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Depression and Anxiety

Low mood, constant worry, poor sleep, no energy and no interest in things you used to enjoy are common reasons people come to a family doctor, and they deserve to be taken as seriously as any other symptom. Before a diagnosis is made here, Dr. Gisi carries out a full physical examination and asks about your general health — because several treatable physical conditions produce exactly the same picture.

If you need help right now

If you are in immediate danger or thinking about ending your life, call 911 or go to the nearest emergency room. In the United States you can call or text 988 for the Suicide and Crisis Lifeline, at any hour. Please do not wait for an appointment.

Checking for physical causes first

Symptoms that look like depression or anxiety can be caused or worsened by low vitamin D, low hormone levels, thyroid problems, blood sugar problems, or alcohol and substance use. Some medications do it too.

None of that means your symptoms are imaginary — it means the right treatment might not be the one you expected. Testing for these things is straightforward, and it is worth doing before settling on a diagnosis.

The conversation itself

Expect to be asked how long this has been going on, how it started, what it is stopping you doing, how you are sleeping and eating, how much you are drinking, what has changed at home or at work, and whether you have had thoughts of harming yourself. That last question is asked of everybody. It is asked because it matters, not because of anything you have said.

Treatment options

There is more than one route, and often more than one is used together. Sleep, exercise, alcohol and nutrition genuinely affect mood, and correcting a deficiency that shows up on testing can make a real difference.

Dr. Gisi's general approach is to use nutritional support as a first-line therapy where that is reasonable, while recognizing that medication treats many conditions effectively and is sometimes the right thing to start with. Talking therapy is often the most useful part of treatment, and Dr. Gisi will refer you to a counselor or psychiatrist where that is appropriate.

Follow-up matters more than the first appointment

If medication is started, it needs review — for benefit, for side effects and for dose. Antidepressants take weeks rather than days to show an effect, and should not be stopped abruptly without talking to your doctor. Expect a follow-up appointment rather than a prescription and silence.

What to expect at your visit

  • A full physical examination and questions about your general health
  • Blood work to look for physical contributors such as thyroid, vitamin D, hormone or blood sugar problems
  • An open conversation about mood, sleep, alcohol, stress and safety
  • A treatment plan discussed with you, which may include lifestyle changes, nutritional support, medication, or referral for counseling
  • A follow-up appointment to see whether it is working

Common questions

Will I be put straight on antidepressants?
No. A physical examination and appropriate testing come first, because several treatable conditions produce identical symptoms. If medication is the right option, it is discussed with you before anything is prescribed.
Can a family doctor treat depression and anxiety, or do I need a specialist?
A great many people are treated successfully in primary care, and Dr. Gisi already knows your medical history and medications. Where specialist psychiatric care or counseling would serve you better, she will refer you.
Is what I say confidential?
Yes. Your discussions and records are confidential, subject to the legal duties that apply to any physician, including situations where there is an immediate risk to your safety or someone else's.
Call (951) 303-6158