Depression Treatment in Southlake, TX

Depression is treated here, at your regular visits, usually starting the day you bring it up. Most depression in this country is managed in primary care, and waiting months for psychiatry is the main reason people go untreated.

Screening and measurement

We screen with the PHQ-9 at every physical and any time symptoms come up. The score is not the diagnosis, it is a measurement, and repeating it is how we tell whether treatment is actually working rather than relying on impressions in a fifteen-minute visit.

We ask specifically about the things people do not volunteer: how you are sleeping, whether you are eating, whether you have stopped doing things you used to enjoy, and whether you have had thoughts of hurting yourself. That last question gets asked directly and without flinching, because asking it does not plant the idea and not asking it misses people.

Ruling out physical causes

Testing first is not a delay tactic. It is how you avoid treating the wrong thing for a year.

Thyroid disease, anemia, low B12 or vitamin D, sleep apnea, chronic pain, alcohol use and several common medications produce a picture indistinguishable from depression. In older adults, early cognitive decline sometimes presents as depression, and the reverse is also true.

See thyroid disorders, sleep apnea and fatigue for how those overlaps get worked through.

Treatment

SSRIs and SNRIs are where most people start. Selection depends on your symptom pattern, your other conditions, side effects you want to avoid, and what has worked for you or a close relative before.

Sertraline and escitalopram are reasonable first choices for most people. Bupropion is useful when fatigue and low motivation dominate, or when sexual side effects are a dealbreaker, and it also helps with smoking cessation. Mirtazapine helps when insomnia and poor appetite dominate.

We start low and check in at two weeks, by phone or telehealth if that is easier. That early contact is the highest-value part of the whole process. Side effects peak before benefit arrives, and most people who abandon treatment do so in that window.

Dose increases happen at four to six weeks if the response is partial. A common failure is leaving someone on a starting dose for a year and concluding the drug did not work.

Sexual side effects

These are common, they are the most frequent reason people stop, and they are frequently not mentioned by either side of the conversation.

We raise it directly. There are options: dose reduction, switching to bupropion or mirtazapine, or adding something. Nobody should quietly stop a medication that was helping because of a side effect that could have been managed.

When to involve psychiatry

Two adequate trials without response. Bipolar features, including any history of periods of elevated mood, decreased need for sleep or impulsive behavior, since antidepressants alone can worsen bipolar illness. Psychotic symptoms. Significant suicidality.

We refer with your history attached rather than sending you in cold to repeat everything.

Therapy

Medication and therapy together outperform either alone for moderate to severe symptoms. We keep a referral list and help you work out what your insurance covers, which is usually the real barrier.

The physical side

Depression makes blood pressure, diabetes and weight harder to control, and the reverse is true too. We manage them together rather than in separate silos, which is the main advantage of doing this in primary care rather than elsewhere.

In a crisis

If you are in danger, call or text 988 any time, or go to the nearest emergency department.

Depression is followed through our chronic condition management program. Learn about our primary care Southlake practice.