Depression Treatment in San Francisco
Written by: Genesis Javaherian. PMHNP-BC
Last edited: 2/25/26
Depression is more than “feeling down.” It is a common and treatable mental health condition that can affect how you feel, think, and function at work, at home, and in relationships. With the right support, many people feel significantly better.
In-person at 999 Sutter St, San Francisco &
Telehealth throughout California
✓ Most patients seen within 3–5 days
✓ In-network with Aetna, Cigna, UHC, Medicare & more
Takes ~2 minutes. Responses are anonymous.
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Most patients pay $0–$40/visit
What is depression?
Everyone feels sad sometimes, but those feelings usually pass. Depression (also called major depressive disorder or clinical depression) is different. It can cause symptoms that affect daily activities like sleep, appetite, energy, concentration, and motivation.
Depression can affect anyone, and it is often influenced by a mix of genetic, biological, environmental, and psychological factors.
Depression is one of the most common mental health conditions in the U.S. and one of the most treatable. With the right evaluation and a coordinated care plan, most people experience meaningful improvement.
Quick Takeaways
Depression can show up emotionally and physically, not just sadness.
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Symptoms that last at least 2 weeks and interfere with life may be depression.
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Treatment often includes therapy, medication, or both, and the best plan depends on your symptoms and preferences.
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You don’t have to wait. If something feels off, that’s enough reason to reach out.
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Depression & Treatment
Common questions about depression
Answers written by licensed clinicians, designed to help you understand what you're experiencing and what to do next.
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SYMPTOMS
Depression feels different for everyone. Common experiences include persistent low mood, emotional numbness, fatigue, loss of interest in activities you once enjoyed, changes in sleep or appetite, difficulty concentrating, and feelings of worthlessness or hopelessness. Unlike ordinary sadness, these symptoms are pervasive — they don't lift after a good night's sleep — and they begin to interfere with your work, relationships, and daily routine. If this sounds familiar and has been going on for two weeks or longer, it's worth speaking with a clinician.
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DIAGNOSIS
Depression is a clinical diagnosis — it cannot be determined by a quiz or self-assessment alone. A licensed psychiatrist or therapist will evaluate your symptoms against the DSM-5 criteria: five or more symptoms (including low mood or loss of interest) present most of the day, nearly every day, for at least two weeks, causing meaningful impairment. Other conditions like thyroid disorders or sleep apnea can mimic depression, so a comprehensive evaluation is essential before beginning treatment.
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Mild low mood can sometimes improve on its own. But clinical depression — particularly when it disrupts sleep, concentration, or your ability to function — rarely resolves fully without support. Untreated depressive episodes tend to last longer, increase the risk of recurrence, and can deepen over time. The good news: depression is one of the most treatable mental health conditions. With the right combination of therapy, medication, or both, the majority of people experience significant improvement.
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RECURRENCE
Depression is considered a recurrent condition: after one episode, the risk of experiencing another increases. After two or more episodes, the likelihood of recurrence is higher still. However, this is not inevitable. Ongoing therapy, consistent medication management where appropriate, and evidence-based lifestyle changes (sleep, exercise, stress reduction) have all been shown to reduce the frequency and severity of future episodes. A long-term treatment relationship with a clinician is one of the most protective factors available. -
GETTING HELP
It depends on your symptoms and goals. Therapists provide evidence-based talk therapies — such as cognitive behavioral therapy (CBT) or psychodynamic therapy — which are highly effective for depression. Psychiatrists are medical doctors who can diagnose, prescribe and manage antidepressant medications, and monitor your response to treatment. For moderate-to-severe depression, research consistently shows that a combined approach — therapy plus medication — produces better outcomes than either alone. Our clinic offers both, so you can get coordinated care in one place. -
TREATMENT OPTIONS
Several treatments have strong clinical evidence behind them. Cognitive behavioral therapy (CBT) and other structured therapies are first-line options for mild-to-moderate depression. SSRIs and SNRIs (antidepressant medications) are effective, particularly for moderate-to-severe symptoms. For treatment-resistant depression, newer options — including TMS (transcranial magnetic stimulation) and ketamine-based therapies — have shown promising results. The right starting point depends on your history, severity, and preferences. A thorough evaluation is the first step to finding what will work best for you.
10 Common signs of depression & When to get help
Depression doesn’t look the same for everyone. Some people feel persistently sad or empty; others feel irritable, exhausted, or physically unwell without a clear cause. Knowing the signs is the first step toward getting support.
If you’re in crisis right now: Call or text 988 (Suicide & Crisis Lifeline) — free, confidential, 24/7. Or go to your nearest emergency room.
Feeling sad, empty, or emotionally “numb”
Loss of interest or pleasure in activities you used to enjoy
Changes in sleep (insomnia, waking early, or sleeping more than usual)
Changes in appetite or weight
Fatigue or low energy
Difficulty concentrating or making decisions
Feelings of guilt, worthlessness, or hopelessness
Irritability or frustration
Physical symptoms without a clear cause (headaches, digestive issues, body aches)
Thoughts of self-harm or suicide or feeling like you’d be better off not being here (If you’re experiencing this, please call or text 988 now)
You don’t need to be in crisis to ask for help. If these symptoms have lasted two weeks or more or are affecting your work, relationships, or daily life, a licensed clinician can help you figure out what’s going on and what to do next.
READY TO TAKE THE NEXT STEP?
Most patients seen within 3–5 days
We offer therapy and psychiatry — so you can get the right care, in one place.
Depression evaluation in San Francisco and throughout California
Whether you’re in San Francisco or anywhere in California, Defina offers in-person and telehealth evaluations for depression — so you can get answers and start feeling better.
Depression vs sadness, stress or burnout
Stress and burnout can feel awful, but depression tends to be more persistent and more disruptive. A helpful rule of thumb is:
Sadness or stress often comes and goes and is tied to a specific situation.
Depression can last for weeks or longer and affects multiple areas of life (sleep, motivation, concentration, self-worth).
Even if you are not sure what is going on, you can still reach out. You do not need to “prove” you are depressed to deserve care.
Types of depression
Depression is an umbrella term. Some common forms include:
Major depression: symptoms most of the day for at least 2 weeks that interfere with daily life
Persistent depressive disorder: longer-lasting symptoms, often milder day-to-day, but present for years
Seasonal affective disorder: depression that tends to appear in certain seasons
Depression with psychotic features: a severe form that can include delusions or hallucinations
Bipolar disorder: includes depressive episodes, plus manic or hypomanic episodes (this is treated differently)
This is one reason a proper evaluation matters. The right diagnosis guides the right treatment.
How is depression diagnosed?
A clinician typically diagnoses depression through a conversation about your symptoms, health history, and how you are functioning day to day. To be diagnosed with depression, symptoms are generally present most of the day, nearly every day, for at least 2 weeks. Your clinician may also use a standardized tool like the PHQ-9 to measure symptom severity and track your progress over time.
Depression treatment options overview
Depression treatment commonly includes therapy, medication, or a combination. Many people do best with a plan that matches symptom severity, preferences, and medical history.
For milder depression, therapy is often tried first, with medication added if needed.
For moderate to severe depression, medication is often part of the initial treatment plan.
It’s common to try more than one approach before finding what works. That’s not failure — it’s how treatment works.
Therapy vs psychiatry:
Which do I need?
Many people benefit from both, but here is a simple guide:
Therapy may be a good first step if you want help with:
negative thought loops, low motivation, or emotional numbness
relationship patterns, grief, or life transitions
coping skills, routines, and self-compassion
processing trauma or chronic stress
Psychiatry may be especially helpful if:
symptoms are moderate to severe
sleep, appetite, or functioning is significantly impacted
you have tried therapy but still feel stuck
you want to explore medication options, or you have medication questions
If you are not sure, you do not have to figure it out alone. A first visit can clarify what level of care fits best.
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Therapy (talk therapy) helps you understand what is driving your symptoms and build practical tools to feel better. It can help you shift unhelpful thought patterns, change behaviors that keep depression going, and improve how you cope with stress and relationships. Different therapy approaches work in different ways. The best fit depends on your symptoms, history, and goals.
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Our therapist may use one approach or a blend, based on your goals:
Cognitive Behavioral Therapy (CBT): helps you identify and change patterns of thinking and behavior that fuel depression
Interpersonal Therapy (IPT): focuses on relationships, life events, and communication skills that affect mood
Psychodynamic Therapy: explores how past experiences, emotions, and relational patterns contribute to current symptoms
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Most people start with weekly sessions, then adjust frequency over time. In early sessions, you will focus on:
what you are experiencing right now
what has helped or not helped in the past
goals that matter to you (sleep, energy, relationships, work, self-worth)
a plan you can realistically follow between sessions
There’s no pressure to have everything figured out before your first session. Showing up is enough.
Therapy for depression
Psychiatry for depression
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Your psychiatric provider will conduct a thorough evaluation of your symptoms, health history, and how depression is affecting your daily life. From there, they can diagnose, recommend treatment options including medication, and screen for overlapping conditions like anxiety, bipolar disorder, or trauma-related symptoms that are often missed without a proper assessment.
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Antidepressants are commonly used for depression. They work by changing how the brain produces or uses certain chemicals involved in mood and stress.
A few things patients often want to know:
How long do antidepressants take to work? It can take time, often 4 to 8 weeks, and sleep or appetite may improve before mood improves.
Will I be monitored? Yes. Follow-up is important to adjust dose, address side effects, and track progress.
Do I have to be on medication forever? Not necessarily. Many people use medication for a period of time while they stabilize and build other supports. Your plan should be individualized.
If you are under 25 or starting or changing a medication dose, your provider may recommend closer monitoring early on.
The goal is always the lowest effective dose with the fewest side effects and your input matters throughout.
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Most people start with sessions every few weeks, then adjust frequency as symptoms stabilize. In your first visit, your provider will:
∙ Review your symptoms, history, and any previous treatments
∙ Discuss medication options if appropriate, including what to expect
∙ Answer your questions — there are no wrong ones
∙ Create a follow-up plan tailored to where you are right now
You won’t leave with a prescription unless it makes sense. The first visit is about understanding your situation fully.
When standard antidepressants haven't been enough
Approximately 30% of people with depression don't respond adequately to first-line antidepressants. If that's your experience, you're not out of options.
Defina Health offers in-clinic Spravato (esketamine) — the first FDA-approved treatment specifically for treatment-resistant depression. We evaluate fit, assist with insurance authorization, and administer it at our San Francisco office under medical supervision.
Wondering if you might have depression?
Take this 2 min depression screener
This questionnaire is not intended to replace professional diagnosis. It is not monitored in real time and responses are not added to a patient profile.
Source: Patient Health Questionnaire-9 (PHQ-9) ADAA
Therapy and psychiatry in one place. If you benefit from both, your therapist and psychiatric provider share clinical notes and coordinate your plan directly. No repeating your story at every appointment.
We track real progress. At every follow-up, we use the PHQ-9 — the same validated tool as the screener above to measure how your symptoms are actually changing. You can see your own trajectory over time.
UCSF-trained, evidence-based care. Defina was founded by Genesis Javaherian, PMHNP-BC, a UCSF-trained psychiatric nurse practitioner and former Behavioral Health Commissioner for the City and County of San Francisco. This isn't a telehealth mill — it's a practice built by clinicians who have worked inside San Francisco's mental health infrastructure.
In-person and telehealth. See us at 999 Sutter St or connect by secure video anywhere in California.
Why Defina for Depression?
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Depression is more than a bad day or a period of stress. The key indicators are symptoms — low mood, loss of interest, changes in sleep or appetite, fatigue, difficulty concentrating, or feelings of worthlessness — that persist most of the day, nearly every day, for at least two weeks, and that interfere with your ability to function. The only way to know for certain is an evaluation with a licensed clinician.
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Yes — therapy is one of the most effective treatments for depression and is recommended as a first-line option for mild to moderate symptoms. Cognitive behavioral therapy (CBT) has the strongest evidence base, but interpersonal therapy and psychodynamic approaches are also well-supported. Many people experience significant improvement within 8 to 16 sessions, though this varies depending on symptom severity and personal history.
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Not necessarily. Medication is one option, not a requirement. For mild depression, therapy alone is often sufficient. For moderate to severe depression, antidepressants — particularly SSRIs — are frequently recommended alongside therapy because the combination tends to produce better outcomes than either alone. The right approach depends on your symptoms, history, and preferences. A psychiatric evaluation can help clarify whether medication makes sense for you.
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Please reach out now. Call or text 988 (Suicide & Crisis Lifeline — free, confidential, 24/7), or go to your nearest emergency room if you are in immediate danger. Thoughts of self-harm are a signal that you need support sooner rather than later — not something to wait out alone. If you are not in immediate crisis but these thoughts are present, let your clinician know at your first appointment.
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Yes. Telehealth therapy and psychiatry for depression have strong clinical evidence behind them and produce outcomes comparable to in-person care for most people. Telehealth removes barriers; commute, scheduling, stigma, that often delay people from getting help. At Defina, we offer telehealth across California, so you can access care from wherever you are.
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Very commonly. Depression frequently co-occurs with anxiety disorders, chronic pain, thyroid conditions, sleep disorders, and substance use. This is one reason a thorough evaluation matters — treating depression in isolation without identifying what else might be contributing often leads to incomplete improvement. Your provider will screen for related conditions as part of your initial assessment.
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Recovery timelines vary widely. With treatment, many people notice meaningful improvement within 4 to 8 weeks. Full remission — where symptoms largely resolve — often takes 3 to 6 months. Some people recover fully after one episode; others manage depression as a chronic condition with ongoing support. What research consistently shows is that people who engage in treatment recover faster and are less likely to relapse than those who don’t.
FAQs about depression
Medical disclaimer
This page is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. If you have concerns about your mood or mental health, we encourage you to schedule an appointment with a licensed clinician — at Defina or elsewhere.
References and resources
National Institute of Mental Health (NIMH). Depression overview, symptoms, and treatments
National Institute of Mental Health (NIMH). Depression brochure and fact sheet
988 Suicide & Crisis Lifeline. Free, confidential crisis support 24/7