Online depression treatment
in California.

Screening for bipolar before treating depression

This step is non-negotiable — and often skipped by providers who aren't careful. Starting antidepressants in someone with undiagnosed bipolar disorder can trigger manic or hypomanic episodes. Before initiating antidepressant treatment, the evaluation screens for a lifetime history of elevated mood, decreased need for sleep, racing thoughts, increased goal-directed activity, and other signs that the depression may be part of a bipolar spectrum disorder.

This doesn't mean bipolar will be found. Most people presenting with depression have unipolar depression. But checking matters, and the treatment approach is meaningfully different when bipolar is present.

What depression looks like clinically

Major depressive disorder requires at least two weeks of depressed mood or loss of interest, plus associated symptoms that impair functioning. Common presentations include:

• Persistent low mood, hopelessness, or emotional numbness
• Loss of interest in things that previously gave pleasure (anhedonia)
• Significant changes in sleep — insomnia or hypersomnia
• Fatigue and low energy that doesn't respond to rest
• Cognitive changes — poor concentration, indecision, slowed thinking
• Appetite changes and unintended weight gain or loss
• Withdrawal from social interaction
• Feelings of worthlessness or excessive guilt
• In some cases, thoughts of death or suicide

Persistent depressive disorder (dysthymia) involves a lower-grade but chronic depressed mood lasting at least two years. It often goes unrecognized because it becomes a person's baseline rather than an obvious episode.

Medication options for depression

Antidepressants typically take 4–6 weeks to produce meaningful symptom change, and 8–12 weeks to see full effect at an adequate dose. This timeline matters — and is one of the most important things to understand before starting.

SSRIs

Selective serotonin reuptake inhibitors are typically the first-line choice for depression. Sertraline (Zoloft) and escitalopram (Lexapro) are often preferred because of their tolerability profiles. Fluoxetine (Prozac) has a longer half-life, which can be an advantage or a disadvantage depending on the situation. Paroxetine (Paxil) has more side effects and discontinuation symptoms than others in the class.

SNRIs

Serotonin-norepinephrine reuptake inhibitors — venlafaxine (Effexor) and duloxetine (Cymbalta) — are often chosen when pain, anxiety, or fatigue is a significant component alongside depression. Duloxetine is also FDA-approved for chronic pain conditions that frequently co-occur with depression.

Bupropion

Bupropion (Wellbutrin) works on dopamine and norepinephrine rather than serotonin. It's often chosen when motivation, energy, and concentration are the primary complaints, or when sexual side effects from SSRIs/SNRIs are a concern. It's also used for smoking cessation and has some evidence for ADHD.

Mirtazapine

Mirtazapine works differently from SSRIs and can be effective when sleep, appetite, and anxiety are prominent. Its sedating properties make it typically dosed at night. It's sometimes added to other antidepressants rather than used as monotherapy.

What to expect in the first 6–8 weeks

Side effects often appear before benefits do. Sleep and appetite changes frequently improve before mood does. A meaningful reduction in depressive symptoms typically appears around weeks 4–6. If there's no response by 8 weeks at an adequate dose, the medication, the dose, or the diagnosis warrants review.

When medication isn't working

"My antidepressant isn't working" is a common and important situation that requires a systematic review, not a reflex switch to a different medication. Possible explanations include:

• Inadequate dose or duration — the most common explanation; many antidepressants are underdosed or not given enough time
• Missed diagnosis — undiagnosed bipolar disorder, ADHD, hypothyroidism, or substance use can all limit antidepressant response
• Medication interaction — other medications can affect how antidepressants are metabolized
• Adherence — inconsistent use reduces efficacy
• Augmentation — adding a second medication to enhance the primary antidepressant's effect is sometimes more effective than switching

Each of these possibilities is considered before concluding that a medication has failed.

Insurance and cost

Accepted plans: Aetna, Cigna, Quest Behavioral Health, Carelon Behavioral Health, Anthem Blue Cross California. Questions? Call (323) 970-2625 or see insurance details.

How telehealth works

All appointments are via secure video — no in-person visit required. You need a device with a camera, a stable internet connection, and a private space. Services available to adults throughout California, Monday through Friday, 10:00 AM – 6:00 PM PT.