Depression
Depression is common, treatable, and frequently undertreated — not because effective treatments do not exist, but because people sometimes get discouraged and give up after the first or second medication does not seem to work.
What does depression actually look like?
Often not like sadness. Many people describe flatness rather than grief — an absence of interest, motivation and pleasure rather than the presence of sorrow. Common features include loss of interest in things that previously mattered, fatigue that sleep does not fix, difficulty concentrating and making decisions, changes in appetite or sleep, physical heaviness, disproportionate guilt, and thoughts that others would be better off without you.
In men in particular, it frequently presents as irritability and anger rather than low mood, which is one reason it goes unrecognized.
My antidepressant did not work. What now?
This is one of the most common reasons people come to us, and it is a solvable problem more often than people assume. Several things are worth checking before concluding a medication failed:
- Was the dose adequate and given long enough? Many trials are stopped early or at a dose below therapeutic range.
- Is something else driving it? Thyroid dysfunction, B vitamins deficiencies, vitamin D deficiency, hormone dysregulation, anemia and sleep apnea all produce or worsen depressive symptoms.
- Is it actually bipolar depression? If so, antidepressants alone may not work and can make things worse instead of better. See bipolar disorder.
- How do you metabolize it? An ultra-rapid metabolizer may never reach therapeutic level on a standard dose — which looks identical to the medication not working. See pharmacogenetic testing.
- Is there a hormonal contribution? See perimenopause.
“Treatment-resistant” frequently means “not yet treated in a way that accounts for why the earlier attempts failed.”
How long does an antidepressant take to work?
Typically two to six weeks at an adequate dose for a fair assessment, though some improvement in sleep or energy may appear sooner. Side effects, if they occur, usually appear first and often settle within a couple of weeks — which is why the early period is where people most often stop prematurely.
Will I have to take medication forever?
Not necessarily. It depends on how many episodes you have had, how severe they were, and what else is in place. For a first episode, treatment is often continued six to twelve months after recovery and then reassessed. For recurrent depression, longer maintenance frequently makes sense, and abandoning therapy prematurely increases risk, duration, and severity of future depressive episodes. It is a conversation, not a life sentence, and stopping is something to plan rather than improvise.
What about nutrition and lifestyle?
They matter, and they are not a substitute for treatment in moderate or severe depression. Correcting documented deficiencies, addressing sleep, and building in physical activity all contribute measurably. See nutritional psychiatry.
Depression is not a failure of lifestyle or willpower: it is a complex illness that requires careful, skillful, and expert attention.
If you are in crisis, please immediately call or text 988 for the Suicide & Crisis Lifeline, or call 911. Safety is our top priority, and our outpatient office is not equipped to handle emergencies.
Treatment in person and throughout Arizona
We see patients in person at our office in Glendale (in the Arrowhead area) and via telehealth anywhere in Arizona — from Tucson, to Flagstaff, to the east valley, and everywhere between. Virtual visits are the same appointment with the same provider at the same rate.
Getting Started
Our comprehensive, new patient evaluations are $375 and require 60 to 90 minutes.
Our psychiatric follow-up visits are $125 and require 30 minutes.
(Thank you for arriving early, as we are unable to see late patients and must reschedule if life gets in the way of you arriving on time.)
We are out-of-network with all insurance carriers but will gladly provide a superbill you can submit to insurance to seek reimbursement.
For more info, please see our fees page.
Pinnacle Psychiatry
17505 N 79th Ave, Suite 309, Glendale, AZ 85308
Phone 623.321.2221 · Text 877.749.7502
Monday–Wednesday 8:00am–5:00pm · Thursday 7:00am–5:00pm