Depression

Depression is not a character flaw, and it is not something you can decide your way out of. It is a medical condition that affects sleep, appetite, concentration, and the capacity to feel pleasure, and it responds to treatment.

What it looks like varies more than people expect. Some people cannot get out of bed. Others go to work or school every day, keep up appearances, and feel nothing underneath it. Some people are not sad so much as flat, irritable, or worn down in a way that rest does not fix. In children and younger teenagers, depression often shows up as irritability, anger, or physical complaints rather than obvious sadness, which is one reason it gets missed or mistaken for something else.

What the first appointment covers

The first visit is a full evaluation, about 60 minutes, either in person in Raleigh or by secure video from anywhere in North Carolina. It covers your history, what has been happening recently, what you have already tried, and what you want to be different. It also means looking for physical contributors, because thyroid problems, anaemia, poor sleep, and the side effects of other medication can all produce something that looks like depression and will not respond to an antidepressant on its own.

Building a plan that fits

From there, treatment is built around what fits you and your life. That might mean medication, psychotherapy, or a combination of the two. If medication becomes part of the plan, you will know what it is meant to do, roughly how long it takes to take effect, what to watch for, and when it will be reviewed. Follow-up appointments run about 30 minutes and happen regularly at the start, because the first thing tried is not always the thing that ends up helping, and adjusting the plan is a normal part of care rather than a sign that something has failed.

If you are having thoughts of suicide

Thoughts of death, or of not wanting to be here, are a symptom of depression, and they are more common than most people realise. They are safe to say out loud in an appointment, and your provider will ask about them directly rather than waiting for you to bring them up.

If you are in immediate danger, do not wait for an appointment. Call or text 988 to reach the Suicide & Crisis Lifeline, call 911, or go to your nearest emergency room. This practice does not provide emergency services.