Recognizing depression
Depression is more than feeling sad. It is a medical condition that affects mood, energy, sleep, appetite, concentration, and motivation. Symptoms must be present for at least two weeks and represent a change from previous functioning to meet diagnostic criteria. Depression can range from mild (some difficulty with daily tasks) to severe (inability to function, suicidal thoughts).
Common symptoms include persistent low mood, loss of interest in previously enjoyable activities, changes in sleep (insomnia or oversleeping), changes in appetite (weight loss or gain), fatigue, feelings of worthlessness or excessive guilt, difficulty concentrating, and in some cases, thoughts of self-harm or suicide. Not everyone experiences all symptoms, and severity varies.
- Persistent low mood or irritability lasting two weeks or more
- Loss of interest or pleasure in activities (anhedonia)
- Sleep disturbance (insomnia or hypersomnia)
- Fatigue and reduced energy most days
- Difficulty concentrating or making decisions
- Feelings of worthlessness or excessive guilt
- In severe cases, thoughts of death or self-harm
Related: Psychiatry → · Dr. Jitendra Knowledge Hub → · ICHD-3 Topic →
Treatment options
Depression treatment is individualized based on severity, patient preference, prior treatment response, and co-occurring conditions. For mild depression, psychotherapy (particularly CBT or behavioral activation) is often the first-line treatment. For moderate to severe depression, combining psychotherapy with antidepressant medication (typically an SSRI) produces better outcomes than either alone.
Dr. Shrestha discusses the benefits, timeline, and potential side effects of each treatment option. Antidepressants typically take 2–4 weeks to begin showing benefit, with full effect by 6–8 weeks. CBT provides skills that persist beyond the end of treatment, while medication benefits typically continue only while taking it. Regular follow-up ensures treatment effectiveness and safety.
| Severity | Recommended approach | Expected timeline |
|---|---|---|
| Mild | CBT or behavioral activation | 8–16 sessions |
| Moderate | CBT + SSRI combination | Improvement by 6–8 weeks |
| Severe | SSRI + CBT + safety planning | Monitoring weekly initially |
What to expect at evaluation
The initial evaluation takes 45–60 minutes and includes a detailed review of symptoms, their duration and impact on daily life, personal and family psychiatric history, medical history, substance use, and any previous treatments. A mental status examination assesses mood, thought content, cognition, and risk.
If depression is diagnosed, you and Dr. Shrestha will collaboratively decide on a treatment plan. This may include starting psychotherapy, initiating medication, or a combination. Safety planning is discussed if there are any concerns about self-harm. Bring a list of current medications and a brief written summary of your main concerns to your first appointment.
- Comprehensive 45–60 minute psychiatric evaluation
- Mental status examination and risk assessment
- Collaborative treatment planning
- Bring medication list and symptom summary
- Safety planning discussed when indicated