Understanding Depression: Beyond the Basics

Depression isn't simply feeling sad or having a "bad day." Major depressive disorder is a complex neurobiological condition affecting mood, cognition, motivation, sleep, appetite, and the capacity to experience pleasure. When I evaluate patients with depression, I'm assessing multiple systems: neurotransmitter function, inflammatory markers, sleep architecture, circadian rhythms, stress response, and often underlying trauma or attachment patterns.

What makes depression particularly challenging is that it's not uniform. Some patients experience primarily emotional symptoms—persistent sadness, hopelessness, loss of interest. Others experience primarily cognitive symptoms—difficulty concentrating, memory problems, indecisiveness. Some experience primarily physical symptoms—fatigue, sleep disruption, appetite changes, physical pain. Most experience a combination.

Research indicates that depression involves dysregulation across multiple neurotransmitter systems (serotonin, norepinephrine, dopamine, glutamate, GABA) as well as inflammatory processes, stress hormone dysregulation, and disruptions in neural plasticity. The National Institute of Mental Health estimates that approximately 21 million adults in the United States experienced at least one major depressive episode in 2021.

An Integrative Approach to Depression Treatment

Integrative psychiatry recognizes that depression has multiple drivers and requires a comprehensive treatment approach. Medication can be transformative when used appropriately, but it's most effective when combined with psychotherapy, lifestyle optimization, and attention to underlying physiological factors.

My approach includes:

Comprehensive Evaluation: Thorough assessment of symptoms, medical history, medication history, lifestyle factors, sleep patterns, stress levels, and psychosocial context
Medication Management: When medication is indicated, I use evidence-based approaches, starting conservatively and monitoring closely. This may include SSRIs, SNRIs, atypical antidepressants, or combination strategies when appropriate
Psychotherapy Integration: Evidence-based psychotherapeutic approaches woven into treatment, including cognitive-behavioral techniques, supportive therapy, and trauma-informed care when indicated
Lifestyle Medicine: Attention to sleep architecture, circadian rhythms, nutrition, physical activity, stress management, and mind-body practices that support mood regulation
Nutritional Support: Assessment and optimization of nutritional factors that influence neurotransmitter synthesis, including B vitamins, vitamin D, omega-3 fatty acids, and magnesium

This integrative model recognizes that depression isn't just a neurotransmitter imbalance—it's a condition that affects and is affected by multiple body systems. Treatment addresses these systems comprehensively.

Treatment-Resistant Depression

Some patients have tried multiple antidepressants without significant improvement. This doesn't mean their depression is untreatable—it often means we need to identify contributing factors that haven't been addressed. These may include:

Undiagnosed medical conditions (thyroid dysfunction, sleep disorders, autoimmune conditions)
Sleep architecture disruption preventing proper mood restoration
Nutritional deficiencies affecting neurotransmitter synthesis
Chronic inflammation from stress or other sources
Underlying trauma or attachment patterns requiring therapeutic processing
Circadian rhythm disruption affecting mood regulation

When I work with patients who haven't responded to prior treatments, I conduct a thorough reevaluation, looking beyond medications to identify all contributing factors. Often, addressing sleep, nutrition, inflammation, or trauma—in combination with appropriate medication—leads to meaningful improvement.

What to Expect in Treatment

Your initial evaluation is comprehensive—typically 90 minutes—allowing time to understand your history, symptoms, and goals thoroughly. We develop initial diagnostic impressions and discuss evidence-based treatment options. Treatment proceeds collaboratively, with regular check-ins to assess progress and adjust approaches as needed.

Follow-up appointments may focus on medication management, psychotherapy, or both, depending on your needs. Some patients benefit from short-term treatment for a specific episode. Others benefit from ongoing treatment focused on long-term stability and resilience.

The goal isn't just symptom reduction—it's restored function, improved quality of life, and increased capacity for resilience. Treatment is individualized, paced thoughtfully, and grounded in clinical evidence.

Serving Los Angeles Area

I provide adult depression treatment to patients throughout Los Angeles County, including Hollywood, Beverly Hills, Santa Monica, West Hollywood, Burbank, Glendale, Pasadena, and surrounding areas. The practice is located in Hollywood and offers both in-person and telepsychiatry visits for adults throughout California.

If you're experiencing symptoms of depression, know that effective treatment is available. Depression is a treatable condition, and many patients experience significant improvement with appropriate care.

References & Resources

For additional information about depression, I recommend these authoritative sources:

Contact us to schedule a consultation or learn more about our approach to depression treatment.