What we treat
Compassionate, evidence-based psychiatric care for depression and mood disorders
Depression affects about 8.4% of US adults in a given year. It is not weakness, and it is not something you can "snap out of." It is a medical condition, and it responds to treatment.
Depression is different from sadness. Sadness fades when circumstances change. Depression is persistent and changes how the brain functions: mood, energy, concentration, sleep, appetite, and the ability to enjoy things. Without treatment it can last weeks, months, or years, and it does not lift just because life improves. It also does not always look like sadness. In men especially, it often shows up as irritability, anger, risk-taking, or withdrawal.
Depression involves changes in the brain circuits and chemical messengers that regulate mood, sleep, energy, and motivation. Medication, better sleep, exercise, and treatment of contributing medical problems can help those systems recover. Dr. Fredes takes time to identify what is contributing to your depression so treatment fits your situation. Whether you have been struggling for years or are noticing symptoms for the first time, an evaluation is a reasonable next step.
Persistent low mood or loss of interest lasting two weeks or more, with changes in sleep, energy, concentration, or self-worth. The most common form of depression, and one that responds well to treatment.
A chronic, lower-grade depression lasting two years or longer, often so long that people assume it is just how they are. Treatment can lift it.
Depression during pregnancy or the first year after childbirth, more severe and longer-lasting than the "baby blues." Care during pregnancy and after birth is a focus of Dr. Fredes' practice, and she weighs medication choices carefully for pregnancy and breastfeeding. Signs of postpartum psychosis (confusion, hallucinations, paranoia, thoughts of harming yourself or your baby, severe inability to sleep) need emergency care now: call 911 or go to the nearest emergency room. Learn more about perinatal psychiatry →
Depression that has not responded adequately to at least two antidepressant trials at adequate dose and duration. It affects roughly 10–30% of people with depression and calls for a more deliberate strategy: augmentation, switching medication classes, combinations, genetic testing, or referral for options beyond standard medication.
Depressive episodes within bipolar disorder need different treatment. Antidepressants alone can trigger mood cycling or mania, so a mood stabilizer is usually the foundation. Telling bipolar from unipolar depression at the first evaluation prevents treatment missteps.
Depression with a clear seasonal pattern, usually worsening in fall and winter as daylight shrinks. Treatment combines light therapy, vitamin D, sometimes medication, and planning ahead of the season.
Mood still lifts briefly when something good happens, alongside increased appetite, oversleeping, and heaviness in the limbs. It responds differently to certain medications, so recognizing the pattern guides treatment.
Low mood and hopelessness alongside worry, tension, and physical anxiety symptoms. Sometimes one medication covers both; sometimes a combination works better.
Depression affects how you feel, how your body works, and how you think. An occasional symptom is normal. Depression means persistent symptoms that interfere with daily life.
Rarely one thing. Depression usually comes from several factors together, and knowing which ones apply to you shapes the plan.
Depression runs in families. A parent or sibling with depression, bipolar disorder, or an anxiety disorder raises your risk, though many people with a family history never develop it.
Medical problems cause or worsen depression more often than people expect: thyroid disease, low B12, folate, vitamin D, or iron, chronic pain, autoimmune and neurological disease, and hormonal changes. Some medications (certain blood pressure drugs, corticosteroids, hormonal contraceptives) can contribute. The initial evaluation screens for these so they can be treated directly.
Loss, breakups, job loss, and health crises can set off an episode. Chronic stress wears down resilience, and childhood trauma creates vulnerability later in life. These are real stressors, and they belong in the treatment conversation.
Alcohol and drug use both cause and complicate depression, often while seeming to relieve it. Poor sleep, inactivity, poor nutrition, and isolation make everything worse, and they are also places where changes help.
Treatment starts with a 60-minute initial evaluation covering your symptoms and their timeline, personal and family history, medical conditions and medications, sleep, lifestyle, relationships, work, and what you want from treatment.
Then we look at what is feeding the depression. Sleeping poorly? That worsens it. Underactive thyroid or a vitamin deficiency? We check and treat. Trauma that needs processing? We discuss a referral for therapy. Medication? We approach it systematically, with evidence-based guidelines and close follow-up.
Different antidepressants act on different brain systems, which is why one medication can work well for one person and not another. The choice is made carefully, based on your symptoms, history, and how you respond.
Selective serotonin reuptake inhibitors (sertraline, escitalopram, fluoxetine, and others) are usually the first choice. They are generally well tolerated, though some people have sexual side effects, weight gain, or agitation. Full effect takes 4–6 weeks.
Serotonin-norepinephrine reuptake inhibitors (venlafaxine, duloxetine, desvenlafaxine) act on two systems and can suit depression with prominent fatigue or low motivation. They can cause more withdrawal symptoms if stopped abruptly. Same 4–6 week timeline.
Works on dopamine and norepinephrine rather than serotonin, which makes it a fit for fatigue, low motivation, or mental fog. It is less likely to cause sexual side effects or weight gain, can be activating in some people, and often pairs well with an SSRI.
Helpful when depression comes with insomnia, anxiety, or poor appetite. Taken in the evening because it is sedating; weight gain is the main drawback. Some people notice benefit within 1–2 weeks.
Older medications such as amitriptyline and nortriptyline are rarely first-line because of side effects and overdose safety. They remain useful in specific situations, especially depression with chronic pain, where they help both, or in low doses for sleep.
Monoamine oxidase inhibitors require dietary restrictions and careful attention to drug interactions, so they are reserved for depression that has not responded to other options. In the right situation they can work when nothing else has, and many people manage the precautions well.
When one antidepressant gives a partial response, adding a second medication can complete it: bupropion added to an SSRI, a low-dose antipsychotic such as aripiprazole, or thyroid hormone. The choice depends on your symptom profile.
Antidepressants do not work instantly. Most take 4–6 weeks at a therapeutic dose, and side effects often appear before benefits do. Dr. Fredes starts with a medication matched to your symptoms and medical situation, raises the dose gradually, and does not judge the response until it has had a fair trial. If the response is incomplete after a fair trial, she makes one change at a time, with follow-up and monitoring after each: a higher dose, augmentation, or a different class. Your feedback on side effects and response drives the decisions.
About 30–40% of people do not reach remission on the first medication. That is common and expected, and it does not mean you are untreatable. It means the plan needs another step.
Treatment-resistant depression (TRD) means inadequate response to two or more adequate trials of different antidepressants, each at a therapeutic dose for at least 4–6 weeks. Before that point, we are still in the normal adjustment phase. A first medication that does not work is common and is not a verdict; changes are made carefully, one at a time, with follow-up.
The options are a higher dose (some people need more to respond), a different class (especially if side effects are the problem), augmentation with a second medication, genetic testing to see which medications you metabolize well, and a second look for medical factors we may have missed: thyroid function, vitamin levels, sleep apnea, pain conditions. We also ask whether life circumstances, trauma, or substance use are limiting what medication can do, and whether therapy targeting specific patterns would help.
Sometimes an incomplete response points back to the diagnosis. We periodically step back and ask: Could this be bipolar depression? Is trauma or PTSD complicating the response? Has substance use resumed? Are there medication interactions? Is sleep still disrupted? Reassessment is how the plan gets better.
Sadness is a normal response to loss, disappointment, or stress, and it usually passes with time. Depression is a persistent medical condition lasting at least two weeks. It brings loss of interest in things you usually enjoy, changes in sleep and appetite, fatigue, trouble concentrating, and feelings of worthlessness, and it affects how you function day to day. If low mood has dominated your days for two weeks or more, a psychiatric evaluation can clarify what is going on.
It varies. Antidepressants typically take 4–6 weeks to reach full effect, so we wait at least that long before adjusting. Some people improve within weeks; others need adjustments or combinations to find what works. Many people notice steady improvement over 2–3 months of consistent treatment, and we adjust the plan with you along the way.
It depends on your history. Some people take an antidepressant for 6–12 months, recover fully, and stop without relapse. People who have had several episodes or chronic depression often do better on longer-term maintenance. Dr. Fredes works with you to decide the right duration based on severity, number of past episodes, life circumstances, and your goals. Any change is made together, with monitoring for withdrawal effects and mood changes.
They differ by medication. Common ones include nausea, headache, sleep changes, dry mouth, fatigue, weight changes, and sexual side effects, and many ease after 2–4 weeks as your body adjusts. If a side effect is a problem, we can adjust the dose, change the timing, add a medication to counter it, or switch. Tell us about side effects; we cannot manage what we do not know about.
Yes, especially after multiple episodes. That does not mean treatment failed. For some people depression is a condition that needs ongoing management, like diabetes or high blood pressure, and the risk of recurrence is lower with continued medication. This is why we review your history of episodes and decide together between short-term treatment and longer-term maintenance. Knowing your early warning signs helps catch a recurrence early.
Partly. Depression runs in families, and having a parent or sibling with depression, bipolar disorder, or an anxiety disorder raises your risk. Genetics is not destiny: depression comes from a mix of genes, life experiences, stress, and medical conditions, and many people with a family history never develop it. Genetic testing can sometimes help guide medication selection.
Yes. Regular exercise is one of the best-supported non-medication treatments for depression. It improves sleep, reduces inflammation, and lifts mood, and even 20–30 minutes of walking several times a week shows measurable benefit. Dr. Fredes includes exercise in the treatment plan alongside medication when appropriate. In moderate to severe depression it works best combined with medication rather than on its own.
If there is no relief after 4–6 weeks at an adequate dose, Dr. Fredes reviews the options with you, usually one change at a time: raising the dose, adding an augmentation medication, or switching to a different class. Genetic testing can sometimes help show which medications your body metabolizes efficiently. For depression that has not responded to several medications, we can discuss a referral for options beyond standard medication.
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Self-pay pricing is posted, and we provide superbills for out-of-network reimbursement. View full pricing details →
You see the psychiatrist every time. Dr. Fredes sees every patient herself: no nurse practitioners, no physician assistants, no rotating providers. You build continuity with one board-certified psychiatrist who knows your history and how you have responded, which matters when treatment depends on small, well-timed adjustments.
Individualized treatment. Rather than the same medication for everyone, Dr. Fredes takes time to understand your symptoms, medical history, medications, lifestyle, trauma history, and what you have already tried.
Evidence-based, with room for the individual. Dr. Fredes follows research-backed guidelines and adapts them to how you respond.
A careful, step-by-step approach. If the first medication does not work after a fair trial, Dr. Fredes makes one change at a time, with follow-up and monitoring after each. When standard approaches are not enough, she discusses augmentation, other classes, and referral for options beyond standard medication.
Schedule a consultation with Dr. Fredes to discuss your depression and explore treatment options.