Understanding depression — more than sadness

Everyone feels sad, discouraged, or low at times — that’s part of being human. Depression is different, and it is both common and very treatable. This page explains what depression actually is, how we evaluate it at OhanaPsych, and how we approach treatment — with the goal of helping you feel like yourself again.

What depression actually is

The American Psychiatric Association’s DSM-5-TR describes major depressive disorder as a period of at least two weeks in which a person experiences a persistently low or empty mood, or a loss of interest or pleasure in things they used to enjoy, along with other changes — in sleep, appetite, energy, concentration, and sense of self-worth. What sets depression apart from ordinary sadness is that it lingers, it’s often there for no clear reason, and it interferes with daily life rather than lifting on its own.

Depression is a medical condition, not a personal weakness or something you should be able to “snap out of.” It reflects real changes in the brain and body, and like other medical conditions, it responds to treatment. Diagnosis is something we work through together, not a checklist you score on yourself.

Signs and symptoms

Depression shows up across mood, thinking, and the body. Emotionally, people describe sadness, emptiness, hopelessness, irritability, or a flatness where feeling used to be. In thinking, it can bring trouble concentrating, indecision, and harsh self-criticism or guilt. Physically, it often disrupts sleep (too much or too little), appetite and weight, and energy — many people feel exhausted no matter how much they rest. Some people lose interest in sex, withdraw from people they love, or stop doing the things that once brought them joy. In its harder moments, depression can bring thoughts that life isn’t worth living — and that’s a sign to reach out for help right away, not to wait.

A picture of what this can look like

Consider someone who is “managing” on the outside — still going to work, still showing up — but who privately feels like they’re moving through fog, can’t enjoy anything anymore, sleeps poorly, and quietly wonders whether things will ever feel better. (This is a fictitious, illustrative composite, not a real patient.) Depression often hides behind a functional exterior, which is one reason it goes untreated for so long. Naming it is the first step toward treating it.

How we understand and evaluate depression

A thorough evaluation does two things: it confirms what’s going on, and it rules out other contributors — thyroid and other medical conditions, medication effects, sleep disorders, grief, trauma, substance use, and conditions like bipolar disorder that need a different treatment approach. The U.S. Preventive Services Task Force recommends that all adults be screened for depression, and we use validated screening tools as part of a full history. The goal is an accurate, whole-person picture so your plan actually fits you.

How depression is treated — and our approach

Depression is highly treatable, and most people get meaningfully better. The strongest evidence supports psychotherapy — including cognitive behavioral therapy and other proven approaches — and medication, used alone or, often most effectively, together. Antidepressants such as SSRIs and SNRIs are well-studied and effective; large analyses comparing many antidepressants confirm they work better than placebo, though the “right” medication varies from person to person. Finding the best fit can take some adjustment, and we’ll guide you through it — including what to expect in the first few weeks, since antidepressants take time to work.

We start from lōkahi — balance across the connected parts of your life — and treat depression in the context of your ‘ohana (family), relationships, and daily life, not as an isolated symptom. Care is collaborative: we build a plan you actually agree with, and we pay attention to sleep, movement, connection, and stress, which all influence mood. For depression that hasn’t responded to first treatments, there are further evidence-based options, and we’ll talk through them honestly.

Brief screening (96127)

As part of getting started — and to track your progress over time — we use brief, validated questionnaires that are administered, auto-scored, and documented on the CNS Vital Signs platform and billed under code 96127 (brief emotional/behavioral assessment). For depression, that includes the PHQ-9 (Patient Health Questionnaire), with the DASS and the Zung Self-Rating Depression Scale also available (CNS Vital Signs, n.d.). Each takes only a few minutes and gives your provider objective information to guide care.

Getting care by telehealth

About 85% of our care is delivered by telehealth, and depression treatment works very well remotely — evaluation, therapy, and ongoing medication management can all happen by secure video. The antidepressants used to treat depression are not controlled substances, so they can be prescribed and managed entirely through telehealth, without an in-person requirement. These are video visits; phone-only visits have additional requirements under Hawaii law — see our telehealth page. We provide care to patients located in Hawaiʻi, and language assistance is available, so distance, cost, and language aren’t barriers to getting help.

One more note on access: as we complete the final stages of becoming a Rural Health Clinic (RHC), telehealth for mental-health care is here to stay with us. Under Medicare’s rural-health rules, RHCs are permanently authorized to provide behavioral and mental-health care by telehealth — including into your home, anywhere in Hawaiʻi — not under the temporary flexibilities that expire and must be renewed. (Prescribing of controlled medications still follows the separate Ryan Haight Act and DEA rules.) For our patients, that means dependable, lasting telehealth access to the care you need.

Wherever you live, OhanaPsych is your statewide practice. We provide care across the entire state of Hawaiʻi by telehealth, reaching every island — Hawaiʻi Island, Maui, Oʻahu, Kauaʻi, Molokaʻi, Lānaʻi, and Niʻihau. If you would rather be seen in person, you have that option at our offices in Hilo and Honolulu.

When to reach out — and when it’s an emergency

If low mood, loss of interest, or the other changes described here have lasted more than a couple of weeks or are getting in the way of your life, that’s a good reason to reach out — you don’t have to hit bottom to deserve help, and earlier care tends to work better.

If you or someone you love is having thoughts of suicide or self-harm, please get help right away — you don’t have to handle it alone. Call or text the 988 Suicide & Crisis Lifeline (call or text 988, or chat at 988lifeline.org). In Hawaiʻi, Hawaiʻi CARES is available by calling or texting 988, or at 808-832-3100 / 800-753-6879. In a life-threatening emergency, call 911.

Medically reviewed by George Mackel, MSN, APRN, NP-C, PMHNP-BC, CARN-AP — President & Owner, OhanaPsych / Ohana Care Clinic.
Last reviewed: June 28, 2026. Citations verified: June 28, 2026.

This page is general health education from OhanaPsych. It is not a substitute for a personal evaluation by a qualified clinician who knows your situation, and reading it does not create a provider–patient relationship. If you think you may have depression or another condition, reach out to us or another licensed provider. In an emergency, call 911.

References

CNS Vital Signs. (n.d.). CNS Vital Signs computerized rating instruments. https://www.cnsvs.com/WhitePapers/CNSVS-RatingInstruments.pdf

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

Cipriani, A., Furukawa, T. A., Salanti, G., Chaimani, A., Atkinson, L. Z., Ogawa, Y., Leucht, S., Ruhe, H. G., Turner, E. H., Higgins, J. P. T., Egger, M., Takeshima, N., Hayasaka, Y., Imai, H., Shinohara, K., Tajika, A., Ioannidis, J. P. A., & Geddes, J. R. (2018). 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. The Lancet, 391(10128), 1357–1366. https://doi.org/10.1016/S0140-6736(17)32802-7

U.S. Department of Health and Human Services. (2026). Telehealth policy updates. Telehealth.HHS.gov. https://telehealth.hhs.gov/providers/telehealth-policy/telehealth-policy-updates

U.S. Preventive Services Task Force. (2023). Screening for depression and suicide risk in adults: US Preventive Services Task Force recommendation statement. JAMA, 329(23), 2057–2067. https://doi.org/10.1001/jama.2023.9297