Depression Treatment in North Carolina

I am a board-certified psychiatrist. I provide depression treatment in North Carolina for adults by secure video. Patients in Wilmington can also be seen in person by request.

My practice is small by design. You see one physician at every appointment, and that physician is me. If you’re looking for outpatient psychiatric care from a physician, this page explains how I work.

• One physician for every patient. No handoffs and no rotating providers.
• 45-60 minute video visits.
• $250/month flat. No insurance billed. Labs and medications are separate.
• Adults only. You must be physically in North Carolina at the time of your visit.
• I reply to messages within 1 to 2 business days.
• Free 15-minute consultation before you commit to anything.

Depression is common, and most of it is treatable in outpatient care. The quality of that care depends on two things: a thorough diagnostic workup, and enough time to do it.

Where Depression Treatment in North Carolina Starts

Depression is a diagnosis of exclusion before it is a diagnosis of prescription. A number of medical problems look exactly like depression.

Hypothyroidism slows everything down. Obstructive sleep apnea wrecks energy, concentration, and mood. Anemia does the same. Low testosterone in men can present as flat mood and lost drive, so I check it in men with depression.

Medications can cause depression too, including steroids and some acne and blood pressure drugs. Alcohol and cannabis both cause and maintain depressive symptoms.

I also separate major depression from grief, adjustment, and ordinary demoralization. Two weeks of symptoms is the floor for a diagnosis. How much those symptoms cost you day to day tells me how severe it is.

I use severity scales such as the PHQ-9 to set a baseline and to track whether treatment is working, visit over visit.

This is why my visits run 45 to 60 minutes. That time covers a differential diagnosis, a substance history, a sleep history, and a medication review. The first appointment is a full psychiatric history. Follow-ups are long enough to change course when the data say to.

What the Evidence Supports

Antidepressants work on average. The largest network meta-analysis, covering 21 antidepressants and 116,477 patients, found all of them beat placebo in acute treatment (Cipriani et al., 2018). Average effect sizes are modest, and no drug wins for everyone.

Choosing among them is an individual decision based on your symptoms, your history, and side effect tradeoffs.

The STAR*D trial showed what real-world sequencing looks like: some people remit on the first medication, others need several steps (Rush et al., 2006). A later reanalysis put the true remission rate at about 35%, roughly half what was originally reported (Pigott et al., 2023). I tell patients this. Most people need more than one trial before something works.

Therapy works. A 2023 meta-analysis of 409 trials and 52,702 patients found cognitive behavioral therapy effective against control conditions, with a moderate to large effect (g=0.79). It held up about as well as medication in the short term and did better at 6 to 12 months (Cuijpers et al., 2023). Combining therapy with medication beat medication alone, and came out about even with CBT on its own.

Behavioral activation, which is structured re-engagement with rewarding activity, is simpler and works about as well.

Exercise belongs on the list. A 2024 BMJ network meta-analysis found walking or jogging, yoga, and strength training all produced meaningful reductions in depressive symptoms, with effects proportional to intensity (Noetel et al., 2024).

I will recommend what fits your severity and your preferences, and I will tell you how confident I am in each piece.

What Else Can Look Like Depression

Some conditions look like depression but need different treatment. Bipolar II disorder is the classic example. It looks like recurrent unipolar depression, and antidepressants alone can destabilize it.

Adult ADHD frequently hides behind complaints of low motivation and poor follow-through. Trauma and PTSD produce a flat, avoidant state that mimics depression. Sleep disorders and substance use belong on the same list.

Low testosterone in men is worth checking, and the treatment evidence here is split. A 2019 meta-analysis in JAMA Psychiatry found testosterone treatment was associated with reduced depressive symptoms, with a response odds ratio of 2.30 (Walther et al., 2019).

Larger and newer work points the other way. A 2023 individual-participant meta-analysis of 5,601 men with total testosterone below 12 nmol/L found no significant improvement in Beck Depression Inventory scores (Hudson et al., 2023), and a 2025 secondary analysis of the T4DM trial reported that testosterone had no impact on depression (Wittert et al., 2025).

I still check testosterone, because low levels cause fatigue and low drive that look like depressive symptoms. I’m more cautious than I used to be about treating low testosterone as a way to treat the depression itself. I write more about that connection in my post on low testosterone and depression.

The old chemical imbalance slogan made all of this sound simpler than it is.

The serotonin story in particular never matched the evidence well. An umbrella review of the main areas of serotonin research found no consistent evidence of an association between serotonin and depression, and no support for the idea that depression is caused by lowered serotonin (Moncrieff et al., 2023). My post on the chemical imbalance theory of depression takes that apart in detail.

Depression has many different drivers. One physician holds the whole picture: mood, hormones, sleep, attention, trauma, and substances. That is what the first visit is for.

When Treatment Stalls

Treatment-resistant depression is depression that hasn’t improved after 2 or more antidepressants, each at an adequate dose for an adequate length of time.

When resistance is confirmed, the options are switching within or across classes, combination strategies, and augmentation with agents such as lithium or thyroid hormone. These are the standard next steps.

For depression that still doesn’t respond, I’m preparing to offer IV ketamine and Spravato at my Wilmington office.

My page on treatment-resistant depression care in North Carolina covers how I evaluate it and what I offer. I go deeper on what to do when an antidepressant is not working in a separate post.

Coming Off Antidepressants Safely

Some patients come to me because they want off their medication. Antidepressant discontinuation syndrome is real and common, especially with paroxetine and venlafaxine.

Dizziness, brain zaps, flu-like symptoms, insomnia, and irritability are typical. These are withdrawal effects, and they can look like relapse.

Withdrawal tracks the taper schedule and eases as the nervous system readjusts. If it’s withdrawal, I slow the taper. If it’s relapse, I treat the depression.

Tapering should be supervised, slow, and individualized. Sometimes that means months of small reductions. Sometimes it means liquid formulations or compounding to make the final steps tolerable. This is a core part of my practice, and I have written a full walkthrough of antidepressant discontinuation syndrome.

What It Costs

My pricing for depression treatment in North Carolina is flat and published. There are no surprise bills.

Service	Cost
Free 15-minute consultation	$0
Monthly depression care	$250/month flat
Labs and medications	Billed separately by the lab and pharmacy
Good-faith estimate	Available at thebh.us/good-faith-estimate/

My services page covers the full scope of the practice.

Frequently Asked Questions

What are the most effective treatments for depression in adults?

For mild to moderate depression, cognitive behavioral therapy, behavioral activation, structured exercise, and medication all have evidence behind them, alone or in combination. Combining therapy with medication outperforms medication by itself. The right starting point depends on severity, your history, and your preference.

What is the most effective antidepressant for treating depression?

There is no single winner. On average, the 21 antidepressants in the largest network meta-analysis were all more effective than placebo, with only modest differences between them (Cipriani et al., 2018). The best antidepressant is the one that fits your symptom pattern and side effect tolerance.

How much does treatment cost?

A flat $250 a month covers up to four visits. You start with a free 15-minute consultation. Labs and medications are billed separately by the lab and pharmacy. A good-faith estimate is available on request.

Do you take insurance?

No. I do not bill insurance. That’s how the flat price and the 45-60 minute visits work. Many patients still use their insurance for labs and pharmacy costs, which are separate.

How do I get started?

Start with the free 15-minute consultation. I reply to messages within 1 to 2 business days, and after the call I book your evaluation on my next open date.

This page is educational and does not create a physician-patient relationship. If you are in crisis, call or text 988, the Suicide and Crisis Lifeline.

References (9)

1. Cipriani A, Furukawa TA, Salanti G, et al. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. Lancet. 2018;391(10128):1357-1366. PMID: 29477251
2. Rush AJ, Trivedi MH, Wisniewski SR, et al. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. Am J Psychiatry. 2006;163(11):1905-1917. PMID: 17074942
3. Pigott HE, Kim T, Xu C, Kirsch I, Amsterdam J. What are the treatment remission, response and extent of improvement rates after up to four trials of antidepressant therapies in real-world depressed patients? A reanalysis of the STAR*D study’s patient-level data with fidelity to the original research protocol. BMJ Open. 2023;13(7):e063095. PMID: 37491091
4. Cuijpers P, Miguel C, Harrer M, et al. Cognitive behavior therapy vs. control conditions, other psychotherapies, pharmacotherapies and combined treatment for depression: a comprehensive meta-analysis including 409 trials with 52,702 patients. World Psychiatry. 2023;22(1):105-115. PMID: 36640411
5. Noetel M, Sanders T, Gallardo-Gómez D, et al. Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials. BMJ. 2024;384:e075847. PMID: 38355154
6. Walther A, Breidenstein J, Miller R. Association of testosterone treatment with alleviation of depressive symptoms in men: a systematic review and meta-analysis. JAMA Psychiatry. 2019;76(1):31-40. PMID: 30427999
7. Hudson J, Cruickshank M, Quinton R, et al. Symptomatic benefits of testosterone treatment in patient subgroups: a systematic review, individual participant data meta-analysis, and aggregate data meta-analysis. Lancet Healthy Longev. 2023;4(10):e561-e572. PMID: 37804846
8. Wittert GA, Robledo KP, Handelsman DJ, et al. Testosterone treatment and sexual function in men: secondary analysis of the T4DM (Testosterone for Diabetes) trial. J Clin Endocrinol Metab. 2025;110(7):e2157-e2170. PMID: 39928571
9. Moncrieff J, Cooper RE, Stockmann T, Amendola S, Hengartner MP, Horowitz MA. The serotonin theory of depression: a systematic umbrella review of the evidence. Mol Psychiatry. 2023;28(8):3243-3256. PMID: 35854107