Most people I evaluate for depression do not describe themselves as sad.
They describe being tired in a way sleep does not touch. Snapping at people they love. Watching a show they used to like and feeling nothing. Getting the work done, badly, and then lying awake about it. Sadness is the version in the brochure. Flatness, irritability, and exhaustion are the versions that walk in.
Before deciding it is depression
Several conditions imitate it well enough to fool everyone including the patient. Thyroid problems, anemia, and sleep apnea all produce fatigue and low mood, so bloodwork and a real sleep history matter before anyone reaches for a prescription. Untreated ADHD in an adult often arrives looking like depression, because years of underperforming against your own ability is genuinely demoralizing. Grief is not depression, though it can become complicated. Alcohol is a depressant, and a nightly drink to get to sleep quietly makes everything worse.
I ask about all of it, because the treatment depends on which one it is. This is also why a ten-minute appointment is not enough to answer the question honestly.
What starting treatment is actually like
Antidepressants work on the scale of weeks, not days. That gap is where a lot of people give up, and it is harder than it sounds, because the adjustment period tends to arrive before the benefit does. Knowing that in advance is most of what gets people through it.
I will give you a realistic timeline for whatever we actually start, and what to watch for along the way, rather than a generic one out of a pamphlet. Some of that depends on the medication and some of it depends on you, which is why it belongs in a conversation rather than on a page like this.
If we reach a fair trial and nothing has moved, that is information, not failure. The first medication is frequently not the right one. I would rather say so and adjust than ask you to keep waiting.
What I keep an eye on
There are specific warnings that apply to some patients and not others, particularly for younger patients starting an antidepressant. Where one applies to you, I will walk you through exactly what it means before you start rather than after. I also stay alert to signs that what looks like depression is part of something broader, because that changes the plan entirely.
You will hear those things from me directly. That is the part I do not want you reading off a label at the pharmacy.
What treatment is for
Not relentless positivity. Enough energy to engage with your actual life, and enough distance from the flatness to want to. Therapy does work that medication cannot, and for many patients the combination outperforms either alone. If you are already seeing a therapist, I would rather work alongside them than replace that relationship.
I see patients age 6 and older across New Mexico by telehealth.
Kevin Lazar, MSN, APRN, PMHNP-BC · WellnessRx · View the source
If you are in crisis, call or text 988 (Suicide & Crisis Lifeline). Medications prescribed only when clinically appropriate. Individual results vary. Telehealth services available to New Mexico residents.