Depression
Depression
Depression is more than a period of low mood. It is a persistent state that can affect how you think, feel, move through the world, and make sense of yourself. It can arrive with an identifiable cause, after a bereavement, a relationship ending, a job loss, a health diagnosis, or a period of sustained stress, or it can arrive without one, which can make it harder to understand and easier to dismiss. Many people with depression continue to function in daily life while carrying something that is significantly affecting them. The gap between how you appear to others and how you actually feel can itself become exhausting.
What depression feels like
Depression varies considerably in how it presents. Common experiences include:
- Persistent low mood or a pervasive sense of emptiness that doesn’t lift
- Loss of interest or pleasure in things that usually matter
- Fatigue and reduced energy, often disproportionate to activity levels
- Difficulty concentrating or making decisions
- Disrupted sleep, either difficulty sleeping or sleeping too much
- Changes in appetite or eating
- Feelings of worthlessness, shame, or excessive self-criticism
- Withdrawal from people and activities
- Physical symptoms including unexplained pain, heaviness, or slowed movement
- Thoughts that life is not worth living
If you are having thoughts of suicide or self-harm, please contact your GP, call the Samaritans on 116 123, or go to your nearest A&E. You don’t need to be in immediate danger to ask for help.
Types of depression
Depression is not a single presentation. Understanding which type you may be experiencing can help in finding the right support.
Major depression involves persistent low mood and associated symptoms for at least two weeks, affecting the ability to function in daily life. It may occur as a single episode or recurrently.
Persistent depressive disorder (dysthymia) describes a lower-level but chronic depression lasting two years or more. Because it persists rather than arriving acutely, it can be easy to normalise or mistake for personality.
Seasonal affective disorder (SAD) follows the seasons, typically beginning in autumn and lifting in spring, connected to changes in light levels.
Postnatal depression develops after the birth of a child and is more significant and persistent than the low mood many new parents experience in the early weeks. It deserves prompt clinical attention.
What causes depression
From a psychodynamic perspective, depression often has roots that go deeper than current circumstances. It can be connected to grief that hasn’t been fully processed, to early relational experiences that shaped how you understand your own worth, to chronic patterns of self-suppression, or to losses, including emotional losses, that were never adequately mourned. Understanding those roots tends to produce more durable change than symptom management alone.
Depression and trauma are also frequently connected. Many people whose depression has felt treatment-resistant find that addressing underlying trauma, particularly developmental or relational trauma, shifts something that other approaches haven’t reached.
Should I see my GP?
Yes. It’s worth letting your GP know how you’re feeling. There can be physical factors contributing to low mood, including thyroid function and vitamin deficiencies, worth ruling out. Your GP can also discuss medication if that feels relevant. Medication and therapy are not mutually exclusive, and for some people a combination is the most effective approach. I’m happy to work alongside your GP or psychiatrist if that’s part of your care.
How I work with depression
My approach is relational and psychodynamic. I’m interested in the history behind the depression as much as its current presentation, in what it might be communicating, and in what conditions allow it to begin to lift. The therapeutic relationship itself is part of what helps. For depression that has roots in early relational experience, having a consistent, attuned, and genuinely safe therapeutic relationship offers something that insight alone cannot.
Some people find that relatively short-term work is sufficient to shift an episode and build enough understanding to manage future ones. Others find that longer-term depth work is what’s needed, particularly where depression has been present for many years or is connected to complex trauma or relational patterns.
Further reading
- The Drama of Being a Child — Alice Miller
- Lost Connections — Johann Hari
- Reasons to Stay Alive — Matt Haig
- Mind: mind.org.uk
- Samaritans: samaritans.org, 116 123
Samantha Merry is a BACP Senior Accredited Psychotherapist in private practice in Bromley, South East London, and a doctoral researcher at the University of Chester.