Depression Treatment in Southlake, TX

Understanding Depression

Depression affects millions of adults in the United States in any given year – about 8.4% of the adult population. It’s not a sign of weakness and it’s not something you can simply “snap out of.” Depression is a medical condition with real biological underpinnings, and it responds well to proper treatment.

It’s important to recognize that depression presents differently across genders. In men, depression often manifests as irritability, anger, risk-taking behaviors, or social withdrawal rather than the sadness more commonly discussed. Understanding these variations helps ensure proper diagnosis and treatment for everyone.

Depression differs fundamentally from sadness. Sadness is an emotion that typically fades when the circumstances change. Depression is a persistent medical condition that alters how your brain functions – affecting your mood, energy, concentration, sleep, appetite, and ability to experience pleasure. It can last weeks, months, or years without treatment, and it doesn’t improve just because your circumstances improve.

At the neurochemical level, depression involves imbalances in key neurotransmitters – the brain’s chemical messengers. Serotonin regulates mood, sleep, and appetite. Norepinephrine affects alertness and motivation. Dopamine drives pleasure and reward. When these systems aren’t functioning optimally, depression takes hold. This isn’t a character flaw; it’s physiology. The good news is that targeted medication, combined with lifestyle changes and integrative care, can restore balance and return you to feeling like yourself.

Whether you’ve been struggling for months or years, or you’re noticing symptoms for the first time, seeking help is a sign of strength. Dr. Fredes approaches depression with the seriousness and compassion it deserves, working to identify not just what’s wrong, but why – so treatment can be personalized to your specific situation.

Types of Depression We Treat

Recognizing Depression Symptoms

Depression affects the whole person – how you feel emotionally, how your body functions, and how you think. Symptoms vary widely from person to person, and severity matters. Experiencing one symptom occasionally is normal; depression involves persistent symptoms that interfere with daily life.

Emotional Symptoms

• Persistent sadness or emptiness: A pervasive low mood that doesn’t go away with normal activities or even good news
• Hopelessness and despair: A sense that things won’t improve, that there’s no way out, that the future is bleak
• Loss of interest (anhedonia): Activities you used to enjoy no longer bring pleasure – hobbies, time with friends, sports, even food or sex
• Irritability and mood lability: Feeling quick to anger, impatient, frustrated, or emotionally reactive to minor things
• Guilt and shame: Self-blame, feeling like a burden, excessive guilt over things that aren’t your fault
• Emotional numbness: Not feeling sad exactly, but not feeling much of anything – a flatness or disconnection

Physical Symptoms

• Fatigue and low energy: Persistent exhaustion disproportionate to activity level, feeling physically heavy or weighted down
• Sleep disturbances: Insomnia (trouble falling asleep or staying asleep), early morning awakening, or hypersomnia (sleeping too much)
• Appetite and weight changes: Significant increase or decrease in appetite, unintended weight gain or loss
• Psychomotor changes: Moving or speaking more slowly (retardation) or increased agitation and restlessness
• Physical pain: Unexplained aches, chronic pain, or somatic complaints that don’t have a clear physical cause
• Reduced libido: Loss of sexual desire or difficulty with sexual function

Cognitive Symptoms

• Difficulty concentrating: Trouble focusing, reading, or following conversations even when well-rested
• Indecisiveness: Paralyzed by even minor decisions, unable to commit to choices
• Memory problems: Difficulty remembering information or retrieving memories, feeling mentally foggy
• Negative thinking patterns: Pessimistic thoughts, catastrophizing, self-criticism, rumination
• Suicidal thoughts: Thoughts of death, harming yourself, or that others would be better off without you (this requires immediate professional help)

Depression looks different in different people and presents differently across genders and cultures. Some people have primarily emotional symptoms; others are bothered most by physical fatigue or cognitive fog. Older adults might focus more on bodily complaints; younger people might emphasize mood. This is why a careful, individualized evaluation matters – we listen to your specific experience, not just a checklist of symptoms.

What Causes Depression?

Depression rarely has a single cause. It typically results from a combination of factors – some within your control, some not. Understanding what contributed to your depression helps us address it comprehensively.

Genetic Factors

Depression runs in families. If your parents, siblings, or close relatives have experienced depression, bipolar disorder, or anxiety disorders, your genetic risk is elevated. This doesn’t mean you will definitely develop depression – it means your brain may be somewhat predisposed to mood dysregulation. Genetics loads the gun; environment pulls the trigger. Many genetically vulnerable people never develop clinical depression because they don’t encounter triggering stressors or have strong protective factors.

Brain Chemistry

Imbalances in neurotransmitters like serotonin, norepinephrine, dopamine, and others disrupt mood regulation. These imbalances can arise from genetics, chronic stress, medical illness, or trauma. Brain imaging studies show structural and functional differences in people with depression – in areas controlling mood, motivation, and emotional processing. This is real biology, not imagination or character weakness.

Medical Conditions and Medications

Many medical conditions cause depression: thyroid dysfunction (hypothyroidism especially), vitamin deficiencies (B12, folate, vitamin D), anemia, chronic pain conditions, autoimmune diseases, neurological disorders, and hormonal changes. Some medications cause depression as a side effect – including some blood pressure medicines, corticosteroids, and hormonal contraceptives. During the initial evaluation, we screen for medical contributors so we can address them directly.

Life Events and Trauma

Major losses – death of a loved one, relationship breakup, job loss, health crisis – can trigger depression. Chronic stress (ongoing financial strain, difficult relationships, work pressure) wears down resilience. Childhood trauma or abuse creates vulnerability to depression later in life. Current adversity – discrimination, social isolation, instability – contributes significantly. These aren’t “reasons to just get over it” – they’re real stressors that reshape brain chemistry and deserve acknowledgment in treatment.

Substance Use

Alcohol and drug use both cause and complicate depression. Some people use substances to self-medicate depression; the substances temporarily relieve symptoms but ultimately worsen them. Regular alcohol use disrupts sleep and neurotransmitter function. Stimulants create crashes that mimic depression. Cannabis in heavy users is associated with depression and apathy. Addressing substance use is part of treating depression comprehensively.

Lifestyle Factors

Sleep deprivation, sedentary lifestyle, poor nutrition, social isolation, and chronic stress all contribute to depression. These are areas where you have real control and where changes can have significant impact – not as a replacement for medication when needed, but as powerful adjuncts to treatment.

Our Approach to Treating Depression

Dr. Fredes takes an integrative, individualized approach to depression treatment. Rather than assuming one-size-fits-all, we start with a comprehensive 60–90 minute initial evaluation to understand your complete picture: your symptoms, timeline, personal and family history, medical conditions, medications, lifestyle, relationships, work situation, and goals for treatment.

We look beyond symptom lists to understand contributing factors. Are you sleeping poorly? That worsens depression. Is your thyroid underactive? That needs addressing. Are you nutritionally depleted? We check. Are there life circumstances we can modify? We explore that. Do you have trauma that needs processing? We discuss referrals for specialized therapy. Is medication needed? We approach that systematically, with evidence-based guidelines and careful monitoring.

Medications for Depression

Antidepressant medications work by restoring balance to neurotransmitter systems. Different medications work on different systems, which is why one medication might work wonderfully for one person and not for another. Finding the right medication is part science, part art.

SSRIs (Selective Serotonin Reuptake Inhibitors)

SSRIs are the most commonly prescribed antidepressants and are usually the first-line choice. They increase serotonin availability in the brain by preventing its reabsorption. Examples include sertraline (Zoloft), escitalopram (Lexapro), paroxetine (Paxil), and fluoxetine (Prozac). SSRIs are generally well-tolerated with relatively few serious side effects, though some people experience sexual dysfunction, weight gain, or activation/agitation. SSRIs typically take 4–6 weeks to reach full effect.

SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors)

SNRIs work on both serotonin and norepinephrine, making them effective for depression with prominent fatigue or motivation loss. Examples include venlafaxine (Effexor), duloxetine (Cymbalta), and desvenlafaxine (Pristiq). Some research suggests SNRIs may be slightly more effective than SSRIs for moderate-to-severe depression, though they have more withdrawal symptoms if stopped abruptly. They work within the same 4–6 week timeframe as SSRIs.

Bupropion (Wellbutrin)

Bupropion is different – it works primarily on dopamine and norepinephrine, not serotonin. It’s excellent for depression with fatigue, motivation loss, or cognitive fog. It’s also less likely to cause sexual dysfunction or weight gain than SSRIs. The downside is a slightly higher seizure risk (minimal at recommended doses) and potential for activation/agitation in some people. Bupropion often combines well with SSRIs when additional symptom relief is needed.

Mirtazapine (Remeron)

Mirtazapine works on multiple neurotransmitter receptors and is especially helpful for depression with insomnia, anxiety, or poor appetite (it increases appetite). It’s often given in the evening because it causes sedation. The main drawback is weight gain, which some people tolerate for the benefit of better sleep and mood. It tends to work quickly – some people notice improvement within 1–2 weeks.

Tricyclic Antidepressants

Older antidepressants like amitriptyline and nortriptyline are less commonly used as first-line treatments because of side effects and safety concerns with overdose. However, they remain useful in specific situations – particularly for depression with chronic pain (where they provide dual benefit) or in lower doses for sleep. Genetic testing sometimes reveals that certain individuals metabolize tricyclics efficiently, making them a good choice.

MAOIs (Monoamine Oxidase Inhibitors)

MAOIs like phenelzine (Nardil) and tranylcypromine (Parnate) are powerful but rarely used first-line because they require dietary restrictions (avoiding high-tyramine foods) and careful medication interactions. They’re reserved for treatment-resistant depression that hasn’t responded to other options. When they’re the right choice, they can be remarkably effective, and many people do well managing dietary precautions.

Augmentation Strategies

When a single antidepressant at therapeutic dose provides partial response, we can add a second medication to boost effect. Common augmentation strategies include: adding bupropion to an SSRI, adding a low-dose antipsychotic (aripiprazole, quetiapine) to increase serotonin activity, adding thyroid hormone to enhance antidepressant response, or combining medications that work on different systems. Augmentation requires careful selection based on your specific symptom profile.

Timeline to Improvement

Antidepressants don’t work instantly. Most take 4–6 weeks at a therapeutic dose to reach full effect, though some people notice improvement within 1–2 weeks. During the first 1–2 weeks, you might notice side effects before you notice benefit – this is temporary and usually improves. We don’t judge response adequately until the medication has been at therapeutic dose for at least 4–6 weeks. If response is incomplete after that time, we adjust: increase dose, add augmentation, or try a different medication. Patience and communication are essential during this process.

Dr. Fredes’ Systematic Approach

Dr. Fredes follows a systematic, evidence-based approach: Start with a thorough evaluation to identify depression type and contributing factors. Select a first-line medication matched to your symptom profile and medical situation. Dosing gradually, monitoring response and side effects. If adequate response isn’t achieved, we adjust systematically – trying higher doses, different medication classes, or combinations. Every medication trial teaches us about your brain’s neurochemistry, bringing us closer to the right match. Treatment decisions are collaborative; your input on side effects and response matters.

When Depression Doesn’t Respond to Initial Treatment

About 30–40% of people with depression don’t achieve remission with the first medication tried. This doesn’t mean you’re “untreatable” or that depression is hopeless. It means your depression requires a more sophisticated approach.

Defining Treatment-Resistant Depression

Treatment-resistant depression (TRD) is defined as failure to achieve remission after two or more adequate trials of different antidepressants at therapeutic doses for sufficient duration (usually 4–6 weeks at each). If you haven’t reached that threshold, we’re still in the adjustment phase – which is normal and expected. Don’t lose hope during adjustments; finding the right medication is often a process.

Our Response to Inadequate Response

When a medication isn’t providing sufficient relief, we explore several paths: Increasing the dose (some people need higher doses to respond), Switching to a different medication class (especially if side effects are problematic), Augmentation with a second medication to boost response, Genetic testing (GeneSight) to identify medications you metabolize most efficiently, Investigating medical factors we might have missed (thyroid function, vitamin levels, sleep apnea, pain conditions). We also ask hard questions: Are life circumstances or trauma playing a role that medication alone can’t address? Would therapy targeting specific patterns help? Is substance use or medication interactions complicating the picture?

Advanced Treatment Options for TRD

For depression that hasn’t responded to multiple medication trials, additional interventions exist: Ketamine-assisted therapy – IV ketamine combined with psychotherapy shows rapid response in 40–70% of TRD cases, with effects sometimes appearing within hours to days. Esketamine (Spravato) – a nasal spray FDA-approved for TRD, typically combined with an oral antidepressant. Transcranial Magnetic Stimulation (TMS) – magnetic pulses targeting specific brain circuits, effective for 50–60% of TRD cases. Electroconvulsive Therapy (ECT) – despite its reputation, ECT is highly effective for the most severe, treatment-resistant cases and works quickly. We discuss which advanced options fit your situation.

The Importance of Reassessment

Sometimes inadequate response reflects something missed in the initial evaluation. We periodically step back and ask: Could this be bipolar depression masquerading as unipolar? Is there a medical condition driving it (chronic illness, hormonal changes, autoimmune disease)? Is trauma or PTSD complicating treatment response? Has substance use resumed? Are there medication interactions? Is sleep still disrupted? Reassessment isn’t a failure; it’s how we refine our understanding and adjust course.

Frequently Asked Questions

How do I know if I’m depressed or just sad?

Sadness is a normal emotional response to life events like loss, disappointment, or stress, and it typically passes with time or shifts when circumstances change. Depression is different – it’s a persistent medical condition lasting at least two weeks that involves not just sadness, but loss of interest in activities you usually enjoy, changes in sleep and appetite, fatigue, difficulty concentrating, and feelings of worthlessness. Depression affects how you function day-to-day, not just how you feel emotionally. If sadness dominates your experience for more than a few days, or if you’ve lost interest in things that usually matter to you, that warrants a psychiatric evaluation to clarify what’s happening.

How long does depression treatment take?

The timeline varies significantly. Antidepressant medications typically take 4–6 weeks to reach their full effect, so we wait at least that long before adjusting dosages or trying something different. Some people feel significant improvement within weeks; others need medication adjustments or combinations to find what works best. Many people notice steady, progressive improvement over 2–3 months with consistent treatment. Early intervention and finding the right medication quickly can shorten the timeline. We work closely with you throughout this process, adjusting as needed and celebrating progress along the way.

Will I need antidepressants forever?

This depends on your specific situation and history. Some people take antidepressants for 6–12 months, achieve full recovery, and discontinue successfully without relapse. Others benefit from longer-term use, especially if they’ve had multiple depressive episodes or have chronic depression. People with a single episode might stop after one year of stability; those with recurrent depression often do better on maintenance therapy long-term to prevent recurrence. Dr. Fredes works with each patient to determine the right duration based on severity of depression, number of previous episodes, life circumstances, and your personal goals. The decision to continue, adjust, or stop medication is made collaboratively with careful monitoring for withdrawal effects and mood changes.

What are the side effects of antidepressants?

Different antidepressants have different side effect profiles. Common side effects include nausea (usually temporary), headaches, insomnia or drowsiness, dry mouth, fatigue, weight changes, and sexual dysfunction – many of which improve after 2–4 weeks as your body adjusts. Some people have minimal side effects; others find them bothersome. The goal is finding a medication that provides relief from depression with side effects you can tolerate or manage. If side effects are problematic, we have options: adjusting the dose, taking the medication at a different time of day (morning vs. night), adding a companion medication to counteract side effects, or switching to a different antidepressant. Open communication about side effects is essential – we can’t help manage them if we don’t know they’re happening.

Can depression come back after treatment?

Yes, depression can recur, particularly if someone has had multiple episodes in the past. The risk of recurrence is significantly higher after multiple episodes than after a first episode. This doesn’t mean treatment failed – it means depression, for some people, is a condition requiring ongoing management, like diabetes or hypertension. The risk of recurrence is significantly lower with continued medication use. This is why we discuss your history of depressive episodes and work together to decide whether short-term treatment or longer-term maintenance therapy makes sense for you. Staying alert to early warning signs and maintaining connection with your psychiatrist helps prevent relapse and catch recurrence early if it happens.

Is depression genetic?

Yes – depression does run in families. If your parents, siblings, or close relatives have experienced depression, bipolar disorder, or anxiety disorders, your genetic risk is elevated. Studies show heritability of depression around 37%, meaning roughly a third of risk is genetic. However, genetics is not destiny. Depression results from a combination of genetic factors, brain chemistry, life experiences, stress, trauma, and medical conditions. Even if depression runs in your family, many people never develop it. If it does develop, recognizing the genetic component helps remove stigma – depression in genetically predisposed families is not a personal weakness; it’s a treatable medical condition. Genetic testing (GeneSight) can sometimes guide medication selection by identifying which antidepressants your body metabolizes most efficiently.

Can exercise help depression?

Absolutely. Research consistently shows that regular exercise is one of the most effective non-medication interventions for depression. It works through multiple mechanisms: improving sleep quality, reducing inflammation, boosting neurotransmitters like serotonin and dopamine, improving cardiovascular function, and providing a sense of accomplishment and control. Even moderate activity like 20–30 minutes of walking several times per week shows measurable benefits in mood. More intense exercise (running, cycling, strength training) tends to show stronger effects. Dr. Fredes always includes exercise recommendations as part of an integrative treatment plan alongside medication when appropriate. Exercise works best combined with other treatments, not as a replacement for medication in moderate to severe depression – but the combination is powerful.

What if my antidepressant isn’t working?

If your antidepressant isn’t providing relief after 4–6 weeks at an adequate dose, we have several evidence-based options. We might increase the dose, add an augmentation medication (a second drug that boosts the effect), switch to a different antidepressant from a different class, or try a combination approach. Some people need genetic testing to understand which medications are metabolized most efficiently by their body. For treatment-resistant depression that doesn’t respond to multiple medications, we explore advanced options like ketamine-assisted therapy, esketamine (Spravato), transcranial magnetic stimulation (TMS), or other interventions. The key is not giving up – there are always more options to try. Treatment-resistant depression is challenging but not hopeless; we have effective tools available.

Insurance & Pricing

We accept major insurance plans to make depression treatment accessible:

Self-pay options and superbills for out-of-network reimbursement are also available. View full pricing details →

Why Choose Dr. Fredes for Depression Treatment?

You see the psychiatrist every time. Dr. Fredes sees every patient herself – no nurse practitioners, no physician assistants, no rotating providers. You develop continuity of care with a board-certified psychiatrist who knows your history, your response patterns, and your goals. This matters enormously in depression treatment, where subtle adjustments and attentiveness make the difference.

Integrative, individualized approach. Rather than defaulting to the same medication for everyone, Dr. Fredes takes time to understand your complete picture: your symptoms, medical history, medications, lifestyle, trauma history, and what you’ve tried before. Treatment is customized to you, not a checklist.

Evidence-based but flexible. Dr. Fredes follows research-backed guidelines while remaining open to individual variation. If standard approaches aren’t working, she explores advanced options. She stays current with literature and brings that knowledge to your care.

Commitment to finding what works. If the first medication doesn’t work, we adjust. If the second doesn’t, we try again. Dr. Fredes’ philosophy is that with depression, persistence and systematic trial-and-adjustment leads to relief in the vast majority of cases.