When Everything Feels Too Heavy

If you're here, you're probably carrying something that's gotten too heavy to manage alone. Maybe it's depression that's dulled all the colors in your life. Maybe your mood swings between extremes. Maybe you just feel... numb. Empty. Like you're going through the motions but not really living.

Here's what we want you to know: Depression and mood disorders are real medical conditions. They're not weakness, character flaws, or something you can just "snap out of." And they're treatable.

Table of Contents

• What Depression & Mood Disorders Actually Look Like
• Types of Mood Disorders We Treat
• Medical Causes We Rule Out First
• Our Approach to Treatment
• Medication Management
• What Treatment Looks Like
• Ages We Serve
• Telehealth Throughout Colorado
• Insurance & Access
• Crisis Support
• Let's Talk About Hope
• Frequently Asked Questions

What Depression & Mood Disorders Actually Look Like

Major Depressive Disorder Might Look Like:

• Persistent sad, empty, or hopeless feelings
• OR feeling numb, emotionally flat (not everyone feels "sad")
• Loss of interest or pleasure in things you used to enjoy
• Significant changes in appetite or weight
• Sleep changes: insomnia, early waking, or sleeping too much
• Fatigue and loss of energy
• Feeling worthless or excessively guilty
• Difficulty thinking, concentrating, or making decisions
• Moving slowly or feeling physically heavy
• Recurrent thoughts of death or suicide
• Physical symptoms: headaches, digestive problems, chronic pain

Important: Depression doesn't always look like crying or sadness. It often looks like numbness, irritability, or just... nothing.

Persistent Depressive Disorder (Dysthymia):

• Depressed mood most days for at least 2 years
• Less severe than major depression but chronic
• Periods of major depression may occur on top of dysthymia ("double depression")
• Feels like depression is just your baseline

Seasonal Affective Disorder (SAD):

• Depression that occurs at specific times of year
• Most commonly fall/winter (shorter days, less sunlight)
• Symptoms include low energy, oversleeping, weight gain, social withdrawal
• Improves in spring/summer

Premenstrual Dysphoric Disorder (PMDD):

• Severe mood symptoms in the week before menstruation
• Significant mood swings, irritability, depression, anxiety
• Interferes with work, relationships, daily activities
• Different from typical PMS (more severe)

Postpartum Depression:

• Occurs after childbirth (within weeks to a year)
• More severe than "baby blues"
• Severe mood swings, excessive crying, difficulty bonding with baby
• Withdrawal from family and friends
• Thoughts of harming self or baby
• Requires immediate treatment

Bipolar Disorder:

• Mood episodes that swing between depression and mania/hypomania
• See our dedicated Bipolar Disorder page for comprehensive information

Types of Mood Disorders We Treat

• Major Depressive Disorder: Single or recurrent episodes of depression
• Persistent Depressive Disorder (Dysthymia): Chronic, long-term depression
• Bipolar I & II Disorder: Depression with manic or hypomanic episodes
• Cyclothymic Disorder: Chronic mood instability
• Seasonal Affective Disorder: Seasonal pattern of depression
• Premenstrual Dysphoric Disorder: Severe premenstrual mood symptoms
• Postpartum Depression: Depression following childbirth
• Depression with Psychotic Features: Depression with delusions or hallucinations
• Treatment-Resistant Depression: Depression that hasn't responded to multiple treatments
• Depression Due to Medical Condition: When medical issues cause mood symptoms

Medical Causes We Rule Out First

Before diagnosing depression, we check for medical conditions that can cause or worsen mood symptoms:

We Test For:

• Thyroid problems: Both hypo and hyperthyroidism affect mood
• Vitamin deficiencies: B12, vitamin D, folate, iron
• Anemia: Causes fatigue and can look like depression
• Hormonal imbalances: Testosterone, estrogen, progesterone, cortisol
• Diabetes or blood sugar problems: Affects mood and energy
• Autoimmune conditions: Many cause depression and fatigue
• Chronic infections: Can cause mood changes
• Medication side effects: Many medications affect mood
• Substance use: Alcohol and drugs worsen depression

We order comprehensive lab work to ensure we're treating the actual cause.

Considering Other Conditions: Sometimes what looks like depression is actually:

• Bipolar disorder: Especially if antidepressants haven't worked or made things worse
• ADHD: Can cause low motivation and difficulty functioning
• PTSD or trauma: Emotional numbing, avoidance, negative thoughts
• Anxiety disorders: Often co-occur with depression
• Eating disorders: Depression is very common with eating disorders
• Substance use disorders: Depression and substance use often co-occur
• Chronic pain conditions: Pain and depression are bidirectional

We take time to understand the full picture.

Our Approach to Treatment

Understanding Your Experience: In our initial evaluation, we explore:

• What you're experiencing and how long it's been happening
• Previous episodes of depression or mood changes
• Family history of mood disorders (genetics play a role)
• What's happened in your life (losses, trauma, stress)
• What you've tried before and what helped (or didn't)
• How depression affects your daily life
• Medical history and current medications
• Substance use
• Thoughts of suicide or self-harm

Collaborative Treatment Planning: Together, we create a plan that might include:

• Medication management
• Lifestyle modifications
• Therapy referrals
• Addressing co-occurring conditions
• Crisis planning

Medication Management

First-Line Antidepressants:

SSRIs (Selective Serotonin Reuptake Inhibitors):

• Most commonly prescribed antidepressants
• Generally well-tolerated
• Examples: sertraline, escitalopram, fluoxetine, paroxetine, citalopram
• Take 4-6 weeks for full effect

SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors):

• Help with both serotonin and norepinephrine
• Good for depression with pain or low energy
• Examples: venlafaxine, duloxetine, desvenlafaxine

Atypical Antidepressants:

• Bupropion: Good for low energy, focus issues; doesn't cause sexual side effects
• Mirtazapine: Helps with sleep and appetite; sedating
• Trazodone: Often used for sleep in depression
• Vilazodone, vortioxetine: Newer options with different mechanisms

When First-Line Treatments Don't Work:

For Bipolar Depression:

• Mood stabilizers as foundation
• Careful use of antidepressants (can trigger mania)
• Atypical antipsychotics
• Lamotrigine (especially effective for bipolar depression)

For Seasonal Affective Disorder:

• Antidepressants (especially bupropion)
• Light therapy
• Vitamin D supplementation

For PMDD:

• SSRIs (can be taken just during luteal phase for some people)
• Hormonal birth control in some cases

For Postpartum Depression:

• SSRIs or SNRIs (many are safe with breastfeeding)
• Consideration of breastfeeding safety
• Specialized postpartum medications if needed

Our Medication Approach:

• Start with evidence-based first-line treatments
• Consider your symptoms, preferences, and past responses
• Start low, increase gradually
• Monitor for side effects and effectiveness
• Adjust based on your actual experience
• Consider genetic testing if multiple trials fail
• Plan for maintenance treatment to prevent relapse

Important About Antidepressants:

• They take 4-6 weeks for full effect (some improvement may be sooner)
• Side effects often improve after first 2 weeks
• Don't stop suddenly—withdrawal symptoms can occur
• Finding the right medication often takes trial and adjustment
• Most people need treatment for at least 6-12 months
• Some people need longer-term maintenance treatment

Genetic Testing: We offer GeneSight pharmacogenomic testing to understand how your genes affect antidepressant response and side effects. See our GeneSight page for details.

Beyond Medication

Therapy is Often Essential: We're not therapists, but we strongly recommend therapy for depression. We can connect you with excellent therapists who specialize in:

• Cognitive Behavioral Therapy (CBT)
• Interpersonal Therapy (IPT)
• Behavioral Activation
• Psychodynamic therapy
• EMDR for trauma-related depression

Combined medication and therapy is often most effective.

Lifestyle Factors That Matter:

• Sleep: Depression disrupts sleep; poor sleep worsens depression
• Exercise: One of the most effective depression treatments
• Nutrition: Diet affects mood (we're not diet cops, but nutrition matters)
• Social connection: Isolation worsens depression (even when you don't feel like connecting)
• Structure and routine: Helps when everything feels overwhelming
• Light exposure: Especially for SAD
• Substance use: Alcohol and drugs worsen depression

What Helps During Severe Depression:

• Breaking tasks into tiny steps
• Not judging yourself for what you can't do right now
• Accepting help from others
• Safety planning if having suicidal thoughts
• Sometimes short-term intensive treatment (PHP, IOP) if needed

What Treatment Looks Like

Initial Evaluation (60-90 minutes): Comprehensive assessment of mood symptoms, history, medical factors, and suicide risk.

Lab Work: Blood work to rule out medical causes of depression.

Treatment Planning: Discussion of medication options, therapy referrals, lifestyle modifications, and crisis planning.

Starting Medication: Usually beginning with SSRIs or SNRIs at low doses, increasing gradually based on response.

Follow-Up Appointments: Initially every 2-4 weeks to monitor response and side effects. Once stable, appointments every 1-3 months.

Long-Term Management: Most people need treatment for at least 6-12 months. Some need longer maintenance to prevent relapse.

Between Appointments: You can reach out if medication isn't working, side effects are problematic, or you're in crisis.

Ages We Serve

We provide depression and mood disorder treatment for:

• Teens (12+): Depression often begins in adolescence
• Young adults: High-risk period for first depressive episodes
• Adults: Ongoing management or new episodes
• Older adults: Late-life depression and mood changes

Telehealth Throughout Colorado

All appointments are virtual:

• No need to leave home when you're already struggling
• Available throughout Colorado
• Easier to maintain consistent appointments
• Comfortable, private space

Insurance & Access

We accept most major insurance including:

• Aetna
• Cigna
• United Healthcare
• Oscar
• Optum
• Blue Cross Blue Shield
• Private pay options

Note: We do not accept Medicaid or Medicare at this time.

Crisis Support

If you're having thoughts of suicide:

• 988 Suicide & Crisis Lifeline: Call or text 988
• Crisis Text Line: Text HELLO to 741741
• Colorado Crisis Services: 1-844-493-8255
• 911 if in immediate danger
• Nearest emergency room if you're not safe

We want you alive. These resources are available 24/7.

Let's Talk About Hope

Depression lies. It tells you things won't get better, that you're stuck like this forever, that you're the problem.

But we've seen people move from barely surviving to actually living. We've seen medication and support create space for healing. We've seen people reconnect with parts of themselves they thought they'd lost forever.

It's not always fast. It's not always linear. But recovery is absolutely possible.

Ready to Feel Better?

If you're tired of carrying this alone, if you're ready for treatment that actually works, if you want support that sees you as a whole person—we're here.

Book an appointment online or call us at (719) 212-1951.

Same-week appointments available. You don't have to keep feeling like this.

Frequently Asked Questions

Forest Path Psychiatry & Healing is a nurse-led psychiatric practice serving all of Colorado via telehealth. Our board-certified PMHNPs provide comprehensive, evidence-based treatment for depression and mood disorders with a trauma-informed, whole-person approach.