What It Actually Is: 

Depression isn't sadness. Sadness makes sense. You lose something, you grieve, you feel it, and eventually it passes. Depression is different. It's a flatness that doesn't care if your life is objectively fine. It steals your energy, your motivation, your ability to care about things you used to care about. It makes everything feel pointless. 

Neurologically, we're talking about disrupted serotonin, dopamine, and norepinephrine. Your brain's reward and motivation circuits aren't firing right. That's why you can know you should get up, should exercise, should call someone, and still not be able to make yourself do it. It's not laziness. It's a system malfunction. 

But here's the part that's hard to hear when you're in it: depression lies to you. It tells you nothing will help, nothing matters, and you're too far gone. Those are symptoms, not facts. And at some point, you have to choose to act against what your brain is telling you, even when every cell in your body says don't bother. 

What This Looks Like in Real Life: 

You're exhausted but you didn't do anything. You slept ten hours and woke up tired. Or you can't sleep at all, lying awake at 4am while your brain runs through everything you've ever screwed up. 

Things you used to enjoy feel like obligations now. Hobbies, friends, sex, food. It all just feels like effort. You're going through the motions at work, at home, in conversations. People ask how you're doing and you say "fine" because explaining it feels impossible and pointless. 

Your brain is slow. Concentrating is hard. Making decisions feels overwhelming, even small ones. You start avoiding things because everything requires energy you don't have. The dishes pile up. The emails go unanswered. You stop returning texts. 

Sometimes there's a heaviness in your chest or a numbness that scares you. Sometimes you think about not existing anymore, not necessarily killing yourself, but just... not being here. That's a sign you need help now, not eventually. 

How This Wrecks Things: 

Depression is erosive. It doesn't blow up your life all at once; it slowly degrades everything. Work suffers because you can't focus and you don't care. Relationships suffer because you're withdrawn and irritable, and people get tired of trying to reach you. Your health suffers because you stop exercising, eat like crap (or don't eat at all), and let everything slide. 

The isolation creates a feedback loop. You pull away from people because you don't have the energy for them. Then you're alone, which makes depression worse. So you pull away more. And the thing keeps feeding itself. 

People who love you get frustrated because they can't fix it and they don't understand why you can't just snap out of it. That frustration turns into distance, and then you've got evidence that nobody cares, which your depressed brain was already telling you anyway. 

The Numbers: 

About 7% of U.S. adults experience a major depressive episode in any given year. Women are diagnosed more often, though men are notoriously bad at recognizing or admitting they're depressed. A lot of male depression shows up as irritability, anger, recklessness, or just working constantly to avoid feeling anything. 

The good news buried in the statistics: about 80% of people who get treatment see significant improvement within four to six weeks. Depression is one of the most treatable conditions we deal with. The problem isn't that treatment doesn't work. The problem is people don't get it, or they quit too early. 

What Actually Works: 

The combination of therapy and medication works better than either alone for moderate to severe depression. That's not opinion; that's what the research consistently shows. 

Medication, usually an SSRI or SNRI, helps correct the neurochemical imbalance. It's not a personality change or a happy pill. It just takes the boot off your chest enough that you can start functioning again. Some people need it short-term to get through a crisis. Others have recurrent depression and do better staying on something long-term. We figure out what makes sense for you. 

Therapy, especially CBT, addresses the thought patterns that keep depression going. The negative self-talk, the hopelessness, the all-or-nothing thinking. These aren't just symptoms; they're maintenance factors. If you don'taddress them, you're more likely to relapse. 

Here's the uncomfortable part: you also have to do things you don't feel like doing. Exercise, even when you don't want to. Socializing, even when you'd rather stay home. Getting out of bed, even when it feels impossible. Waiting to feel motivated before you act is a trap. Action comes first. Motivation follows. 

How We Do This: 

We see patients in person and via telehealth across Washington and Oregon. We'll figure out what's driving your depression, get you on medication if that's appropriate, and give you concrete tools to start digging out. 

We're not going to just hand you pills and send you on your way. Depression treatment that works requires engagement. You have to show up, be honest about what's actually happening, and be willing to do things that feel hard. We'll push you, not because we're trying to be harsh, but because staying stuck isn't good for you. 

We also won't pretend that medication and therapy magically fix everything. Sleep, exercise, nutrition, social connection, purpose. These things matter. They're not sexy interventions, but they move the needle. We'll talk about all of it. 

How Often You'll Come In: 

We start with frequent visits, usually weekly or biweekly, to get medication adjusted and make sure you're moving in the right direction. Once things stabilize, we spread out to monthly or as needed. Depression management is a long game. We're not trying to get you through a crisis and then disappear. We're trying to help you build something sustainable.