Dr. Tim O’Connor, MD
Psychiatrist
Depression Treatment in North Carolina
Longer Appointments. Better Care.
Medication Management for the Triangle
In-Network with Insurance
Immediate Appointments
If you’ve been getting through each day but not really living it — carrying a heaviness that won’t lift, losing interest in things that used to matter — you may be dealing with depression that hasn’t been properly treated.
We offer depression evaluations, medication management, therapy, and TMS, covered by most major insurance, with offices in Raleigh, Chapel Hill, and Cary and Telehealth available statewide.
Our approach starts with understanding what’s actually driving your symptoms — because getting that right is what makes treatment work.
Depression Care at Our North Carolina Locations
We provide depression treatment for adults across North Carolina, with in-person offices in three Triangle locations and Telehealth available statewide. Whether you’re looking for care close to home or prefer the flexibility of virtual appointments, our integrated model of psychiatry and therapy is available to you.
Depression Treatment in Raleigh
Our Raleigh office serves adults throughout the Triangle with the full range of depression treatment — including psychiatry, therapy, medication management, TMS for treatment-resistant depression, and higher levels of care through our Intensive Outpatient Program (IOP) for Depression
Depression Treatment in Chapel Hill
Our Chapel Hill office offers psychiatric evaluations, medication management, and therapy for adults dealing with depression in Chapel Hill, Carrboro, Hillsborough, and surrounding communities. When additional support is needed, higher levels of care are available through our Raleigh location within the same system.
Depression Treatment in Cary
Our Cary office provides outpatient depression treatment for adults in Cary, Apex, Morrisville, and the surrounding area — with the same integrated model of psychiatry and therapy available at all three locations.
What is Depression?
Depression is one of the most common mental health conditions in the world and one of the most misunderstood. It isn’t sadness — or at least, not only sadness. For many people it shows up as emptiness, numbness, or a kind of flattening of experience. For others it looks like irritability, exhaustion, or the inability to feel satisfaction in anything, even things that used to bring genuine joy.
It’s also not a character flaw, a sign of weakness, or something you can resolve by thinking positively or pushing harder. Depression involves real changes in how the brain and nervous system function. Understanding that is often the first step toward actually getting better.
Signs and Symptoms of Depression
Depression presents differently in different people, but common experiences include:
- Persistent low mood, emptiness, or emotional flatness that doesn’t lift
- Loss of interest or pleasure in activities that used to feel meaningful
- Fatigue that sleep doesn’t fix — a bone-deep tiredness that makes everything harder
- Difficulty concentrating, remembering things, or making decisions
- Changes in sleep — too much, too little, or waking in the night unable to settle
- Changes in appetite or weight that feel outside your control
- Feelings of worthlessness, guilt, or the sense that you’re a burden to others
- In more severe cases, thoughts of death or not wanting to be here
If any of this sounds familiar — including the last one — you’re not alone, and it’s worth talking to someone who can help you understand what’s happening and what your options are.
Types of Depression
Depression isn’t one thing. It presents differently depending on the person, the circumstances, and the underlying pattern driving it — and getting the right treatment starts with understanding which type you’re dealing with.
While there are many different types of depression, the below are just a few examples.
Depression and Anxiety
Depression and anxiety co-occur so frequently that many clinicians treat them as two expressions of the same underlying vulnerability. Feeling persistently worried and persistently low at the same time isn’t contradictory — it’s one of the most common presentations we see.
When both are present, treatment needs to address both. A medication that helps depression but spikes anxiety isn’t a success. A therapy approach that builds distress tolerance but doesn’t address the depressive core won’t hold over time. AIM’s providers are experienced with this combination and know how to navigate the clinical complexity it introduces.
→ Learn more about Anxiety Treatment at AIM
Postpartum Depression
Postpartum depression is more than the ‘baby blues’ — the temporary mood shifts many new parents experience in the first days after birth. Postpartum depression involves persistent symptoms that interfere with your ability to function and care for yourself and your child, and it can develop any time in the first year after delivery.
It’s also far more common than most people realize and it’s treatable. If you’re a new parent struggling with persistent low mood, difficulty bonding with your baby, intrusive thoughts, or the sense that you’re failing at something that should feel natural, please reach out. What you’re experiencing has a name, and there’s effective help available.
Seasonal Affective Disorder
Seasonal Affective Disorder (SAD) is a pattern of depression that follows the seasons — most commonly emerging in fall and winter as daylight decreases and lifting in spring. It’s more than just disliking cold weather. SAD involves the same core symptoms as major depression — low energy, changes in sleep and appetite, difficulty concentrating, withdrawal from activities — on a predictable seasonal cycle. Treatment includes therapy, medication, and light therapy depending on the severity and pattern.
High-Functioning Depression
High-functioning depression — sometimes called persistent depressive disorder or dysthymia — is one of the most commonly missed presentations because the people experiencing it are often still showing up, still performing, still managing their responsibilities. From the outside, nothing looks wrong. From the inside, everything feels harder than it should, motivation is chronically low, and a persistent sense of emptiness or flatness has become the baseline. If you’ve felt this way for so long it just feels like your personality, it’s worth getting evaluated.
How Do I Know I Need Help for Depression?
Most people who would benefit from depression treatment wait longer than they should — not because they don’t recognize something is wrong, but because depression itself makes it harder to take action. Low motivation, self-doubt, and the quiet assumption that things will eventually get better on their own are all part of the condition. They’re also the things that keep people from reaching out.
There’s no threshold you need to hit before you deserve care. You don’t need to be in crisis. You don’t need to have been struggling for a specific amount of time. If depression is interfering with your life — your relationships, your work, your ability to find meaning in things that used to matter — that’s enough.
Signs to Get Help for Depression
- Feeling persistently low, empty, or hopeless for two weeks or more
- Losing interest in activities or relationships that used to matter to you
- Changes in sleep — sleeping too much, too little, or waking up exhausted regardless of how long you slept
- Changes in appetite or weight that aren’t explained by anything else
- Fatigue or a heavy, slowed-down feeling that doesn’t improve with rest
- Difficulty concentrating, making decisions, or following through on things
- Withdrawing from people you care about or canceling plans consistently
- Going through the motions of daily life without feeling present or engaged
- A persistent sense that things won’t get better — or that you wouldn’t be missed if you weren’t here
If you’ve been managing on your own and not getting better — or if you’ve tried treatment before and it didn’t work the way you hoped — that’s also a reason to reach out, not a reason to give up. Depression is treatable, and the right care makes a real difference.
→ Learn more: Severe Depression: Symptoms, Treatments, and When to Get Help
Depression Evaluation And Diagnosis
Depression is a clinical diagnosis — which means it requires more than a checklist. At AIM, your initial evaluation is a detailed clinical conversation, not a form to fill out and hand in.
Your provider will want to understand your history: when it started, how it’s shown up over time, what has and hasn’t helped, and what your life looks like at your best and your worst — including your physical health, your sleep, your relationships, and your work.
Depression doesn’t occur in a vacuum, and neither does recovery. The more we understand your full picture, the better we can help.
Depression vs. Bipolar Disorder — Why Getting It Right Matters
One of the most consequential diagnostic distinctions in psychiatry is between depression and bipolar disorder. Both involve episodes of depression that can look and feel identical — but bipolar disorder also involves periods of elevated or expansive mood (mania or hypomania) that may be subtle, brief, or easy to mistake for simply feeling good or productive for a stretch.
This distinction matters enormously for treatment. Some medications that work well for depression can actually destabilize someone with bipolar disorder if used without a mood stabilizer. Getting the diagnosis right isn’t a formality — it’s the foundation of a treatment plan that actually works.
If you’ve been treated for depression but haven’t gotten meaningfully better, or if your mood tends to cycle in ways that feel out of proportion to your circumstances, it’s worth exploring whether bipolar disorder might be part of your picture.
→ Learn more: Bipolar Disorder Treatment at AIM
How is Depression Treated?
There’s no single treatment that works for everyone with depression. The right approach depends on the nature and severity of your symptoms, your history with previous treatment, what else is going on in your life, and your own preferences and values. At AIM, we build treatment plans around the person, not the diagnosis.
Therapy for Depression
Therapy is one of the most effective treatments for depression — not as a substitute for medication when medication is indicated, but as a genuine intervention in its own right, and a powerful complement when both are appropriate.
Our therapists work with adults with depression using approaches that have strong evidence behind them, including Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), and relational approaches that help people understand the interpersonal patterns that can sustain or deepen depression over time.
Therapy for depression isn’t just about learning coping skills. At its best, it helps you understand the roots of how you experience yourself and the world — and builds the kind of internal capacity that makes lasting change possible.
→ Learn more about therapy for Depression at AIM
Medication for Depression
For many people with depression, medication is an important part of treatment. Antidepressants can be effective tools — when the right medication is matched to the right person, carefully introduced, and monitored over time by someone who knows what they’re looking for.
That last part matters more than most people realize. Medication management isn’t just writing prescriptions — it’s watching for side effects, adjusting doses, noticing when something that was working stops working, and knowing when it’s time to try a different approach entirely.
Our psychiatric providers carry smaller caseloads specifically so they have the time and attention to do this well.
→ Read more: Psychiatry for Depression at AIM
When Therapy and Medication Work Together
The research is clear that for moderate to severe depression, a combination of therapy and medication produces better outcomes than either alone. The medication addresses the neurological dimension of depression — lifting the floor enough to make genuine psychological work possible. The therapy builds the skills, insight, and relational capacity that sustain improvement after medication is eventually tapered.
Because AIM has psychiatrists and therapists under one roof who communicate directly with each other, this coordination actually happens. It isn’t left to chance or to the patient to manage.
Alternatives to Antidepressants
Medication isn’t the right starting point for everyone — and for some people, it’s not the right fit at all. There are evidence-based alternatives worth understanding before making treatment decisions, from therapy-first approaches to lifestyle factors that have meaningful clinical impact to newer modalities like TMS.
Sleep, nutrition, exercise, and stress management are not soft add-ons to depression treatment. They are clinical targets. Sleep disruption alone can maintain and worsen depression even when everything else in the treatment plan is correct. Regular aerobic exercise has demonstrated antidepressant effects in the research. Your provider will ask about these areas and help you address them as part of your overall plan — because for some people, getting sleep under control or addressing a chronic stressor is the intervention that makes everything else finally start to work.
→ Read more: Alternatives to Antidepressants
Alternative Depression Treatments
If you’ve tried therapy, tried medication — or several medications — and you’re still not where you need to be, you’re not out of options. Transcranial Magnetic Stimulation (TMS) is a non-invasive, FDA-cleared treatment for depression that works through a completely different mechanism than medication, which is why it can succeed where antidepressants haven’t.
AIM offers TMS at our Raleigh location for adults with depression who haven’t responded adequately to other treatments.
What Is TMS and Who Is It For?
TMS uses targeted magnetic pulses to stimulate specific areas of the brain associated with mood regulation. It’s done in our office, requires no anesthesia, and has no systemic side effects because it works locally rather than throughout the body the way medication does.
TMS is most commonly recommended for people who have tried at least one antidepressant without adequate relief, or who have had difficulty tolerating medication side effects. It’s also an option for people who prefer not to take medication or for whom medication is contraindicated for other reasons.
TMS for Treatment-Resistant Depression
Treatment-resistant depression — usually defined as depression that hasn’t responded to two or more adequate medication trials — is more common than most people realize. If that’s your experience, the problem isn’t that you’re beyond help. It’s that you haven’t yet found the right treatment for how your particular brain and nervous system are organized.
TMS was specifically developed for this population. For many people who had largely given up on feeling better, TMS has been the thing that finally worked. We’ll be transparent with you about what realistic expectations look like for your specific history.
What to Expect During TMS
A standard TMS course involves daily sessions, typically five days a week for four to six weeks. Each session lasts roughly twenty to forty minutes, and most people can drive themselves, return to work the same day, and live their normal life throughout the treatment course — there’s no recovery time required.
During treatment, you’ll sit comfortably while a magnetic coil is positioned against your scalp. You’ll feel a tapping sensation and hear clicking sounds during the pulses. Some people experience mild scalp discomfort or headaches early in treatment, which typically diminishes after the first week.
Your AIM team monitors progress throughout the course and adjusts the treatment protocol as needed. If you’re also seeing a therapist or prescriber — inside or outside AIM — we coordinate with them so your care stays connected.
Does Insurance Cover TMS?
TMS is covered by most major insurance plans for patients who meet clinical criteria — typically, documented failure to respond to a minimum number of antidepressant trials. AIM is in-network with Blue Cross Blue Shield, Cigna/Evernorth, Aetna, UNC Health Alliance, Optum/United, the NC State Health Plan, Ambetter, TRICARE, and more.
Insurance authorization for TMS can require prior authorization and documentation of your treatment history. Our team handles this process with you and will let you know what to expect before you commit to a course of treatment.
→ Read more: TMS Treatment at AIM
When Therapy Isn’t Enough for Depression
For most people with depression, outpatient care — regular therapy, periodic medication check-ins — is the right level of support. But depression exists on a spectrum, and some presentations require a more intensive structure to stabilize.
If symptoms are severe, daily functioning is significantly impaired, or you’re struggling to stay safe, stepping up the level of care is a clinical decision — not a sign of failure — and it typically produces better outcomes and gets people back to their lives faster.
Intensive Outpatient Programs for Depression
AIM’s mental health Intensive Outpatient Program (IOP) provides structured therapeutic support multiple days per week for people who need more than weekly therapy but don’t require inpatient hospitalization. IOP for depression typically involves group therapy, individual sessions, and psychiatric oversight — all coordinated within AIM’s system.
The advantage of accessing IOP through AIM rather than an outside program is continuity. Your outpatient providers already know you. When you step up to IOP and eventually step back down, the transition is seamless rather than a hand-off between strangers.
Treatment for Complex Depression
Depression that’s layered with trauma, substance use, significant anxiety, or longstanding relational patterns often requires a treatment system rather than a single provider. At AIM, you don’t have to build that system yourself. Your psychiatrist, therapist, IOP team, and TMS providers all operate within the same organization — sharing relevant information, coordinating on your care, and adjusting the plan as your needs change.
For patients with complex presentations, this kind of integration isn’t a convenience. It’s what makes meaningful recovery possible.
→ Read more: IOP for Depression
Why Choose AIM for Depression Care?
Most depression care gives you a rushed prescriber who barely knows your name and a treatment plan that doesn’t account for the rest of your life. AIM was built to be the opposite — providers who actually know you, care that connects across every part of your mental health, in-network insurance, and access across North Carolina whether you come in person or not.
A Different Kind of Psychiatric Practice
At most psychiatric practices, patients see their prescriber for fifteen minutes, four times a year. That’s not how good depression care works. Our providers carry intentionally smaller caseloads so they have the time to actually know you — to notice when something has changed, to ask the questions that matter, and to adjust care proactively rather than reactively.
This is a deliberate model. We believe the therapeutic relationship is itself a clinical tool — and that the quality of your care depends directly on your provider having the bandwidth to show up for it.
Integrated Care Under One Roof
AIM is built as an integrated system. That means your psychiatrist, your therapist, your TMS team, and any other providers involved in your care aren’t operating in isolation — they communicate directly, share relevant information, and collaborate on your plan. For people with depression who also have anxiety, trauma, ADHD, or substance use concerns, this integration is what produces better outcomes.
Ready to Take the Next Step?
Depression is treatable — and you don’t have to have it all figured out before reaching out. Whether you’re looking for answers, trying to understand your options, or ready to get started, we’re here.
We’re currently accepting new patients at our Raleigh, Chapel Hill, and Cary locations and throughout North Carolina via Telehealth.
Lindsay Hildreth, PA-C, CAQ-Psychiatry
Psychiatric Physician Assistant
Elizabeth Morgan, PA-C
Psychiatric Physician Assistant
Madeline Hooper, MSW, LCSW
Clinical Therapist
Our Team
At AIM, our team is built around one goal — helping you get better.
A Team Committed to Your Wellbeing
We believe good care starts with good people. Our clinicians, prescribers, and support staff work together so that every part of your treatment is connected. You won’t have to repeat your story to providers who don’t talk to each other. Everyone on your team knows who you are and what you’re working toward.