Depression & mood disorders

Depression is common; depression that has not responded to several adequate treatments is less so, and it deserves a different kind of attention. Much of Dr. Pellionisz’s work is with people for whom the standard sequence has not worked.

Who this is for

• A first episode of major depression, where getting the initial treatment right matters most.
• Recurrent depression, or depression that returns each time treatment is stopped.
• Persistent depressive disorder — the long, low-grade course that is easy to mistake for temperament.
• Depression that has not responded to two or more antidepressants at adequate dose and duration.
• Depression complicated by anxiety, insomnia, attention difficulties or a possible bipolar course.

How we evaluate

“Treatment-resistant” is a description, not a diagnosis. Before adding a fourth medication the practice asks what the first three actually showed: were they taken at a therapeutic dose, for long enough, and did anything change? Was the diagnosis right — is this unipolar depression, or a bipolar-spectrum illness, or a mood disorder secondary to a medical or sleep problem? The evaluation builds a longitudinal timeline of episodes, treatments and responses, so that the next step is chosen from evidence rather than from the last thing tried.

Treatment

• Medication, precisely. Antidepressant selection and optimization, augmentation strategies, and — where the history warrants it — a change of diagnostic frame that changes the medications altogether.
• Psychotherapy. Evidence-based approaches delivered in the practice or in coordination with your existing therapist.
• Image-guided TMS. For depression that has not responded to medication, transcranial magnetic stimulation with personalized targeting informed by your own imaging. Read about TMS in this practice.
• Measurement. Standardized symptom measures at each visit, so that improvement is documented and the plan changes when it stalls.