Expert Telehealth Care for Depression in New York
Depression is one of the leading causes of disability worldwide. According to the National Institute of Mental Health (NIMH), approximately 21 million American adults — 8.3% of the adult population — experienced at least one major depressive episode in 2021. In New York State, rates of depression have increased significantly in recent years, and for many adults, access to timely, quality care remains a barrier that goes unaddressed.
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At Strong Enough Mental Health, Salvatore Marchica, PMHNP-BC, specializes in the evaluation and treatment of depression — providing compassionate, evidence-based telehealth psychiatric care for adolescents and adults across New York State. You do not have to keep carrying this alone.
What is Depression?
Depression — clinically known as Major Depressive Disorder (MDD) — is far more than feeling sad or having a few difficult days. It is a serious, pervasive mood disorder that affects how a person thinks, feels, and functions across every area of their life. Depression is not a character flaw, a sign of weakness, or something a person can simply choose to stop experiencing. It is a medical condition with biological, psychological, and environmental contributors — and it is highly treatable.
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Other depressive disorders treated at Strong Enough Mental Health include:
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Persistent Depressive Disorder (Dysthymia): A chronic, lower-grade form of depression lasting two or more years
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Postpartum Depression: Depression arising in the weeks or months following childbirth
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Seasonal Affective Disorder (SAD): Depression following a seasonal pattern, most commonly occurring in fall and winter
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Premenstrual Dysphoric Disorder (PMDD): Severe mood and physical symptoms in the week before menstruation
What Are The Signs And Symptoms of Depression?
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Persistent Sadness: A constant feeling of sadness, emptiness, or hopelessness that does not lift, even during positive events
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Loss of Interest or Pleasure: A marked decrease in interest in activities once enjoyed — hobbies, socializing, work, intimacy
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Fatigue and Low Energy: Persistent exhaustion making even simple tasks feel overwhelming — often described as feeling like walking through concrete
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Sleep Disturbances: Difficulty falling asleep, staying asleep, waking too early, or sleeping excessively
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Appetite and Weight Changes: Eating significantly more or less than usual; notable weight changes
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Difficulty Concentrating: Problems with memory, focus, and decision-making that interfere with daily responsibilities
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Feelings of Worthlessness or Guilt: Excessive or disproportionate self-blame and self-criticism
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Psychomotor Changes: Slowed thinking, movement, or speech — or, in some cases, agitation and restlessness
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Physical Symptoms: Unexplained aches, headaches, or digestive problems without clear medical cause
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Thoughts of Death or Suicide: In severe cases, recurrent thoughts of death, suicidal ideation, or self-harm
What Are The Risk Factors of Depression?
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Genetic predisposition: A family history of depression or other mood disorders
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Neurobiological factors: Imbalances in serotonin, dopamine, and norepinephrine systems
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Life events: Loss, relationship breakdown, financial stress, job loss, major life transitions, grief
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Chronic medical conditions: Diabetes, heart disease, chronic pain, and thyroid disorders are strongly associated with depression
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Trauma or adverse childhood experiences
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Co-occurring mental health conditions: Anxiety, ADHD, and substance use disorders frequently co-occur with depression
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Certain medications: Some medications can cause or worsen depressive symptoms
How is Depression Diagnosed?
Depression is diagnosed through a comprehensive clinical evaluation assessing the presence, duration, and severity of symptoms, ruling out medical causes, and exploring any co-occurring conditions. At Strong Enough Mental Health, Salvatore conducts a thorough initial evaluation — reviewing your full mental health history, physical health, current medications, sleep patterns, and lifestyle factors — to arrive at an accurate diagnosis and build a treatment plan genuinely tailored to you.
What Are Possible Treatments For Depression?
Medication for Depression
Antidepressant medications can significantly reduce the symptoms of depression and are often a cornerstone of treatment, particularly for moderate to severe presentations. At Strong Enough Mental Health, medication decisions are always made collaboratively, with careful attention to your history, other medications, preferences, and any co-occurring conditions.
Selective Serotonin Reuptake Inhibitors (SSRIs) — First-Line Treatment
SSRIs are the most widely prescribed antidepressants and are typically the first medication choice for depression due to their balance of effectiveness and tolerability. They work by increasing serotonin availability in the brain.
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Sertraline (Zoloft)
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Escitalopram (Lexapro)
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Fluoxetine (Prozac) — Longer half-life; helpful when adherence or discontinuation effects are a concern
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Citalopram (Celexa)
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Paroxetine (Paxil)
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Common side effects: nausea (usually temporary), insomnia, sexual dysfunction, weight changes. Most diminish with time or dose adjustment.
SNRIs may be particularly effective when depression co-occurs with anxiety, chronic pain, or significant fatigue.
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Venlafaxine XR (Effexor XR)
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Duloxetine (Cymbalta) — Also beneficial when chronic pain conditions co-occur
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Desvenlafaxine (Pristiq)
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Levomilnacipran (Fetzima)
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
Atypical Antidepressants
These medications work through unique mechanisms and can be especially useful when SSRIs or SNRIs are not effective, not tolerated, or when specific symptoms require a different approach.
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Bupropion (Wellbutrin SR/XL) — Activating antidepressant; particularly helpful for low energy, cognitive symptoms, and when SSRI sexual side effects are a concern. Also used for smoking cessation.
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Mirtazapine (Remeron) — Especially useful when sleep and appetite are severely affected; works differently from SSRIs and can complement them
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Vortioxetine (Trintellix) — May have beneficial effects on the cognitive symptoms of depression
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Vilazodone (Viibryd)
When a single antidepressant provides only partial improvement, augmentation — adding a second medication — can produce significant additional benefit.
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Aripiprazole (Abilify) — FDA-approved as an adjunct antidepressant for MDD
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Quetiapine XR (Seroquel XR) — FDA-approved as an adjunct for MDD; particularly helpful when sleep is severely disrupted
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Brexpiprazole (Rexulti) — FDA-approved as an adjunct for MDD
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Lithium — Classic augmentation strategy with strong clinical evidence
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Buspirone
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Thyroid hormone (T3/liothyronine) — Used in treatment-resistant cases