In crisis? Call or text 988 for the Suicide & Crisis Lifeline. In an emergency, call 911. This practice does not provide emergency care.
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Depression treatment in Houston & across Texas
If two or three medications have not worked, the next step is usually not a fourth medication. It is a better assessment.
What depression actually looks like
Sadness is the symptom people expect, and it is frequently not the main one. Depression more often presents as flatness — nothing is enjoyable, nothing is terrible, everything requires effort. It shows up as slowed thinking, difficulty making ordinary decisions, waking at four in the morning, appetite that has shifted in either direction, and a body that feels heavy.
In men and in many cultural contexts it presents as irritability rather than sadness, which is one reason it goes undiagnosed for years.
When it is time to see a psychiatrist
- Symptoms have lasted more than a few weeks and are not lifting.
- Work, relationships or basic self-care are being affected.
- Sleep and appetite have changed noticeably.
- You have tried one or more antidepressants without adequate response.
- You have thoughts of death or of not wanting to be here. If you are having thoughts of harming yourself, call or text 988 now.
How Dr. Torrijos evaluates depression
The first task is confirming that this is depression and not something being treated as depression. Three specific questions get careful attention:
- Has there ever been a period of elevated mood, reduced need for sleep or unusual energy? Bipolar spectrum illness is commonly diagnosed as unipolar depression for years, and the treatment differs substantially.
- Is there a medical contributor? Thyroid dysfunction, B12, folate and iron deficiency, vitamin D, sleep apnea, anaemia, chronic pain, perimenopause, and the psychiatric side effects of cardiac, steroid and neurological medications.
- Were previous trials adequate? A large share of “treatment-resistant” depression turns out to be a series of trials that never reached a therapeutic dose or a sufficient duration.
Treatment options
Several classes of antidepressant have good evidence, and the right choice depends on your symptom pattern, your medical history, your previous trials and the side effects you are prepared to live with. Augmentation strategies exist for partial response. Psychotherapy has strong independent evidence and works well in combination. Sleep, physical activity and daylight are not a substitute for treatment but they measurably affect the outcome.
Where a treatment sits outside this practice — certain interventional treatments, for example — you will get a specific referral rather than a vague suggestion.
What treatment looks like at Tentie
An evaluation of up to 90 minutes, then follow-ups every two to four weeks early on. Antidepressants take time to work, and the most common reason a good medication gets abandoned is being judged at week two instead of week six. Response is tracked deliberately, and the plan is adjusted on evidence rather than impression.
Start with an evaluation
| Patients | Adults 18+ |
| Evaluation | Up to 90 min |
| Fee | [$XXX] |
| Format | In person or video |
| Languages | English, Spanish |
Reviewed by José M. Torrijos, MDBoard-certified adult psychiatrist, licensed in Texas. Last reviewed August 2026.
Related
Frequently asked
How long before an antidepressant works?
Some sleep and appetite changes appear within one to two weeks. Mood and interest typically take four to six weeks at an adequate dose. Judging a medication too early is the most common reason a workable treatment gets discarded.
I’ve tried several medications and none worked. Is there any point?
Yes, and this is one of the more productive reasons to come in. Non-response often traces back to an inadequate dose or duration, an unrecognised bipolar spectrum illness, or an untreated medical contributor. A full re-evaluation is the right next step, not a fourth prescription.
Will medication change my personality?
It should not. Emotional blunting is a recognised side effect of some antidepressants and it is specifically asked about at follow-up, because most patients will not raise it unprompted. If it happens, it is a reason to adjust treatment.
Do I need therapy as well as medication?
For moderate to severe depression the combination generally outperforms either alone. Dr. Torrijos will coordinate with your therapist, or help you find one.
What if I’m having thoughts of suicide?
If you are in immediate danger, call 911, or call or text 988 for the Suicide & Crisis Lifeline. This practice does not provide emergency or after-hours care. Suicidal thoughts are a common symptom of depression and something you can raise directly in an appointment — they are treated as clinical information, not as a reason to be turned away.