Depression and mood disorders
- Major Depressive Disorder
Major depressive disorder is a treatable medical condition: at least two weeks of low mood or loss of interest plus changes in sleep, energy, appetite and concentration. First-line treatment is an SSRI or SNRI antidepressant, psychotherapy, or both. Most people improve within 6 to 12 weeks, and non-responders have options including Deep TMS and Spravato. - Bipolar Disorder
Bipolar disorder causes episodes of mania or hypomania and depression. It is treated with mood stabilizers (lithium, lamotrigine, valproate) and certain atypical antipsychotics (quetiapine, lurasidone, cariprazine), combined with psychotherapy and attention to sleep. Antidepressants alone are avoided. With consistent treatment most people achieve long stretches of stability. - Treatment-Resistant Depression
Treatment-resistant depression is major depression that has not remitted after two or more adequate antidepressant trials, affecting about one third of people treated for depression. Next steps include augmentation with lithium, aripiprazole or bupropion, Deep TMS (FDA-cleared, 36 sessions over six to nine weeks) and Spravato nasal spray (FDA-approved, given in clinic). Most people with TRD respond to one. - Seasonal Affective Disorder
Seasonal affective disorder is major depression with a recurring seasonal pattern, usually fall and winter. It is treated with morning bright light therapy at 10,000 lux, antidepressants such as bupropion XL (FDA-approved to prevent seasonal episodes) or SSRIs, and CBT tailored to seasonal depression. Most people improve within two to four weeks of starting treatment, and starting before symptoms begin prevents many episodes. - Persistent Depressive Disorder (Dysthymia)
Persistent depressive disorder is chronic depression lasting two years or more, with low mood on most days plus symptoms such as fatigue, poor self-esteem and hopelessness. It responds to antidepressants, typically SSRIs or SNRIs, and to psychotherapy, and the combination works best. Because the illness is chronic, treatment is measured in months, with most people seeing meaningful improvement within three to six months. - Chronic Pain and Depression
Chronic pain and depression occur together in a third to half of pain patients and worsen each other through shared brain pathways. Treatment pairs an antidepressant that also reduces pain signaling, usually an SNRI such as duloxetine, with cognitive behavioral therapy for pain and sleep. Most patients improve within six to eight weeks; TMS and Spravato remain available. - Depression in Older Adults
Depression in older adults is common, often shows as fatigue, pain, memory complaints or withdrawal rather than sadness, and responds well to treatment. First-line care is a low-dose SSRI such as sertraline or escitalopram, or mirtazapine when sleep and appetite are poor, plus psychotherapy and a medical workup. Medicare covers care. Most patients improve within eight to twelve weeks. - Depression and Anxiety in Parkinson's Disease
Depression and anxiety affect a third or more of people with Parkinson's disease and stem from the disease's effect on dopamine, serotonin and norepinephrine circuits, not only the stress of diagnosis. Treatment uses SSRIs or SNRIs chosen to avoid interactions with MAO-B inhibitors, pramipexole where mood and motor needs align, and CBT. Most patients improve within six to ten weeks.
You do not have to figure it out alone.
Tell us how to reach you and our scheduling team will help you explore appointment options. Most new patients are seen within one to two weeks, in person or by video. Medicare and most plans accepted; self-pay new-patient visits are $185.