Major depressive disorder, persistent depressive disorder, treatment-resistant depression. Full spectrum of care — medication, Spravato®, TMS, pharmacogenomics — in California.
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Depression is more than feeling down. Clinical depression is a persistent low mood, loss of interest, and physical changes (sleep, appetite, energy) that interfere with your ability to live your life. It can show up as sadness, irritability, numbness, hopelessness, or a sense that nothing matters.
Depression is highly treatable, and treatment options keep expanding. For most patients, an SSRI or SNRI plus therapy is enough. For patients who haven't responded to multiple medications — what we call treatment-resistant depression (TRD) — newer options like Spravato® (esketamine) and TMS can be game-changing.
Common diagnoses we treat: major depressive disorder (MDD), persistent depressive disorder (dysthymia), postpartum depression, seasonal affective disorder, and treatment-resistant depression.
If symptoms are interfering with daily life — or if you've felt this way for more than two weeks — it's worth a conversation with a psychiatrist.
Effective treatment usually combines medication, therapy, and lifestyle factors. We work with you to find the right combination.
First-line treatment. Sertraline, escitalopram, venlafaxine, duloxetine. About 50% of patients respond to the first medication.
Bupropion, mirtazapine, vortioxetine — useful when SSRIs aren't working or cause side effects.
FDA-approved for treatment-resistant depression. Different mechanism than traditional antidepressants. Learn more →
Drug-free, non-invasive magnetic stimulation. FDA-cleared for major depression. Learn more →
Genetic testing to guide medication selection — fewer trial-and-error switches. Especially useful after 2+ failed trials.
Adding lithium, atypical antipsychotic, thyroid hormone, or another antidepressant to enhance response.
Depression treatment is often a process of finding the right combination. We don't believe in "fail first" mandates — if you've already tried multiple medications without relief, we move quickly toward Spravato or TMS evaluation rather than recycling through old options.
Initial evaluations are 60–90 minutes. We screen for medical contributors (thyroid, B12, sleep apnea), substance use, and life circumstances that affect treatment choice. If you've never had pharmacogenomic testing and you've had 2+ failed medication trials, we usually order it at the first visit.
As an integrated practice, we can move you between standard medication, Spravato, and TMS based on response — no referral handoffs.
Four California clinics for in-person care, plus TelePsychiatry for patients anywhere in the state.
Typically 4–6 weeks for full effect, with many patients noticing some improvement around weeks 2–3. If there's no meaningful response by 4 weeks, we usually adjust dose or switch.
Yes — for some patients, anxiety, GI upset, or sleep changes are temporarily worse in the first 1–2 weeks before improving. We discuss this at the first visit so you know what to expect and when to call us.
You may have treatment-resistant depression. Next steps usually include pharmacogenomic testing, Spravato® or TMS evaluation, and reviewing for missed factors (thyroid, sleep apnea, low testosterone, substance use).
Most major insurance, Medicare, and California Medi-Cal cover both for treatment-resistant depression when criteria are met. We handle prior authorization.
Yes. Standard medication management can be done entirely via TelePsychiatry. Spravato and TMS require in-person visits at our Pleasant Hill clinic.
