Depression treatment

Depression is more than a bad week. The National Institute of Mental Health describes major depression as symptoms that last most of the day, nearly every day, for at least two weeks and interfere with work, sleep, eating or enjoying life. Common signs include:

• A persistent sad, anxious or "empty" mood
• Losing interest in hobbies, friends or things you used to enjoy
• Feeling hopeless, guilty, worthless or helpless
• Low energy, fatigue, or feeling slowed down — or, for some people, restless and unable to sit still
• Trouble concentrating, remembering or making decisions
• Sleeping too much or too little; changes in appetite or weight
• Aches, headaches or stomach problems without a clear physical cause
• Thoughts of death or suicide

Not everyone has every symptom, and depression can look different in men, older adults and teenagers — irritability or physical complaints are sometimes more obvious than sadness. If you are having thoughts of harming yourself, call or text 988 or go to the nearest emergency room now; please don't wait for an appointment.

Your first visit is a full psychiatric evaluation lasting about 45 to 60 minutes. We ask when your low mood started, what has been happening in your life, how you are sleeping and eating, and what treatment you have already tried. We use a standard questionnaire such as the PHQ-9 so we can measure change over time rather than relying on memory.

A good evaluation also looks for things that can mimic or complicate depression: past episodes of elevated mood that point toward bipolar disorder, anxiety, trauma, alcohol or substance use, and medical causes such as thyroid problems, anemia or medication side effects. We may ask your primary-care doctor for recent blood work, or order it.

Medication. Antidepressants such as SSRIs, SNRIs, bupropion and mirtazapine are the most commonly used options. NIMH notes they usually take four to eight weeks to show their full effect, and that it may take more than one try to find the right medicine and dose. Our medication management visits are where that fine-tuning happens.

Therapy. Talk therapy — including cognitive behavioral therapy and interpersonal therapy — is effective on its own for many people and works well alongside medication. Our licensed therapists see patients at both offices, or we can coordinate with a therapist you already know.

TMS. Transcranial magnetic stimulation has been FDA-cleared for major depressive disorder since 2008. It uses magnetic pulses to stimulate mood-regulating areas of the brain, without anesthesia, and you drive yourself home afterward. All TMS therapy is delivered at our New City office.

Every plan is individual, but a typical first few months look like this:

• Week 0: Evaluation, working diagnosis, baseline PHQ-9, and a decision together on medication, therapy or both.
• Weeks 2–4: First follow-up (often by video). We check side effects, sleep and safety, and adjust the dose if needed. Therapy sessions are usually weekly.
• Weeks 6–8: We repeat the PHQ-9. If you have improved partly, we may raise the dose or add a second strategy; if nothing has changed, we discuss switching.
• Weeks 10–12: The goal is remission, not just "a bit better." Once you are well, visits space out to every one to three months, and we plan how long to continue treatment.

We usually bring up TMS when depression has not improved enough after one to four adequate antidepressant trials, or when side effects have made medication hard to continue. The exact threshold depends on your insurance: most plans, including those that cover TMS through Optum Behavioral Health, set their own criteria for how many medication trials and how much therapy must come first. We check those criteria before recommending a course.

A standard course is about 30 to 36 sessions, five days a week for four to six weeks, supervised by the same psychiatrist throughout. If you are in Orange County you can have your TMS consultation in Middletown; treatment sessions take place in New City. Read more on what to expect from TMS and treatment-resistant depression.

Depression during pregnancy or after birth is common and treatable. NIMH describes perinatal depression as more intense and longer-lasting than the short-lived "baby blues," with sadness, anxiety, trouble bonding with the baby, or thoughts of harming yourself or your child. It can begin during pregnancy or any time in the first year after delivery.

As a postpartum depression psychiatrist practice serving Rockland County and Orange County, we weigh the benefits and risks of medication during pregnancy and breastfeeding with you, coordinate with your obstetrician, and offer therapy and video follow-ups that fit around a newborn's schedule. Partners are welcome to join visits.

We treat adolescents as well as adults. In teens, depression often looks like irritability, falling grades, pulling away from friends or sleeping all day, and NIMH notes that it can be mistaken for ordinary moodiness. Parents are part of the evaluation, and treatment usually starts with therapy, with medication added when symptoms are moderate or severe. In 2024 the FDA cleared one TMS system for adolescents aged 15 to 21 with major depression, so TMS can now be discussed for older teens when other treatment has not helped.

Later in life, depression can be hidden behind memory complaints, poor appetite or pain, and it is sometimes dismissed as a normal part of aging. It isn't. Older adults often take several other medications, so we pay close attention to interactions and start doses low.

Care is led by Dr. Balveen Singh, D.O., and Dr. Kuljit Singh, M.D., both board-certified psychiatrists, with board-certified psychiatric nurse practitioners and licensed therapists. Visits are available in English, Punjabi, Hindi, Urdu, Gujarati and French. Meet everyone on our team page, or check insurance we accept.