Depression is a medical condition. It deserves to be treated like one.
Talk with a licensed physician about how you're actually doing, from home and usually within 24 to 48 hours. A thorough evaluation, your options explained in plain English, and follow-up that doesn't end when the visit does.
It's more than sadness.
Plenty of people with depression don't feel especially sad. They feel flat. Tired in a way sleep doesn't fix. Things that used to matter stop mattering. That's not a character flaw or a bad attitude. It's a treatable medical condition, and a common one: roughly one in five U.S. adults will experience major depression at some point in their lives.[1] It is also badly under-caught, which is why national guidelines now recommend screening every adult for it in ordinary primary care. Not because everyone is depressed, but because so many people who are never get asked.[2]
What it often looks like
- + Energy that's simply gone: small tasks feel enormous
- + Sleep that's off: too little, too much, or never restful
- + Losing interest in things you used to enjoy
- + Trouble concentrating, deciding, or finishing anything
- + Appetite changes, irritability, or a constant heaviness
- + A quiet feeling that you're a burden or that nothing helps
When it's time to talk to a doctor
- + Symptoms have stuck around most days for two weeks or more
- + Work, relationships, or basic routines are getting harder
- + You're using alcohol or anything else to get through the day
- + "Waiting it out" hasn't worked. It rarely does on its own
- + You keep wondering whether this is normal. That's reason enough.
Thorough first, then a plan.
A lot of online depression care is a five-question quiz and a canned answer. That's not medicine. Here's what care at everydaymd actually looks like.
A real first visit
A private video visit with a licensed physician, and enough time to take an honest history. How you sleep, what your energy is like, what you've tried before, what else is going on medically. Your doctor also screens carefully for the things that change the plan entirely, like bipolar disorder. Before that first visit, you'll review our telehealth consent so there are no surprises about how online care works.
A plan you understand
Your doctor tells you what they found and what they think it means: what's likely driving this, what's worth doing first, and what the honest trade-offs are. If treatment is appropriate for you, that's a conversation for your visit, and your doctor explains the options that fit your history in plain English. If the right move is to start somewhere other than treatment, they'll say that too.
Follow-up, built in
Depression care is measured, not guessed at. At follow-ups your doctor tracks your symptoms with the same kind of structured check-ins used in clinical practice, so you can both see whether things are genuinely improving, and change course if they're not. What you won't get here is one conversation and a doctor who disappears.
What your doctor will ask
- + How long this has been going on, and what it's costing you: sleep, energy, work, relationships
- + Your medical history, plus everything you currently take, including supplements
- + What you've already tried, and how honestly each attempt went
- + Screening questions about mood swings and about safety. We ask everyone, every time
- + Alcohol and substance use, honestly. It changes the plan, never the welcome
- + What "better" would actually look like for you
Not everything that looks like depression is.
This is the part a questionnaire can't do. Several conditions produce the exact same symptoms (flat mood, no energy, poor sleep, foggy thinking), and each one leads somewhere different. A physician's job is to work out which one you're actually dealing with before deciding anything:
- Thyroid disease. An underactive thyroid mimics depression closely enough that it's worth a lab check rather than an assumption.
- Anemia and low B12. Both flatten energy and concentration, and both are ordinary blood tests away from an answer.
- Sleep apnea. If you sleep eight hours and wake up exhausted, untreated apnea can look exactly like depression. Treating the wrong one gets you nowhere.
- Alcohol. A depressant, reliably, and in quantities most people underestimate. Your doctor asks without judgment because it changes the picture.
- Bipolar disorder. Its depressive episodes are indistinguishable from major depression in the moment, and the distinction matters enormously. So your doctor screens for it every time.
- Grief and situational lows. Sometimes the honest answer is that a hard thing happened and you're responding to it like a human being. That deserves saying out loud, not medicalizing.
Sorting this out is most of the value of an unrushed visit with a physician, and it's the part that gets skipped when care is designed around volume.
The options, without the spin.
If medication turns out to fit your situation, these are the ones patients ask about most, and the ones a physician is most likely to discuss first. One thing worth knowing up front: in the largest head-to-head analysis to date, covering 522 trials and more than 116,000 patients, every major antidepressant outperformed placebo. Some performed modestly better than others, but the gaps between them were far smaller than the gap between treating and not treating, which is why side effects and personal fit weigh so heavily in the choice.[3] Other options, including SNRIs like venlafaxine and duloxetine, may come up depending on your symptoms and history.
Sertraline
Often the first option discussed, and one of the best-studied antidepressants there is. Steady on both low mood and the worry that travels with it, and early nausea or jitteriness typically fades within a couple of weeks.
Escitalopram
A close cousin of sertraline with one of the better tolerability records in head-to-head comparisons. A common choice when you want the fewest surprises, though sexual side effects are still possible.
Bupropion XL
Works on dopamine and norepinephrine instead of serotonin, so it tends to be energizing rather than sedating and usually spares sexual side effects and weight gain. It is not safe for people with seizure disorders or certain eating disorders.
Mirtazapine
Often chosen when sleep and appetite have taken the biggest hit. Taken at night, sleep frequently improves within days and mood more gradually, with daytime drowsiness and weight gain as the honest trade-offs.
Examples patients ask about, not a menu and not a promise. Your doctor prescribes only what fits your history, and anything prescribed is dispensed and billed by an independent licensed pharmacy, never by everydaymd.
Important safety information
Antidepressants carry a boxed warning for an increased risk of suicidal thoughts and behaviors in people 24 and younger, particularly in the first weeks of treatment and after dose changes. Anyone starting treatment should be monitored, and worsening mood or new suicidal thoughts mean contacting your clinician immediately, or calling or texting 988 any time, day or night.
Do not stop an SSRI abruptly, because doses are tapered rather than dropped. Combining serotonergic medicines can cause serotonin syndrome. This is not a complete list of risks, and the physician who evaluates you reviews your full history before writing any prescription. In an emergency, call 911.
The foundations do real work.
Medication, when it is part of the plan at all, is one tool rather than the whole plan. Talk therapy is one of the best-evidenced things available for depression. Across 115 studies, cognitive behavioral therapy produced substantial improvement, and it holds up well against the other treatments researchers have compared it with.[5] The care here is medical, not therapy, so we won't pretend to replace a good therapist. We will encourage you to work with one, help you think through what kind fits, and keep the medical side moving in step with it.
There are also foundations that make everything else work better. Nothing mystical. Just physiology:
- Sleep on a schedule. Depression wrecks sleep, and wrecked sleep deepens depression. A consistent wake time is one of the highest-yield changes available to you.
- Movement, even modest. Exercise measurably improves depressive symptoms in randomized trials, walking included, at a level that doesn't require becoming a different person.[6] Start smaller than you think you should.
- Daylight, early. Morning light helps anchor the sleep and energy rhythms depression disrupts.
- Honest accounting of alcohol. Alcohol is a depressant, and it quietly works against nearly everything else you might try. Your doctor will ask, without judgment, because it changes the plan.
Your doctor will help you pick one or two of these to start, not all of them at once, because "overhaul your whole life" is terrible advice for someone whose energy is already gone.
Who this isn't for.
Telehealth is a good setting for evaluating and managing most depression. It is the wrong setting for some situations, and we'd rather tell you that now:
- Active suicidal thoughts or recent self-harm. This needs same-day, in-person care. A video visit cannot provide that level of safety. Use 988, 911, or your nearest emergency department.
- Bipolar disorder. Treating it as though it were ordinary depression can make it worse, which is one reason our first visit screens for it carefully. Managing bipolar disorder well takes a psychiatric specialist and a level of monitoring this setting isn't built for. So if that's what your doctor finds, they'll say so plainly and point you toward the right care instead of pressing ahead anyway.
- Under 18. everydaymd serves adults only. Depression in teenagers is real and treatable, but it belongs with pediatric and adolescent specialists.
- Severe or psychotic depression. If symptoms include losing touch with reality, or you can't manage basic daily care, in-person psychiatric treatment is the safer starting point.
If any of this describes you and you're not sure where to turn, you can still call us at (412) 407-3389. We'll help you find the right door, even when it isn't ours.
Real progress is quiet: sleep, energy, and interest coming back.
Depression care, straight answers.
That's the question most people arrive with, and it's a fair one. Sorting it out is exactly what the visit is for. The rough line is duration and reach. A rough stretch tracks with what's happening in your life and lifts when circumstances do. Depression sticks around most days for two weeks or more, and it starts pulling down things it has no business touching: your sleep, your work, your interest in people you love. If you've been quietly wondering for a while, that's reason enough to ask.
You talk with a licensed physician on video, unrushed. They take a full history: how long this has run, what it's costing you, what you've tried, your medical background. They also screen carefully for the things that change the plan, like bipolar disorder or a thyroid problem hiding underneath. Then they tell you plainly what they think is going on and what they'd do about it. If treatment is appropriate for you, that's part of the conversation. You leave understanding your own situation.
If medication is part of your plan, expect 2 to 6 weeks at an effective dose before mood clearly lifts, and improvement typically begins within the first two weeks and builds from there.[4] Sleep, appetite, and energy often improve first, and interest and mood usually follow. That is exactly why follow-up is built into the care here. Your doctor checks your symptoms in a structured way at around the four-week mark and adjusts if the trend isn't right, rather than leaving you to wonder.
Then the plan changes. This is common, and it is not a sign that you are untreatable. Roughly half of people respond well to the first antidepressant they try. For everyone else, the options are raising the dose, switching to a different medication or class, or adding a second agent, and in the largest real-world study of depression treatment, most people who kept working through those steps eventually reached remission.[7] Because your follow-ups are with the same practice, using measured symptom check-ins, your doctor catches a non-response early instead of letting months drift by.
Most people aren't. A typical first course runs six to twelve months after you are feeling well, and then, if you and your doctor agree, you taper down gradually and see how you do. Some people with repeated episodes reasonably choose to stay on longer, and that is a decision the two of you make together and revisit over time. What doesn't happen is stopping abruptly. Coming off antidepressants suddenly can cause dizziness, irritability, and flu-like discontinuation symptoms, so tapering is always planned and supervised.
No, and we think it's important to say that clearly. Bipolar disorder deserves specialist psychiatric care with closer monitoring than this setting can offer, and mistaking it for ordinary depression can make things worse. Your doctor does screen for it during your first visit, because depressive episodes in bipolar disorder can look identical to major depression from the inside. If that's what your history suggests, your doctor will tell you honestly and help you find appropriate care rather than pressing ahead with a plan that doesn't fit.
Yes. Visits happen over a HIPAA-secure video platform, and your records are confidential. Because everydaymd is cash-pay, no insurance company is billed and no claim about your mental health care is filed with an insurer. The details are in our Privacy Policy and HIPAA Notice.
A single visit is a flat $149, or the membership is $99 a month and includes your initial visit, ongoing video visits, unlimited secure messaging, and adjustments to your plan. That suits depression care well, since the useful part happens over months, not in one sitting. That fee pays for your physician's time, and there are no hidden fees stacked on top of it. It does not include medication of any kind. If your doctor prescribes something, that prescription goes to an independent licensed pharmacy, which sets its own price and bills you directly. Full details in our pricing section.
Sources
- Hasin DS, et al. "Epidemiology of Adult DSM-5 Major Depressive Disorder and Its Specifiers in the United States." JAMA Psychiatry. 2018;75(4):336–346. PubMed
- US Preventive Services Task Force. "Screening for Depression and Suicide Risk in Adults: US Preventive Services Task Force Recommendation Statement." JAMA. 2023;329(23):2057–2067. USPSTF
- Cipriani A, et al. "Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis." Lancet. 2018;391(10128):1357–1366. PubMed
- Taylor MJ, Freemantle N, Geddes JR, Bhagwagar Z. "Early Onset of Selective Serotonin Reuptake Inhibitor Antidepressant Action: Systematic Review and Meta-analysis." Arch Gen Psychiatry. 2006;63(11):1217–1223. PubMed
- Cuijpers P, Berking M, Andersson G, et al. "A meta-analysis of cognitive-behavioural therapy for adult depression, alone and in comparison with other treatments." Can J Psychiatry. 2013;58(7):376–385. PubMed
- Noetel M, et al. "Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials." BMJ. 2024;384:e075847. PubMed
- Rush AJ, et al. "Acute and Longer-Term Outcomes in Depressed Outpatients Requiring One or Several Treatment Steps: A STAR*D Report." Am J Psychiatry. 2006;163(11):1905–1917. PubMed
Ready when you are.
Depression makes starting anything feel impossible. So we made this part small: book a time, and within a day or two you're talking to a physician who listens.
Start your visit →