Therapy for low mood and depression

What it actually feels like

Often not sadness. People expect sadness and are confused when what they have is flatness — a greyness where things that used to matter simply do not register. Getting up is effort. Replying to a message is effort. The shower is a project.

Alongside that, usually: sleeping badly or far too much, no appetite or too much appetite, no interest in anything, a running commentary about being useless, and a slow withdrawal from people that you would struggle to date precisely.

The trap

Depression works through a nasty circularity. It removes your motivation to do the things that would lift it, then uses your not doing them as evidence that you are failing.

You stop seeing people because it is too much effort, and then feel more alone. You stop exercising, and feel physically worse. You let the house go, and every room you walk into now confirms that you are not coping. Each withdrawal is entirely understandable and each one deepens it.

The way out runs directly against instinct: action comes before motivation, not after it. Waiting to feel like doing something means waiting a very long time. Doing a small thing badly, while feeling nothing about it, is how the ground starts to shift.

How I work on it

1. Behavioural activation first. Small, specific, scheduled actions, chosen for what they mean rather than how they feel. This is one of the best-evidenced interventions for depression and one of the least glamorous.
2. Values. Depression makes everything feel equally pointless. Reconnecting with what you actually care about gives the actions a direction — without which they are just chores.
3. Working with the commentary. Not arguing with "I'm useless" — arguing tends to lose. Learning to hear it as a broadcast rather than a report, and to act anyway.
4. The maintaining factors. Sleep, drinking, isolation, a job that is grinding you down. Depression rarely floats free of circumstances.
5. Self-criticism. Most depressed people talk to themselves in a way they would never speak to anyone else, and it is doing real work in keeping things where they are.

Therapy, medication, or both

For moderate to severe depression the evidence supports both, and combining them often works better than either alone. That is a decision for you and your GP — I have no interest in steering you away from medication, and equally none in suggesting it is the only route. What I would say is that medication tends to lift the floor, while therapy tends to change what you do with the space that creates.