Depression Psychiatrists: In-Person and Online

What is Depression?

Many individuals may report having brief, fleeting periods of what they might call “depression” during the course of their lives.  In fact, feelings of sadness or loss of interest in activities are normal and common in many individuals who may not meet a criteria for an established depressive disorder.  What differentiates these experiences from clinical depressive disorders is their intensity, duration and the clear negative impact that depressive symptoms have on a person’s life.

Compared to more common feelings of occasional sadness, clinical depressive disorders usually last for much longer, are more intense and have great impact on someone’s personal life, their work, physical health, and relationships.  When individuals are experiencing this level of disruption in their life as a result of their mood, they may likely benefit from seeking treatment from a mental health professional.

What Are The Symptoms of Depression?

The primary features of depression are 1) a depressed mood for most of the day, nearly every day or 2) reduced interest or pleasure in nearly all activities most of the day, nearly every day.  Many other symptoms commonly accompany depression such as:

• Significant weight gain or loss / changes in appetite
• Disruption in sleep such as insomnia (sleeping much less than usual) or hypersomnia (sleeping much more than usual)
• Slowed movements or slowed speech
• Low energy / fatigue
• Feelings of worthlessness or excessive guilt / shame
• Diminished ability to concentrate and indecisiveness
• Recurring thoughts of death, suicide, or self-harm

If you are experiencing suicidal thoughts, you may need immediate help.  You can receive immediate support by calling 988 or going to your nearest emergency department.

Types of Depression & Depressive Disorders

Major Depressive Disorder

The two more common depressive disorders are Major Depressive Disorder (MDD) and Persistent Depressive Disorder (PDD).

Major Depressive Disorder (MDD), also known as major depression is characterized by either a depressed mood for most of the day, nearly every day and/or a reduced interest or pleasure in nearly all activities for most of the day, nearly every day for at least two weeks but often longer.  The person must also have disruption in a number of other areas of their life that are listed above, including disruptions in sleep, movement/speech, energy, feelings of worthlessness, concentration, libido, or suicidality.  These symptoms must cause problems in a person’s daily life in order to meet criteria for the diagnosis.

Persistent Depressive Disorder (PDD) is a less common but more chronic form of depression.  Previously known as dysthymia, PDD is defined by a depressed mood for most of the day, for more days than not for at least two years.  Common symptoms accompanying low mood are changes in appetite, sleep disruption, low energy, low self-esteem, difficulty concentrating, lower libido, and feelings of hopelessness.  These symptoms must cause problems in a person’s daily life in order to meet criteria for this diagnosis.

Postpartum Depression

Peri-partum / Postpartum Depression is when an individual either during their pregnancy or within months after childbirth experiences the symptoms of major depression.  This is different than the “baby blues” or the expected adjustments that come with having an infant.  Many new mothers report having sleep disruptions, anxiety and/or irritability.  By comparison, peri-partum / postpartum depression features significantly low mood and/or interest in normally pleasurable activities lasting for most of the day, nearly every day, which occur with many other features of depression and interfere with the person’s ability to function normally.

Seasonal Affective Disorder

Seasonal Affective Disorder (SAD) or seasonal depression is a form of depression that follows patterns of the seasons.  Typically, individuals will report symptoms of major depression occurring in the fall and winter months and improvement in the spring and summer months.

Premenstrual Dysphoric Disorder

While many women may report symptoms of premenstrual syndrome (PMS) in the days or weeks leading up to their period, Premenstrual Dysphoric Disorder (PMDD) is a more severe form of this condition.  PMDD is different in that it includes severe mood swings, marked irritability, significant depression, and/or severe anxiety or tension.  These symptoms tend to improve in the days after the person’s period begins and are absent in the weeks after their period.

Perimenopausal Depression

While menopause for most women may not result in significant distress, for others, the period from early to late menopause may represent a higher risk of emotional distress.  This is particularly true for women who have a prior history of clinical depression.  Some individuals in perimenopause (the period around when menopause is occurring) may experience symptoms of major depression and could benefit from an evaluation to determine whether treatment could be beneficial.

Depression in Children

It is thought that depression is one of the most under-diagnosed psychiatric and medical conditions in children. Depression and other mood disorders cause an individual to feel emotional distress that can be severe and persistent. Many do not realize that depression can occur even when a child or adolescent has a healthy and supportive environment – this is why these conditions are called “disorders,” as one’s emotional state is not fully explained by their environment.

Children and Adolescents often lack the ability to articulate their emotions and feelings, which can make recognizing and diagnosing depression and mood disorders in children and adolescents challenging. It can be incredibly frustrating for a child to feel inner distress, sadness or other symptoms, without the ability to understand why they are feeling that way, and the ability to articulate their emotions.

Mood Disorders are treatable medical conditions, and psychiatric diagnosis and treatment should be started as early as possible, to reduce the long-term effects of the illness. “Treatment” does not always mean medication management, but we believe that it is vital that children are evaluated by an experienced child and adolescent psychiatrist, who can discuss all options and monitor symptoms and progress over time.

How Does Rittenhouse Psychiatric Associates Treat Depression?

Your First Visit for Depression

During your initial visit with an RPA provider, you will get a chance to review your concerns.  The provider will ask a number of questions about the symptoms you’ve been experiencing, any history of mental health concerns, your medical history as well as other relevant parts of your background.  Your provider will also ask about your goals, or how you would know if you’re getting what you want from the treatment you receive.

Based on this information, your provider will offer an initial diagnosis.  With this diagnosis your provider can identify treatment options that have shown to be effective for others with a similar collection of symptoms, whether that be medication, talk therapy or some combination of these options. With a team of psychiatrists, nurse practitioners, psychologists, and psychotherapists, there are many options to help address your needs.

Therapy

The psychotherapists at RPA are professionals with a diverse array of training and specialties.  While all offer talk therapy, their training, backgrounds and specialties present a variety of options for patients to choose from depending on their presenting problems and preferences.  All psychotherapists have been trained in evidence-based practices including Cognitive Behavioral Therapy or CBT.  CBT is one of the more well-established and widely researched treatment options, offering effective care across a wide range of mental health problems including depression, anxiety disorders, trauma, addictions and compulsive behaviors, insomnia and others.  Some therapists offer other established treatment modalities as well, including Eye Movement Desensitization and Processing (EMDR), and problem solving approaches.  Psychotherapy can be conducted either in-office or virtually, with many providers being able to see patients virtually in most states in the U.S.

Medication Management

For moderate to severe depression episodes, a combination of therapy and medication should be considered. This combination typically yields the best results. However, due to preferences, time constraints, financial constraints, or other factors, some patients choose one or the other. One of these treatments is certainly better than no treatment at all. Mild depression can sometimes be improved with therapy and lifestyle changes.

There are many medications that can be used for major depressive disorder. The right medication(s) for an individual is/are chosen after careful evaluation which includes consideration of past medication trials, medical condition(s), co-occurring substance use, symptoms present, side effect risks, and preferences of the patient. The most common types of medications used include: SSRIs (selective serotonin reuptake inhibitors), SNRIs (selective serotonin norepinephrine inhibitors) and “other” antidepressants (such as Wellbutrin and Trintellix),) whose mechanisms do not fit into these categories. Less commonly used are TCAs and MAOIs. Medication effects and benefits should be monitored at regular intervals.

Depression Medication Management Available in these States:

• California
• Delaware
• Florida
• Maryland
• Massachusetts
• New Jersey
• New York
• Pennsylvania
• US Virgin Islands

How to Choose a Depression Treatment Provider

There are several options for finding a psychiatrist or psychiatric nurse practitioner who offers Depression Treatment near you. This process can seem overwhelming (particularly if you are struggling with depression or mood instability). However, finding a mood disorder specialist is no different from finding a specialist in other fields of medicine.

• Talk to your doctor about psychiatrists near you who treat depression and mood disorders.
• Call local hospitals and teaching institutions and ask what doctors they recommend.
• Call your insurance carrier and ask about depression treatment near you.
• Search the internet for psychiatrists who treat depression or bipolar affective disorder.
• If you have family or friends who have seen local psychiatrists who specialize in depression or mood disorder treatment, it may be reasonable to ask if they would recommend (or not recommend) a certain doctor or psychiatrist.
• National mental health resources are also available for you to discover more about depression treatment.

Rittenhouse Psychiatric Associates In-Person Depression Treatment Locations

• Wilmington, DE
• Collingswood, NJ
• Manhattan, NY
• Center Valley, PA
• Paoli, PA
• Philadelphia, PA
• Pittsburgh, PA