Depression

Low mood, low energy, and a loss of interest can all point to depression, but none of them belongs to depression alone. The same surface can sit on top of several different things: a response to hard circumstances such as grief, burnout, or sustained stress; a physical cause such as a thyroid problem, low iron, or disrupted sleep; or sadness that has simply run heavier and longer than usual without being a disorder. These are difficult to separate from the inside. Telling them apart is what an assessment is for, and the purpose is not to label you, but to match the right kind of help to whatever is actually going on.

Everyone feels sad. Sadness is a normal emotional response to loss, disappointment, or stress, and it rises and falls with what is happening in your life. Depression is something more specific. It is a clinical condition in which low mood, or a loss of interest and pleasure, persists for most of the day, on more days than not, for at least two weeks, and begins to interfere with how you sleep, think, function, and relate to the people around you. The difference is one of duration, depth, breadth, and how far the state tracks your circumstances rather than running on regardless of them.

Yes. Depression does not always arrive as sadness. For many people it shows up first, or most loudly, in the body: a tiredness that sleep does not fix, sleep that has turned broken or endless, an appetite that has gone strange, a heaviness in the limbs, aches without an obvious cause, a sense of moving through treacle. These are not extras tacked onto a low mood. They are part of how depression is defined, and for some people they are the main event, with little or no feeling of sadness at all. It is also why this kind of depression is so often missed, including by the person living it, who may assume they are simply run down or unwell.

Often, yes. A loss of feeling, where things you used to enjoy land flat, where the day passes without much registering, where even the people and activities you care about cannot quite reach you, is one of the most common features of depression. It has a name, anhedonia, which means a reduced ability to feel pleasure or interest. It is not the same as not caring, and it is not a character flaw. But numbness is not unique to depression. It can follow trauma or overwhelm, and it can be a side effect of some medications. So a flatness that has settled in is worth bringing to someone, rather than carrying on your own.

Yes, though not in the way the word "linked" sometimes suggests. The link is not that one gets mistaken for the other, or that you have to work out which one it really is. Depression and ADHD co-occur: depression is considerably more common in people with ADHD than in the general population, and the two are often present at the same time. For some people they simply travel together. For others, a low mood has built up over years of living with an ADHD that was never recognised or supported. Either way, the two are not rivals, and you do not rule one out in order to attend to the other.

The first session is a conversation, not a test. The shape varies between clinicians and between presentations, but the general arc is the same. The first part is about meeting each other, getting a sense of what has been going on, and starting to map the picture together. The second part is about working out what would be useful from here, what kind of work might fit, and what the next few sessions could look like. There is nothing you need to bring, prepare, or perform. With depression in particular, even getting to the session can take real effort, so if you have made it that far, the hardest part of the day may already be behind you. There is no right way to do a first session. Arriving is the start.

Yes. Therapy for depression can be done online, and for many people it is a genuine option rather than a lesser one. The more useful question is not whether online therapy is good enough in the abstract, but whether it suits you, this presentation, and this stage of the work. For a great many people it suits well. For some, starting in person makes more sense. Both are available here, in person at our Kew and Croydon rooms or online, and the choice is not fixed. People move between the two as their circumstances change.

For some people it does, and for others it does not, and at the point of recovery there is no reliable way to tell in advance which group you are in. This is the honest answer, and it is more useful than a frightening one. Depression can be a one-time episode, or it can be something that returns across a life. Knowing which pattern you are looking at is less about bracing for the worst and more about understanding what tends to raise or lower the odds, so that if low mood does return, you recognise it early rather than late. Recurrence is a pattern to understand, not a verdict to fear.

First, the fear makes sense. Reaching out for help with depression means saying something out loud that you might have spent a long time not saying, even to yourself, and that is a genuinely hard thing to do. Being scared to start is not a sign that you are not ready, or that something is wrong with you on top of everything else. For many people it is simply part of starting. You do not have to feel brave, or certain, or even convinced that it is depression. You only have to be willing to take one small step and see how it feels. The rest can be worked out from there.

The most useful place to start is also the hardest: you cannot fix this for them, and you were never meant to. Depression is not something a person can be loved out of, and if someone you care about is still struggling, that is not a measure of how much you have given. You do not have to be their therapist, find the right words, or have a plan. What helps is quieter than any of that. It is staying close, listening without rushing to mend things, and gently helping them toward support that is built for this. And because caring for someone through depression is genuinely hard, looking after yourself is part of the work, not a distraction from it.