms, history and preferences. If you already take medication, please don't stop or change it without talking to the provider who prescribed it.

Can I see a therapist and a psychiatric provider at the same time?

Yes, and many people do. Therapy and medication management cover different parts of care, and they often work well side by side.

Can a naturopathic doctor help with anxiety or depression?

A naturopathic doctor can look for physical factors that affect mood, support sleep, nutrition and stress, and review supplements for safety. For moderate to severe symptoms, naturopathic care works best alongside psychiatric care and therapy, not instead of them.

What if I'm already seeing a provider somewhere else?

That's fine. Our providers are glad to coordinate with your primary care provider, therapist or specialist so your care stays connected.

You don't have to sort this out alone

Anxiety and depression are common, and asking for help is a reasonable, ordinary thing to do. Whether you start with a counselor, a psychiatric provider or a naturopathic doctor, the goal is the same: care that fits you, from people who talk to each other.

When you're ready, you can contact Origins Integrative Health at 1421 SE Ankeny St in Portland, or call (503) 314-2176.