"I was dealing with debilitating insomnia and anxiety that was affecting my ability to work. After several sessions I had made significant improvement — sleeping decently, more energy, far less anxiety. Dr. Chacko identified and drew on my own strengths to bolster my treatment. Working with him was life-changing for me."
"He was non-judgmental and onboard at going at my own pace. I left there with new ways to help decrease my anxiety. You truly couldn't be in better hands."
Andrew sees patients at his San Francisco office, works with clients throughout the Bay Area, and offers telehealth across California. Anxiety and depression are the most common reasons adults seek therapy and psychiatric care — and they frequently travel as a pair. Roughly one in five U.S. adults meets criteria for an anxiety disorder in any given year, and an estimated 60% of people with anxiety also experience significant symptoms of depression (National Institute of Mental Health; NAMI). The anxious mind exhausts itself until motivation collapses; the depressed mind produces anxiety about its own state. Andrew treats both together, in the same therapeutic relationship, integrating talk therapy and medication management under one roof.
Request a ConsultationPersistent worry that is difficult to control or set aside
Low mood or a pervasive sense of emptiness that doesn't lift
Fatigue that sleep does not resolve — exhaustion as a baseline
Sleep disruption — difficulty falling asleep, staying asleep, or waking unrefreshed
Physical tension — tight muscles, headaches, jaw clenching, a body that won't settle
Difficulty concentrating — mind pulled toward worst-case scenarios or simply blank
Social withdrawal — pulling back from people, relationships, or activities you used to seek out
Loss of pleasure in things that used to matter — hobbies, work, connection
A cycle of anxious thoughts followed by exhaustion and hopelessness about ever feeling different
Anxiety and depression are not simply two separate diagnoses that happen to overlap. They share neurobiological roots — the same dysregulation of serotonin, norepinephrine, and the stress response system underlies both. And they create conditions for each other: chronic anxiety is physiologically exhausting. Sustained activation of the threat-response system depletes the neurochemical resources that support mood, motivation, and energy. The result is depression — not as a separate problem, but as a downstream consequence of an overwhelmed nervous system. Research consistently shows that patients with co-occurring anxiety and depression experience more persistent symptoms, slower recovery, and higher rates of recurrence than those with either condition alone — which is why integrated treatment matters (Hirschfeld, 2001).
The reverse is equally true. Depression generates anxiety about itself. A person struggling with low mood, loss of motivation, and inability to feel pleasure begins to worry: What is wrong with me? Will I ever feel normal again? Am I failing at my life? That worry activates the anxiety system, which further depletes the resources needed to recover. This is why treating one condition without the other so often produces incomplete results — you address the anxiety but the depression keeps it fed, or you address the depression but the underlying anxiety reasserts itself.
Andrew's approach treats both conditions within one relationship — no separate referrals for therapy versus psychiatry, no hand-offs, no gaps between the person managing your medication and the person doing the therapeutic work. He evaluates what is driving each condition, how they interact in your particular case, and builds a treatment plan that addresses both simultaneously. That plan may include:
A significant portion of Andrew's patients are high-functioning professionals. They are meeting their obligations — showing up, delivering, maintaining the external markers of a life that is going well. But internally, they are living in chronic tension or flatness. The words they use: keyed up, hollow, can't turn off, going through the motions. They wake up tired, spend the day managing the distance between how they appear and how they feel, and often don't think they qualify for help because they are, by external measures, fine.
They do qualify. High-functioning anxiety and depression are real and often severe — in some ways more insidious precisely because the performance continues, masking the suffering from others and sometimes from the person themselves. This presentation is one Andrew knows well, and it responds to treatment.
Andrew sees patients for anxiety and depression in person at his Pacific Heights office — conveniently located for those coming from Presidio Heights, Cow Hollow, the Marina, and Nob Hill — and via telehealth throughout California.
Andrew is accepting new patients in San Francisco. The first call is complimentary — no paperwork, no commitment.
Request a ConsultationAnything else — the complimentary phone call is the right place to ask.