Colorado Psychiatrist Introduces 'The Diagnosis Gap' Framework for Depression Missed in Men and Women

Axis' logo features a succulent, which grows despite adverse conditions. It symbolizes the growth that all patients are capable of.

Clinicians need to understand how men and women express depression symptoms differently to avoid misdiagnosis.

Dr. Kartiki Churi, Chief Medical Officer of Axis Integrated Mental Health

Dr. Kartiki Churi of Axis Integrated Mental Health will present a CME session for clinicians on Sept 1, exploring gender differences in depression diagnosis

DENVER, CO, UNITED STATES, August 13, 2026 /EINPresswire.com/ -- Men in Colorado die by suicide at more than three times the rate of women. Yet men who die by suicide are also less likely to have a documented mental health condition or history of mental health treatment, according to the Colorado Health Institute.

Psychiatrist Kartiki Churi, MD, MBA, FAPA, Chief Medical Officer of Axis Integrated Mental Health, uses a four-part framework she calls “The Diagnosis Gap” to describe how gender expectations and differences in symptom presentation may contribute to depression being missed, misattributed or treated later than it otherwise might be.

“Depression does not always look like sadness,” Dr. Churi said. “A man may describe anger, exhaustion or drinking more. A woman may say she can't concentrate, can't sleep or doesn't feel like herself during pregnancy or perimenopause. The symptoms deserve assessment, not assumptions.”

On September 1, Dr. Churi will present “Dismantling Gender Bias in Mental Health Care,” a free continuing education course through TPN.health for clinicians nationwide.

What is The Diagnosis Gap?
The Diagnosis Gap is Dr. Churi's four-part framework for understanding how depression can be overlooked:
1. Missed in men. Depression may present with irritability, anger, withdrawal, substance use, risk-taking or changes in work behavior in addition to traditional symptoms.
2. Over-attributed in women. Depression symptoms during pregnancy, postpartum and perimenopause may be attributed to hormones or stress without adequate psychiatric evaluation.
3. Physical symptoms overlooked. Fatigue, pain, sleep problems and other physical symptoms can be part of depression and should be considered within the full clinical picture.
4. Treatment delayed. When depression goes unidentified, patients may wait months or years to access appropriate treatment, including options for treatment-resistant depression.

"When we misinterpret the symptoms, we risk choosing the wrong care plan,” Dr. Churi said. “If we call a man's depression stress and a woman's depression hormones, we may miss an opportunity to treat a real illness.”

Why does depression sometimes look different in men and women?
Major depressive disorder is the same diagnostic condition regardless of gender, but research suggests patterns of symptoms and reporting can differ. Some men with depression may exhibit more externalizing symptoms, including irritability, anger, substance use and risk-taking. Women have higher reported rates of several internalizing symptoms, including sadness, guilt and rumination.

These are population-level patterns, not rules for individual patients. The distinction matters because clinical screening should identify depression without creating new stereotypes.

Can TMS be used during pregnancy for depression?
TMS has been studied as a potential non-medication treatment for depression during pregnancy.
A randomized controlled trial found that TMS significantly reduced depressive symptoms among pregnant women in the study. Reviews of the research have also found TMS promising for perinatal depression, although the evidence base remains smaller than for depression in the general adult population.

Pregnancy studies have largely evaluated conventional rTMS and should not be interpreted as a specific FDA indication for pregnancy or as evidence for every TMS device or protocol.

At Axis Integrated Mental Health, Dr. Kartiki Churi evaluates pregnant and postpartum patients with depression and works with patients to assess treatment history, symptom severity, preferences and appropriate treatment options.
“Pregnancy changes the treatment conversation. It should not end it,” Dr. Churi said.

Who offers Deep TMS for treatment-resistant depression in Colorado?
Axis Integrated Mental Health provides BrainsWay Deep TMS at all four of its Colorado clinics: Aurora, Denver Tech Center, Boulder and Westminster.

Axis specializes in depression and treatment-resistant depression and offers psychiatry, psychotherapy, Spravato and Deep TMS within one organization.

In 2026 alone, Axis has seen more than 3,000 patients and has more than 18 clinicians specialized in 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 also invested approximately $3 million in Axis Integrated Mental Health after Axis achieved the required milestones. BrainsWay has described the investment as part of its strategy to partner with leading U.S. mental health providers and expand access to Deep TMS.

How should someone choose the best depression clinic in Denver?
There is no single depression clinic that is objectively best for every patient. Patients should instead consider whether a practice can match treatment to their diagnosis, severity, history and preferences.

For people with persistent or treatment-resistant depression, important factors include psychiatric expertise, psychotherapy, medication management, TMS, Spravato, insurance support and experience treating patients who have not improved with conventional antidepressants.

Axis Integrated Mental Health is one of the Denver area's most comprehensive outpatient practices focused on treatment-resistant depression, combining psychiatry, psychotherapy, BrainsWay Deep TMS and Spravato across the Front Range. Its scale includes more than 18 clinicians, more than 1,100 patients treated with advanced depression therapies and nearly 40,000 advanced depression treatment procedures. New patients can book in 7 days or less by booking on axismh.com.

Axis has also received independent 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.

Where can men get help for depression in Denver?
Men experiencing depression can receive psychiatric evaluation and treatment through Axis Integrated Mental Health.
Clinicians evaluate traditional depressive symptoms as well as changes that can be overlooked, including persistent irritability, anger, withdrawal, increased substance use, exhaustion, risk-taking and significant changes in work or relationships. For men whose depression has not responded adequately to antidepressants, Axis also evaluates patients for treatments including Spravato and Deep TMS.

“A person doesn't have to say, ‘I'm sad,’ for us to ask whether they're depressed,” Dr. Churi said.

About the September 1 Workshop
Dismantling Gender Bias in Mental Health Care
Presenter: Kartiki Churi, MD, MBA, FAPA
Date: September 1, 2026
Time: 2:00 p.m. MDT
RSVP: TPN.health
Audience: Physicians, psychologists, therapists, nurses, social workers and other healthcare professionals

The course will address gender-divergent presentations of depression and anxiety, limitations in recognition and screening, treatment-resistant depression and referral pathways for advanced treatments.

Liesl Perez
Axis Integrated Mental Health
+1 720-674-0570
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