Understanding Depression
Major depressive disorder (MDD) is more than feeling sad. It is a complex brain condition characterized by persistent depressed mood, loss of interest or pleasure in activities, changes in appetite and sleep, fatigue, difficulty concentrating, and in severe cases, thoughts of death or suicide. MDD affects 21 million Americans annually and is one of the leading causes of disability worldwide.
Signs & Symptoms
- Persistent sad, empty, or hopeless mood most of the day
- Loss of interest or pleasure in activities once enjoyed
- Significant weight change or appetite disruption
- Insomnia or hypersomnia
- Fatigue and loss of energy nearly every day
- Difficulty thinking, concentrating, or making decisions
- Feelings of worthlessness or excessive guilt
- Recurrent thoughts of death or suicide
How Dr. Agresti Treats This Condition
Dr. Agresti treats depression with 30+ years of psychopharmacology expertise, particularly for treatment-resistant cases. For many patients, an SSRI or SNRI combined with psychotherapy produces excellent results. For those who have not responded to standard treatments, Dr. Agresti can explore augmentation strategies, Spravato (esketamine), or ketamine therapy — treatments that can work when multiple antidepressants have failed.
Medication Options
- SSRIs: Zoloft (sertraline), Lexapro (escitalopram), Prozac (fluoxetine)
- SNRIs: Effexor XR (venlafaxine), Cymbalta (duloxetine)
- Atypical antidepressants: Wellbutrin (bupropion), Remeron (mirtazapine)
- Augmentation: Abilify (aripiprazole), Rexulti (brexpiprazole), lithium
- Spravato (esketamine) for treatment-resistant depression
The Concierge Advantage
With Dr. Agresti's concierge model, medication adjustments happen quickly when you need them — not at your next appointment weeks away. Text him directly if symptoms worsen. Get same-day refills. Reach him directly when you're having a difficult day. This level of access makes a meaningful difference in psychiatric treatment outcomes.
Frequently Asked Questions
Treatment-resistant depression (failing 2+ adequate antidepressant trials) requires a specialist. Dr. Agresti has 30+ years of expertise in complex psychopharmacology — finding what works when standard treatments haven't. Options include augmentation strategies, Spravato, and ketamine.
Most antidepressants require 4–8 weeks for full effect. Some improvement is often noticed in 2–3 weeks. If a medication has not produced meaningful improvement after 8 weeks at an adequate dose, it is typically time to reassess.
For many patients, depression is episodic — with periods of remission between episodes. Some people have a single episode; others have recurrent episodes. Effective treatment reduces the severity and duration of episodes and may extend remission periods significantly.
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