Colorado psychiatrist pushes framework to catch missed depression diagnoses

Axis Integrated Mental Health Chief Medical Officer Kartiki Churi will lead a Sept. 1 CME session on gender bias in mental health care, arguing that depression is often missed when symptoms show up as anger, fatigue, sleep issues or other nontraditional signs. The talk comes as Colorado men die by suicide at more than three times the rate of women.

Why it matters: - Depression can be missed when clinicians expect it to look the same in every patient. - Dr. Kartiki Churi says earlier recognition matters for men, women and pregnant or postpartum patients who may not fit a narrow symptom checklist. - Colorado men die by suicide at more than three times the rate of women, and men who die by suicide are less likely to have a documented mental health condition or treatment history. - Faster diagnosis can affect access to treatment, including options for treatment-resistant depression.

What happened: - Dr. Kartiki Churi, chief medical officer of Axis Integrated Mental Health, is introducing a four-part framework called “The Diagnosis Gap.” - The framework is designed to explain how gender expectations and symptom differences can lead to depression being missed, misattributed or treated late. - Churi will present “Dismantling Gender Bias in Mental Health Care” on Sept. 1, 2026, as a free continuing education course through TPN.health. - The session is open to clinicians nationwide.

The details: - The first part of the framework focuses on depression that is missed in men. - Churi says depression in men may show up as irritability, anger, withdrawal, substance use, risk-taking or changes in work behavior. - The second part covers depression in women being over-attributed to hormones or stress, especially during pregnancy, postpartum and perimenopause. - The third part warns that fatigue, pain, sleep problems and other physical symptoms can be part of depression and should be assessed in context. - The fourth part says delayed recognition can leave patients waiting months or years for appropriate treatment. - Churi said depression does not always look like sadness, and symptoms deserve assessment rather than assumptions. - Churi also said misreading symptoms can lead to the wrong care plan. - Major depressive disorder is the same diagnosis regardless of gender, but research shows symptom patterns and reporting can differ. - Population-level patterns suggest some men are more likely to show externalizing symptoms, while women have higher reported rates of sadness, guilt and rumination. - Those patterns are not rules for individual patients. - TMS has been studied as a potential non-medication treatment for depression during pregnancy. - A randomized controlled trial found TMS significantly reduced depressive symptoms among pregnant women in the study. - Reviews have found TMS promising for perinatal depression, though the evidence base is smaller than for depression in the general adult population. - Pregnancy studies have largely evaluated conventional rTMS and should not be treated as an FDA indication for pregnancy or as proof for every device or protocol. - Axis Integrated Mental Health evaluates pregnant and postpartum patients with depression and considers treatment history, symptom severity, preferences and treatment options. - Churi said pregnancy changes the treatment conversation but should not end it. - Axis provides BrainsWay Deep TMS at its four Colorado clinics in Aurora, Denver Tech Center, Boulder and Westminster. - The practice also offers psychiatry, psychotherapy, Spravato and Deep TMS in one organization. - In 2026, Axis has seen more than 3,000 patients. - Axis has more than 18 clinicians focused on depression, anxiety and other common mental health conditions. - The practice has treated more than 1,100 patients with advanced depression therapies and completed more than 40,000 advanced depression treatment procedures. - BrainsWay has invested about $3 million in Axis after the practice reached required milestones. - BrainsWay has said the investment fits its strategy to partner with leading U.S. mental health providers and expand access to Deep TMS. - Axis says new patients can book in 7 days or less through axismh.com. - The practice has also received Colorado recognition including ColoradoBiz Magazine’s Top Startup of the Year, Best of Mile High, Boulder County Gold, Colorado Companies to Watch and Denver Business Journal's Partners in Philanthropy honors.

Between the lines: - The framework reflects a broader push to reduce diagnostic bias without creating new stereotypes. - The emphasis on symptom presentation suggests screening tools may miss patients if they rely too heavily on classic signs like sadness. - The pregnancy and perinatal discussion shows how treatment decisions can become more complicated when clinicians over-focus on medication risk and under-focus on the illness itself. - Axis is positioning advanced depression care as a multidisciplinary model, not a single-treatment offering.

What's next: - Clinicians can register for the Sept. 1 CME session through TPN.health. - The course will address gender-divergent depression and anxiety presentations, limits in recognition and screening, treatment-resistant depression and referral pathways for advanced care. - Axis says it will continue evaluating patients for medication management, psychotherapy, Spravato and Deep TMS based on diagnosis, severity and history. - People in the Denver area who want a psychiatric evaluation for depression can seek care through Axis Integrated Mental Health.