# Depression > Depression is not sadness with better branding. It is a flatness that outlasts its reasons, takes the colour out of things you loved, and lies to you about whether help would work. It would. It usually does. **Source:** https://www.uniquembhs.com/depression-treatment **Practice:** Unique Minds Behavioral Health Services, LLC. Baltimore, MD: 6810 Park Heights Ave, Suite C6, Baltimore, MD 21215 · Washington, DC: 1402 North Capitol St NW, #1, Washington, DC 20002 · Delaware, OH: 1 W Winter St, Suite 211, Delaware, OH 43015 **Phone:** (443) 538-8400 **Clinically reviewed by:** Dr. Ophilia Mbah, DNP, APRN, PMHNP-BC **Last reviewed:** 2026-08-11 ## Quick answer Depression is a common, treatable condition involving persistent low mood or loss of interest, with changes in sleep, energy, appetite and concentration lasting two weeks or more. Unique Minds treats depression in adults and children across Maryland, Washington, D.C. and Ohio, pairing careful medication management with therapy, in person at our offices or by secure video. ## What depression actually is According to the [National Institute of Mental Health](https://www.nimh.nih.gov/health/topics/depression), depression is a mood disorder that affects how you feel, think and handle daily activities, with symptoms present most of the day, nearly every day, for at least two weeks. It is not weakness, not laziness, and not something people can think their way out of by trying harder. The trying-harder part of the brain is precisely what the illness taxes. It also rarely travels alone. Anxiety, insomnia and substance use commonly arrive with it, in either order, and untangling which came first is part of getting treatment right. ## The shapes depression takes The diagnosis most people mean is **major depressive disorder**. Episodes of low mood or lost interest that meet the two-week threshold and disrupt daily life. But it does not always arrive in that shape, and the variations change the plan: - **Long, low-grade depression.** A flatter, quieter version that has run for years rather than weeks, often mistaken by the person living inside it for a personality trait. Clinicians call it persistent depressive disorder, and it responds to treatment like any other depression. - **Depression around childbirth.** Low mood, anxiety and exhaustion during pregnancy or in the months after it, well beyond the short-lived "baby blues": common, under-reported, and very treatable. - **Depression with a seasonal pattern.** Symptoms that arrive and lift with the time of year, most often through the darker months. - **Depression that has not responded yet.** When two adequate treatments have been tried properly and not worked, that is its own clinical situation with its own next steps, not a verdict on you, and not the end of the options. - **Depression as part of bipolar disorder.** Low episodes that alternate with unusually elevated ones. This distinction is the single most important one an evaluation makes, because antidepressant treatment alone can destabilise [bipolar disorder](/bipolar-disorders-treatment). ## How depression is diagnosed There is no scan or blood test that diagnoses depression. It is a clinical diagnosis, made through an unhurried conversation, a [psychiatric evaluation](/psychiatry-practices/psychiatric-evaluation). That asks four things: - **How long, and how constant.** Symptoms most of the day, nearly every day, for two weeks or more is the threshold that separates depression from an understandably bad fortnight. - **How far it has spread.** Mood is only part of it. Sleep, appetite, energy, concentration, movement and the ability to take pleasure in anything are all part of the picture, and they are often what the person notices first. - **What it is costing.** Work, study, relationships, self-care. The functional cost is what turns a symptom list into a diagnosis. - **What else it could be.** Thyroid disease and other medical conditions, medication side effects, substance use, grief, and, critically, any history of elevated or unusually energised periods that would point to bipolar disorder instead. Risk is asked about directly, because it is safer asked than assumed. Nobody has ever been penalised here for answering honestly. ## What causes it There is no single cause. Per NIMH, research suggests that **genetic, biological, environmental and psychological factors** all play a role, which matches what evaluations actually find: a family history that keeps appearing, a period of loss or prolonged stress, a medical illness or a medication, a stretch of broken sleep, or several of these at once. Two things follow from that. First, depression is not something you caused by being insufficiently grateful or resilient. Second, because several factors feed it, several levers can move it, which is exactly why treatment usually pairs more than one approach. ## How treatment works here Everything starts with a [psychiatric evaluation](/psychiatry-practices/psychiatric-evaluation): your history, your symptoms, medical factors that can masquerade as depression, and. Asked plainly and without drama, whether dark thoughts have appeared, because that changes the plan's urgency, not your welcome. From there, treatment usually pairs two things. [Medication management](/psychiatry-practices/medication-management), where wanted, is a process rather than a prescription: options explained, a careful start, and follow-ups where the dose and choice are tuned to you. [Therapy](/therapy-services/individual-therapy), often [CBT](/therapy-services/cognitive-behavioral-therapy). Works the other side of the street: re-engaging the activities depression has switched off, and challenging the bleak arithmetic it does with your worth. When weekly appointments are not enough support, the plan moves: more frequent sessions, an earlier medication review, and an honest conversation about a higher level of care if that is what the season calls for. ## When to reach out The illness itself will tell you not to bother. That this is just who you are, that help is for worse cases. Those are symptoms talking. Two weeks of most-days flatness is reason enough, and the first appointment is a conversation, not a commitment. ## What it can look like - A mood that stays low, or simply absent, most of the day, most days. - Things you used to enjoy going grey and effortful. - Sleeping too little, too much, or badly either way. - Appetite and weight drifting in either direction. - Thinking through fog: decisions, memory and focus all more expensive. - Tiredness that is not about effort, and guilt that is not about facts. - Irritability, especially in men and teenagers, where sadness hides behind it. - Moving or speaking noticeably slower, or being unable to sit still. - Aches, headaches and stomach trouble with no other explanation. - Thoughts that everyone would be fine without you. (If that one is present, call or text 988 now.) ## How we treat it - [Psychiatric Evaluation](https://www.uniquembhs.com/psychiatry-practices/psychiatric-evaluation) - [Medication Management](https://www.uniquembhs.com/psychiatry-practices/medication-management) - [Cognitive Behavioral Therapy](https://www.uniquembhs.com/therapy-services/cognitive-behavioral-therapy) - [Individual Therapy](https://www.uniquembhs.com/therapy-services/individual-therapy) ## Frequently asked questions ### How do I know it is depression and not just a rough patch? Time and reach. A rough patch tracks its cause and lifts as things change; depression persists for weeks regardless, and it spreads, into sleep, appetite, energy, concentration and the ability to enjoy anything. If most days for two weeks or more have felt flat or heavy, that is the clinical threshold, and it is worth an evaluation. ### Do I have to take antidepressants? No. Therapy alone, medication alone, and the two combined are all evidence-based paths, and the choice is made with you at evaluation. Based on how severe things are, what you have tried, and what you are comfortable with. If you do choose medication, it is started carefully and reviewed at every follow-up, never prescribed and forgotten. ### How long until treatment starts working? Honestly: not instantly. Antidepressants typically need several weeks to show their effect, and therapy builds over sessions. What you should notice early is a plan you understand, a provider tracking your progress with you, and small returns (sleep first, often) that stack. If something is not working, the plan changes; that is what follow-up is for. ### Can depression treatment happen by video? Yes. Both therapy and medication follow-ups work well by secure video, and on the days when leaving the house is the hardest part of the illness, video is not a lesser option. It is the one that actually happens. We see patients this way across Maryland, Washington, D.C. and Ohio ### How is depression diagnosed? Through a clinical interview, not a lab test. Your provider asks how long the low mood or loss of interest has lasted, how far it has spread into sleep, appetite, energy and concentration, what it is costing you, and whether dark thoughts are present. They also check what else could be causing it. Thyroid problems, anaemia, medication side effects, substance use, grief, and bipolar disorder, which is treated very differently. ### Can a physical illness cause depression symptoms? Yes, and this is why the evaluation asks about your medical history rather than only your mood. Thyroid disease, vitamin deficiencies, chronic pain, sleep apnoea and some prescribed medications can all produce genuine depressive symptoms. Finding one does not mean your depression is imaginary. It means part of the treatment plan may sit with your medical doctor, and we will tell you so. ## Sources - Depression. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/depression - Mental Health Medications. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/mental-health-medications ## Related pages - [Bipolar Disorder](https://www.uniquembhs.com/bipolar-disorders-treatment) - [Anxiety Disorders](https://www.uniquembhs.com/anxiety-disorders-treatments) - [Insomnia](https://www.uniquembhs.com/insomnia-treatment) - [Suicide Prevention](https://www.uniquembhs.com/suicide-prevention) --- This page is general health information, not medical advice. In a crisis, call or text 988 (988 Suicide & Crisis Lifeline) any hour, or call 911 in an emergency.