Depression does not look the same in everyone.
Some people feel persistently sad or hopeless. Others notice loss of interest, low energy, irritability, withdrawal, difficulty concentrating, changes in sleep or appetite, or a sense that daily life has become harder to manage.
In children and adolescents, depression may show up through irritability, academic decline, social withdrawal, conflict, or loss of interest in activities that used to matter. In adults, it may appear as reduced motivation, disconnection, difficulty functioning at work or home, or a growing sense that life has narrowed.
EVALUATION
Getting the formulation right helps guide treatment.
The same outward symptoms can arise for different reasons. I try to understand when the problem began, what has changed, how severe and persistent it is, what has helped before, and whether there are overlapping psychiatric or medical issues that need attention.
A psychiatric evaluation considers mood symptoms in context: development, relationships, stress, sleep, medical issues, substance use, anxiety, ADHD, prior treatment, and major changes in life. For younger patients, parents and school information can be important. For adults, work, relationships, identity, and life transitions may also shape the treatment plan.
TREATMENT
Treatment should address both symptoms and context.
For some people, psychotherapy is the main treatment. For others, medication is useful as well. Treatment may also involve attention to sleep, structure, isolation, relationships, stress, or other factors that are maintaining the problem.
Psychotherapy
Psychotherapy can help with mood symptoms while also making room to understand recurring patterns, losses, relationships, self-criticism, conflict, and the experiences that may be contributing to feeling stuck.
PsychotherapyMedication
Medication may be useful when depression is persistent or significantly affecting functioning. Any medication decision should follow a careful assessment and an individualized discussion of benefits, limitations, side effects, and alternatives.
Medication managementOVERLAP
Depression often overlaps with other concerns.
Anxiety, attention difficulties, sleep problems, relationship stress, and major transitions can all interact with mood. Low mood can also make concentration and follow-through more difficult, while chronic ADHD-related frustration can contribute to demoralization or self-criticism.
ACROSS AGES
Depression can look different across development.
Children and teenagers need to be understood in the context of development, family, school, friendships, sleep, and changing independence. Adults may be dealing more with work, relationships, parenting, identity, loss, health, or questions about direction.
COMMON QUESTIONS
Questions about depression treatment.
When should depression be evaluated by a psychiatrist?
A psychiatric evaluation can be useful when mood symptoms are persistent, significantly affecting functioning, the diagnosis is unclear, medication is being considered, or several concerns overlap.
Does depression always look like sadness?
No. Depression can involve low energy, loss of interest, irritability, withdrawal, difficulty concentrating, changes in sleep or appetite, hopelessness, or reduced functioning.
Do you treat depression in children and teenagers?
Yes. Evaluation considers development, family, school, friendships, sleep, and the ways depression may appear differently at younger ages.
Do you treat depression in adults?
Yes. Adult treatment may focus on mood symptoms as well as relationships, work, loss, identity, transitions, self-criticism, or recurring patterns that contribute to feeling stuck.
Does depression treatment always involve medication?
No. Psychotherapy may be the main treatment for some people. Medication may be useful for others, depending on severity, impairment, prior treatment, and individual circumstances.
Can depression occur with anxiety or ADHD?
Yes. Depression can coexist with anxiety or ADHD, and each can affect concentration, motivation, sleep, and functioning. Sorting out the overlap helps guide treatment.
GETTING STARTED
Care begins with an assessment.
Depending on the situation, care may involve medication management, psychotherapy, both, or a focused consultation that helps clarify what kind of treatment makes sense.