Understanding Depression
Depression is a common and treatable medical condition, not a weakness or a character flaw. Major depression is diagnosed when five or more symptoms are present most of the day, nearly every day, for at least two weeks, and at least one is low mood or loss of interest or pleasure. Symptoms can include:
- Sadness, emptiness, or irritability, especially in teens
- Loss of interest in activities you used to enjoy
- Changes in sleep or appetite, or changes in weight
- Low energy, trouble concentrating, or slowed thinking
- Feelings of worthlessness or excessive guilt
- Thoughts of death or suicide
Related conditions include persistent depressive disorder (long-lasting, milder depression), depression with a seasonal pattern, postpartum depression, and the depressed phase of bipolar disorder.
What a Depression Evaluation Includes
We ask about your symptoms, how long they have lasted, your history, family history, medications, sleep, and alcohol and substance use. We assess safety, including any thoughts of self-harm. We also ask about past episodes of unusually high energy or decreased need for sleep, because depression that is part of bipolar disorder is treated differently. Other medical problems, such as thyroid disease, sleep apnea, and certain medications, can contribute to depression, so we may suggest that you follow up with your primary care provider.
Treatment Options
Depression usually responds well to treatment. Plans may include:
- Psychotherapy, such as cognitive behavioral therapy or interpersonal therapy, through referral
- Medication. Common choices include SSRIs and SNRIs, bupropion, mirtazapine, and others, selected based on your symptoms, other health conditions, side effect concerns, and past treatment response
- Combination treatment, which often works better than either alone for moderate to severe depression
- Healthy habits, such as regular activity, a steady sleep schedule, social connection, and limiting alcohol
Antidepressants often take several weeks to reach their full effect, and early side effects are common. Please do not stop an antidepressant suddenly. If the first treatment does not give enough relief, there are many next steps, including adjusting the dose, changing medications, adding another medication, or adding therapy. For depression that does not respond to several treatments, we can discuss referral for procedures that North Star does not provide, such as transcranial magnetic stimulation (TMS) or other specialty care.
Antidepressants carry an FDA boxed warning about increased suicidal thoughts in children, teens, and young adults, so we monitor closely, especially early in treatment.
Postpartum and Perinatal Depression
Depression can occur during pregnancy or after having a baby, and it is common and treatable. If you are pregnant, planning a pregnancy, or breastfeeding, we talk through the risks and benefits of treatment options with you, and with your obstetric provider when appropriate.
Depression in Teens and Older Adults
In teens, depression may show up as irritability, withdrawal, or falling grades. In older adults, it may appear as fatigue, memory or concentration problems, physical complaints, or loss of interest rather than obvious sadness. Both groups deserve a careful evaluation. See also child and adolescent psychiatric care and adult psychiatry.
In-Person and Telehealth Care
You can be seen in our Lexington office or by telepsychiatry if you are located in South Carolina during your visit. Follow-up care is provided through medication management visits.
If You Are in Crisis
If you are thinking about ending your life or hurting yourself, do not wait for an appointment. Call or text 988 (Suicide & Crisis Lifeline), call 911, or go to the nearest emergency room. You are not alone, and help is available at any hour.
Ready to get started?
Register as a new patient and our office will confirm your appointment. Questions first? Call (803) 956-9508, Monday to Friday, 8:30 AM to 5:00 PM.
Frequently Asked Questions
When should I see a psychiatric provider for depression?
Consider an evaluation when low mood, loss of interest, or other symptoms last two weeks or more, or sooner if they interfere with work, school, relationships, or daily life. If you are having thoughts of suicide, seek help right away by calling or texting 988.
Do I need medication for depression?
Not always. Mild to moderate depression may improve with therapy and healthy habits, and moderate to severe depression often responds best to a combination of therapy and medication. The decision is made together, based on your symptoms and preferences.
How long do antidepressants take to work?
Many people begin to notice some improvement in two to four weeks, with fuller benefit over several weeks. Early side effects are common and often ease with time. Please talk with your provider before stopping or changing a dose.
What if the first antidepressant does not work?
That is common, and there are many next steps, including adjusting the dose, switching medications, adding another medication, or adding therapy. Your provider will review these options with you.
Do you treat postpartum depression?
Yes. We evaluate and treat depression during pregnancy and after delivery, and we review treatment options carefully, including during breastfeeding, together with your obstetric provider when appropriate.
Do you treat depression in teens?
Yes. North Star evaluates and treats depression in adolescents, adults, and older adults. Parents or guardians take part in care for minors.
Can depression be treated by telehealth?
Often, yes, when it is clinically appropriate and you are located in South Carolina during the visit.
Start your registration
New to North Star? Complete New Patient Registration. Already a patient? Open the Patient Portal to request an appointment.