Depression care that asks why
Depression is more than sadness. It can feel like heaviness, numbness, exhaustion or a loss of interest in things that used to matter. It affects sleep, appetite, concentration and relationships, and it often makes asking for help harder than it should be. Depression is treatable, and many people who have only partly improved with one approach do better when care looks at the whole picture: mind, body and life.
Signs of depression
- Low or empty mood most days for two weeks or more
- Loss of interest or pleasure in usual activities
- Fatigue, low energy or feeling slowed down
- Sleeping much more or much less than usual
- Changes in appetite or weight
- Difficulty concentrating or making decisions
- Feelings of worthlessness, guilt or hopelessness
- Thoughts that life is not worth living
If you are having thoughts of suicide or self-harm, call or text 988 now, or call 911.
Why depression sometimes doesn’t lift
Standard treatment helps many people, but a significant number continue to struggle after one or two medications. When that happens, it is worth asking what else is going on. Common contributors include:
- Thyroid problems. An underactive thyroid can cause low mood, fatigue and weight gain. See thyroid and mental health.
- Nutrient deficiencies. Low iron, vitamin B12, folate and vitamin D are common and can mimic or deepen depression. See vitamin D and depression.
- Inflammation. Some people with depression have raised inflammatory markers, which may affect motivation and treatment response. See inflammation and depression.
- Sleep problems. Insomnia and untreated sleep apnea both worsen mood. See sleep and insomnia.
- Hormonal transitions. Postpartum and perimenopausal changes are common triggers. See perinatal and postpartum mental health.
- Seasonal patterns. Low winter daylight in the Pacific Northwest affects many people. See seasonal affective disorder.
- Bipolar spectrum. Depression with past periods of unusually high energy or reduced need for sleep needs a different approach. See bipolar disorder.
Read more in depression that doesn’t lift and whole-body depression.
How we treat depression
A thorough assessment
We start with a detailed history of your mood, past treatments, sleep, diet, medical conditions, medications and life circumstances, and recommend targeted labs where they would change the plan.
Psychotherapy
Therapy helps with the thinking patterns, withdrawal and loss of routine that keep depression going. Behavioral activation, gradually rebuilding meaningful activity, is one of the most effective tools and can start right away.
Body-based foundations
We correct deficiencies, treat sleep problems, support regular meals and use physical activity and daylight, all of which have evidence behind them for mood. See nutritional psychiatry.
Medication when it helps
Antidepressants are effective for many people, especially with moderate to severe depression. We review past responses, side effects and options carefully, and adjust over time. See psychiatric medication management.
Our providers are licensed naturopathic physicians and mental health counselors led by Dr. Koichi Tanji, ND, LMHC. In Washington, controlled substances such as ADHD stimulants and benzodiazepines are outside naturopathic prescribing scope, so when one is part of the right plan we coordinate with your prescribing physician or nurse practitioner.
Depression in teens and young adults
In teenagers, depression often looks like irritability, withdrawal, slipping grades, sleeping very late or all day, and dropping activities they used to enjoy, rather than obvious sadness. Heavy late-night screen use, poor sleep, skipped meals and social stress can all feed into it. We work with teens and their parents together, look at sleep, nutrition and screen habits, and coordinate with schools where helpful. See screen dependency.
Small steps that help while you wait for an appointment
- Keep a regular wake-up time, even after a poor night, and get outdoor light in the morning.
- Eat regular meals with protein rather than skipping and grazing.
- Plan one small, doable activity each day that used to bring you satisfaction.
- Move your body for 10 to 20 minutes, even a short walk.
- Cut back on alcohol, which worsens sleep and next-day mood.
- Tell one trusted person how you are really doing.
Measuring progress
We track progress with the PHQ-9 questionnaire alongside goals that matter to you, such as getting back to work, sleeping through the night or enjoying time with family. If part of the plan is not helping, we change it.
Related reading: holistic depression treatment, integrative psychiatry and men’s mental health.
Getting started
We see patients in person at 2135 112th Ave NE, Suite 201, Bellevue, and by secure telehealth anywhere in Washington. We are in-network with Premera, Regence, BlueCross BlueShield, Aetna, Cigna and Kaiser PPO. Most people begin with our Biopsych Assessment. Book online or call (425) 278-6166.
If you are in crisis or thinking about harming yourself, call or text 988 (Suicide & Crisis Lifeline) or call 911.
