Services
Mental health telehealth in Puerto Rico: evaluation and treatment by video
Mental health telehealth in Puerto Rico with us is a video visit with Dr. Diana Nieves Castro, MD, a general practice physician licensed in Puerto Rico. The doctor evaluates anxiety, depression, sleep problems and stress, gives you a lab order when a medical cause needs to be ruled out, and builds a treatment plan with you. If appropriate, the doctor prescribes and we send your prescription to your pharmacy.
Is it an emergency? Call 911.
Pay now, then choose your time right away. Full refund if you cancel 24 hours or more ahead.
See the cancellation policy
You can cancel for a full refund or change the time up to 24 hours before your visit. Within 24 hours you can't cancel and there's no refund. If you don't join in the first 10 minutes, there's no refund.
If you choose a time less than 24 hours away, it can't be cancelled or changed.
If the clinic can't see you, for example because of a technical problem on our side, we refund you in full.
Video visit
- Doctor licensed in Puerto Rico (24027) Verify (opens in a new tab)
- Children and adults of all ages
- In Spanish or English
- Secure video link
- Visits are not recorded
- Full refund if the clinic can’t see you
- No insurance needed
Is this an emergency?
This is not an emergency service. Call 911 or go to the nearest emergency room if you have:
- Thoughts of harming or killing yourself, or a plan to do it: call Línea PAS (1-800-981-0023) or 988; if there is immediate danger, call 911.
- You have hurt yourself, or someone has hurt themselves.
- Seeing or hearing things others do not, or strange beliefs that will not go away (psychosis).
- Severe agitation, violence or confusion that will not settle.
- You took too much of a medicine, alcohol or drugs: call 911.
Help lines
On this page(9)
What we care for: anxiety, depression, sleep and stress
You see Dr. Diana Nieves Castro, MD, a general practice physician licensed in Puerto Rico with several years of emergency-department experience. She sees patients of all ages, in English or Spanish. Book a visit for:
- Anxiety: worry that will not switch off, nerves, tension, a racing heart or panic attacks. Read more about anxiety.
- Depression: sadness, emptiness or irritability most of the day, loss of interest, low energy or changes in appetite. Read more about depression.
- Sleep problems: trouble falling asleep, waking in the early hours or waking up unrested. See insomnia.
- Stress and burnout: from work, school, caring for a family member or money worries.
- Grief and life changes: a loss, a breakup, a move or a diagnosis that turned your routine upside down.
Before you leave home
Why a video visit
For anything that isn’t an emergency, compare what each option takes.
| Comparison | Video visit | Emergency room | CDT or doctor’s office |
|---|---|---|---|
| Getting there | From home: join from your phone, tablet or computer. | Drive and find parking. | Drive and find parking. |
| Waiting room | Skip the waiting room: join from wherever you are in Puerto Rico. | Yes, a waiting room. | Yes, a waiting room. |
| Hours and time | Every day, any time (Puerto Rico time). Video doctor visits 24/7 — book online and choose your time right away. | In Puerto Rico, a median of 4 h 52 min from arrival to departure for patients sent home (US: 2 h 42 min; Oct 2024–Sep 2025).1,2 | An in-person visit takes about 2 hours on average, including travel.3 |
| Price | US$69 visit · US$49 follow-up · US$35 forms. You see it before you pay; no insurance needed. | Depends on your insurance and on what is done. | Depends on your insurance and on what is done. |
| Language | Spanish or English, with the same doctor. | Depends on the place. | Depends on the place. |
| Prescriptions | If appropriate, the doctor prescribes and we send your prescription to your pharmacy. | Yes, if needed. | Yes, if needed. |
| When to go in person | If the doctor needs to examine you in person or run a test, she tells you and guides you. | In an emergency: chest pain, trouble breathing, weakness on one side or bleeding that won’t stop. Call 911. | If you need stitches, an X-ray or a test on the spot. |
For problems that are not emergencies. In an emergency, call 911.
Table sources
- 1. CMS Care Compare, “Timely and Effective Care – State”, measure OP-18b: median time in the emergency department, arrival to departure, for patients sent home (opens in a new tab), data for Oct 2024–Sep 2025 (accessed 2026-10-02)
- 2. CMS Care Compare, “Timely and Effective Care – National”, measure OP-18b (US figure) (opens in a new tab), data for Oct 2024–Sep 2025 (accessed 2026-10-02)
- 3. Ray KN et al., “Opportunity costs of ambulatory medical care in the United States,” Am J Manag Care 2015;21(8):567-74 (US data, 2003–2010) (opens in a new tab) (accessed 2026-10-02)
We found no published source for what a patient pays at an ER or a CDT in Puerto Rico, so we give no figure.
How a mental health telehealth visit works
The visit is an unhurried conversation. The doctor asks what you are feeling and since when, how you sleep and eat, how things are going at work, school or home, and whether you have felt this way before. For depression, the NIMH explains that symptoms are present most of the day, nearly every day, for at least 2 weeks.
She may also use two short, validated questionnaires: the PHQ-9 for depression and the GAD-7 for anxiety. In 2023 the U.S. Preventive Services Task Force (USPSTF) recommended depression screening for all adults, including pregnant and postpartum people and older adults, and anxiety screening for adults 64 or younger. The questionnaires measure how you are doing today and track your progress at later visits.
The doctor also reviews your health conditions and every medicine and supplement you take because, according to the NIMH, some medicines and medical conditions can cause the same symptoms as depression.
Your doctor
Dr. Diana Nieves Castro, MD
General practice physician
Several years of emergency-department experience.
Founding Executive Director of The Health Initiative.
Lab tests to rule out medical causes
Sometimes what feels like anxiety or depression has a physical cause. According to MedlinePlus, an underactive thyroid (hypothyroidism) can cause sadness or depression and fatigue, and an overactive thyroid (hyperthyroidism) can cause nervousness, anxiety and sleep problems. Anemia from vitamin B12 deficiency can cause tiredness and trouble concentrating.
If needed, the doctor gives you a lab order for a lab near you, for example:
- TSH (thyroid function)
- Vitamin B12
- Complete blood count (CBC), to check for anemia
- Glucose (blood sugar)
Treatment: a plan built with you
The plan depends on what the doctor finds and on what you prefer. According to the NIMH, exercise, mindfulness and meditation can ease anxiety and support treatment. The doctor helps you with concrete habits: a sleep schedule, physical activity, alcohol and caffeine, and ways to handle everyday stress.
If appropriate, the doctor prescribes a medicine. For anxiety and depression the most used are the antidepressants called selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs); for depression there are other options, such as bupropion. The doctor decides with you which one fits your symptoms, your health and your other medicines. According to the NIMH, antidepressants usually take several weeks to work; talk with the doctor before starting or stopping any medicine.
To read about each medicine, see our guides to sertraline (Zoloft), escitalopram (Lexapro), fluoxetine (Prozac), bupropion (Wellbutrin), trazodone, mirtazapine and buspirone.
According to MedlinePlus, the main treatments are medicines, psychotherapy (talk therapy) or both. If talk therapy suits you, or your situation calls for a mental health specialist, we refer you and plan the next step with you.
Follow-up and refills
Mental health care works over time, with the same doctor. At follow-up visits the doctor repeats the questionnaires, checks how you feel, any side effects and your lab results, and adjusts the plan.
If you already take a non-controlled medicine and need to continue it, see prescription refills: if the doctor decides it is appropriate, she prescribes and we send your prescription to your pharmacy. A controlled medicine needs a doctor visit, where the doctor decides what is appropriate.
If you are in crisis
If you or someone close to you is thinking about self-harm or suicide, do not wait for an appointment: call Línea PAS now at 1-800-981-0023, which answers 24 hours a day, free and confidential, or call or text 988, also free and confidential (988 text and chat are available in Spanish).
If there is immediate danger, call 911 or go to the nearest emergency room. More warning signs in when to go to the ER.
Privacy: your visit is confidential
You join from a private place, and visits are not recorded. What you discuss with the doctor goes in your medical record, held by a HIPAA-compliant electronic health record provider. Read our privacy policy.
In Puerto Rico the age of majority is 21. If the patient is under 21, a parent or legal guardian signs the consent, stays on camera for the whole visit and shows photo ID.
How to book your visit
Three steps:
Request a visit.
Book online and choose your time right away. Every day, any time (Puerto Rico time). Choose Doctor visit on the booking page.
Join by video.
We send you a secure video link. It works on your phone, tablet or computer. Have a list of your medicines and supplements ready.
Get your plan.
The doctor explains what she found, gives you a lab order if needed and, if appropriate, prescribes and we send your prescription to your pharmacy.
How we care for you
We evaluate, diagnose and treat; if needed, we give you a lab order for a lab near you.
We see adults and children of all ages. Patients under 21: a parent with patria potestad (parental authority) or a legal guardian is on camera for the whole visit and shows photo ID.
Real-time video visit. We send you a secure video link. It works on your phone, tablet or computer.
If appropriate, the doctor prescribes and we send your prescription to your pharmacy.
You must be physically in Puerto Rico during the visit (visitors, tourists and cruise passengers are welcome).
In an emergency, call 911.
Frequently asked questions
Can a general practice doctor treat anxiety and depression?
Can I get anxiety medication through telehealth?
What happens if I need a mental health specialist?
Is a mental health video visit confidential?
What should I have ready for a mental health telehealth visit?
Before you pay
Why do I pay before choosing a time?
Can I cancel or change the time?
Do you record the visit?
Need to see the doctor?
US$69Doctor visit
- You’re charged when you request the visit.
- Full refund if the clinic can’t see you
Video doctor visits 24/7 — book online and choose your time right away.
Doctor visit: US$69 — BookPay now, then choose your time right away. Full refund if you cancel 24 hours or more ahead.
See the cancellation policy
You can cancel for a full refund or change the time up to 24 hours before your visit. Within 24 hours you can't cancel and there's no refund. If you don't join in the first 10 minutes, there's no refund.
If you choose a time less than 24 hours away, it can't be cancelled or changed.
If the clinic can't see you, for example because of a technical problem on our side, we refund you in full.
About this page
Author: The Health Initiative
Medical care provided by Dr. Diana Nieves Castro, MD (PR license 24027)
Disclosure: Founding Executive Director of The Health Initiative
Published: 2026-10-09 · Updated: 2026-10-11
Sources (11)
- NIMH: Depression (opens in a new tab) (accessed 2026-10-09)
- NIMH: Generalized Anxiety Disorder (opens in a new tab) (accessed 2026-10-09)
- MedlinePlus: Depression (opens in a new tab) (accessed 2026-10-09)
- MedlinePlus: Anxiety (opens in a new tab) (accessed 2026-10-09)
- MedlinePlus: Hypothyroidism (opens in a new tab) (accessed 2026-10-09)
- MedlinePlus: Hyperthyroidism (opens in a new tab) (accessed 2026-10-09)
- MedlinePlus: Anemia due to vitamin B12 deficiency (opens in a new tab) (accessed 2026-10-09)
- USPSTF: Anxiety Disorders in Adults: Screening (2023) (opens in a new tab) (accessed 2026-10-09)
- USPSTF: Depression and Suicide Risk in Adults: Screening (2023) (opens in a new tab) (accessed 2026-10-09)
- ASSMCA: Línea PAS (Spanish) (opens in a new tab) (accessed 2026-10-09)
- 988 Suicide & Crisis Lifeline (opens in a new tab) (accessed 2026-10-09)