Depression treatment in English

How people describe it

Not "I am sad." More often: I cannot be bothered. I am tired in a way sleep does not fix. I do the work but there is nobody home. I have no reason to feel like this, which makes it worse.

Along with it, commonly: broken sleep and early waking, appetite up or down, no sex drive, irritability that surprises you, and a self-critical voice that has become so constant you no longer hear it as a voice.

One way of understanding it

Depression often functions as a shutdown. Something became unbearable — a loss, a humiliation, a rage you were not allowed to have, a relationship you cannot leave and cannot stay in — and the system turned everything down rather than let that through.

That is why the flatness is so complete. You cannot dim one feeling on its own. The joy goes out with the anger.

This is not the only account of depression, and it is not true of everyone. But when it fits, therapy has somewhere concrete to go: not "think more positively", but finding what was shut down and letting it move again, at a pace you can carry.

When it is grief, and when it is not

Grief after a real loss is not an illness, and it does not need curing. It needs room. We take it seriously as grief. But grief that has been frozen for years — because there was no time, no space, or nobody to say it to — starts to behave like depression, and then it does need help to move.

Medication

Antidepressants help a great many people, and for moderate to severe depression the evidence supports combining medication with therapy rather than choosing between them. We cannot prescribe. Your GP can, and we will tell you plainly if we think you should have that conversation.

How long

A first depression, caught early, often moves in ten to twenty sessions. Depression that has been there for years, or sits on top of childhood trauma, takes longer — and the honest version is that we will know much more after four sessions than we can tell you now.