Sadness and Depression: Opening the Curtains on the darkness

I think depression is a hard topic to write about and it’s certainly a hard condition to live with, both for the person struggling, and those around them.  I am torn writing this between making sure I do the subject justice, validating people who truly struggle with depressive conditions, and being open and honest about the misuse of the word and the over, or misdiagnosis of the condition, which then leads to further psychological distress and damage, even leading to something known as learned helplessness.

True clinical depression is not simply a synonym for sadness, laziness, or weakness. Neither is it just a messed up chemical equation that can be balanced by “topping up” a single neurotransmitter such as the mythical serotonin. Depression is a lived experience that is felt in bodies, filtered through brains, can invade our lives, and literally make people feel like life isn't worth living. Our understanding of it has been shaped by relationships, culture, history, economics, and biology. It is the fog you can’t reason your way out of, the heaviness in your limbs weighing you down in to inertia when life insists on motion, the self‑critique that mutates ordinary setbacks into 'proof' of personal failure. Yet, paradoxically, it is also something people recover from every day.

I’m inviting you into a friendly, personal, and evidence‑informed walk-through what depression is (and as importantly what it isn’t), what we currently know about its causes, why the much‑touted “serotonin hypothesis” missed the mark, and how change actually happens. We’ll talk through talk therapies, behavioural activation, medication, habits, relationships, and meaning. My hope is that by the end of this if you are struggling in anyway, you can challenge the idea that you are depressed, or just having a difficult time, and either way, what way out of your struggles you want to choose.

What Does “Clinical Depression” Actually Mean?

Let’s talk about clinical depression, or what the The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) officially refers to as Major Depressive Disorder (MDD). This isn’t just feeling low for a few days, or having a week where things feel a bit heavier than usual. It’s a diagnosable mental health condition that requires specific symptoms to be present for a defined period of time, with a clear impact on day-to-day functioning. And I think that’s an important distinction.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), is one of the main reference tools clinicians use to determine whether someone meets criteria for a psychiatric diagnosis. It's a bit like a map, a guide, but it shouldn’t just be a tick box exercise, and with depression, that map includes a checklist of symptoms, but also some essential questions: How long has this lasted? How much is it interfering with your life? And is there something else going on that might explain it better?  We will come to that last bit later because I believe that is the bit many people overlook when being diagnosed, or even self-diagnosing.

DSM-5 Criteria for Major Depressive Disorder (MDD)

According to the DSM-5, to be diagnosed with MDD, a person must experience at least five of the following nine symptoms, nearly every day, for at least two consecutive weeks. One of those symptoms must be either (1) depressed mood, or (2) loss of interest or pleasure.

1. Depressed mood most of the day, nearly every day. This can be observed by others (e.g., appearing tearful), or subjectively reported (e.g., feeling sad, empty, or hopeless).

2. Markedly diminished interest or pleasure in almost all activities.

3. Significant weight loss or gain, or changes in appetite.

4. Insomnia or hypersomnia (sleeping too little or too much).

5. Psychomotor agitation or retardation   either feeling physically restless or slowed down, which others can notice.

6. Fatigue or loss of energy nearly every day.

7. Feelings of worthlessness or excessive or inappropriate guilt.

8. Diminished ability to think or concentrate, or indecisiveness.

9. Recurrent thoughts of death, suicidal ideation, or a suicide attempt.

These symptoms must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. And crucially, they must not be attributable to substances (like alcohol or medication) or a medical condition (such as hypothyroidism or anaemia).

Sadly, some clinicians without specialist training, including even some G.P.s, who are normally not mental health specialists, might diagnose depression at a far lower level of symptomology than these criteria were designed for. If we are meant to diagnose this condition after just two weeks, then the symptoms must be really serious and potentially life threatening, either that or technically we could all meet the criteria for being depressed at times in our life and that isn't how it is meant to be.

To be honest after a significant break up in my life, I ate too much for a few weeks so gained weight, didn't sleep that well so therefore felt tired, felt sad and guilty about the break up and probably struggled to enjoy myself for a while. Did I have a major depressive disorder? No, absolutely not, I was responding appropriately to my situation and soon felt better. And yet, for someone just ticking the boxes on the criteria checklist, I might have been deemed to meet the criteria and labelled as 'depressed'.

In addition to major depressive disorder (MDD), depression comes in many other guises, such as:

• Persistent Depressive Disorder (PDD) – formerly dysthymia

  This is a long-term form of depression where the symptoms are less severe but more chronic. People may feel low or "flat" most days for at least two years. They might function in daily life but feel like they’re just “getting through.”

  
  

• Bipolar Depression

  This occurs in people with bipolar disorder, where periods of depression alternate with episodes of mania or hypomania. The depressive episodes can look identical to MDD, but treatment often differs, as traditional antidepressants alone can trigger manic episodes.

  
  

• Postnatal or Postpartum Depression

  This occurs after childbirth, typically within the first few months. It involves not just typical depressive symptoms but also intense anxiety, difficulty bonding with the baby, and overwhelm. It’s different from the more transient “baby blues,” which are milder and pass in a few days.

  
  

• Psychotic Depression

  This is a severe subtype of depression where a person experiences delusions (false beliefs) or hallucinations (seeing/hearing things that aren’t there), alongside the core symptoms of depression. It often requires antidepressant and antipsychotic medications.

  
  

• Situational Depression (Adjustment Disorder with Depressed Mood)

  This occurs as a response to a specific life event such as divorce, job loss, or bereavement. The symptoms may not meet criteria for MDD, but the emotional distress is significant and can interfere with functioning.

  
  

• Masked or Somatic Depression

  In some people (often from cultures or environments where mental health isn’t openly discussed), depression might appear primarily through physical symptoms like chronic pain, digestive problems, or fatigue rather than emotional symptoms

  
  

Sadly, very often people are told they have depression, without the sub-type which could help inform treatment and understanding of their condition.  Sometimes that is because it might be hard to fully know what is really going on as two people with depression might look completely different; one may cry constantly; another may feel emotionally numb. One might sleep all day; the other be wracked with insomnia. There are however, some cognitive and behavioural similarities in depression.

When Depression Hijacks Your Thinking: The "Don’t Bother" Loop

One of the cruellest features of depression is how it distorts the way we think and gives us a sense of what we called learned helplessness, the idea that, after repeated experiences of failure, exhaustion, or emotional pain, the brain starts to believe there’s no point trying anymore. It’s not a conscious choice. It’s a protective mechanism. It doesn’t just make you feel low, it actively rewires the brain to expect failure, futility, or rejection, even in places where joy or connection might once have lived. It blocks the brain’s access to reward, dampens positive emotion, and makes it harder to recall happy memories or imagine hopeful futures. It’s not that the good things aren’t there, it’s that your brain, quite literally, can’t see them the same way.

You might find yourself caught in thoughts like:

• “Don’t bother, it won’t help.”

• “There’s no point.”

• “It’ll just go wrong again.”

• “I don’t deserve to feel good.”

• “Even if I did it, I wouldn’t enjoy it.”

• “That used to make me happy, but not anymore.”

• “Why try when everything always ends the same?”

• ''They won't even notice if I am not there''

• ''I would be better off not being here''.

These thoughts can feel so automatic and convincing that they don’t feel like thoughts at all, they feel like truth. But they’re not truth. They’re the output of a brain that has learned, often through pain, that trying doesn’t lead to reward so it tries to spare you the pain of hope by cutting off the path before you even begin.

When Depression Hijacks Your Behaviour: The Body That Won’t Move

Depression doesn’t just change how you think it changes how you move, what you do, and what you can bring yourself to do. It seeps into behaviour in quiet but powerful ways. The very things that might help such as getting out of the house, seeing someone who cares, going for a walk, opening the curtains begin to feel impossible. Not because you're being lazy or dramatic, but because depression biologically dulls motivation and physically weighs you down. It’s like trying to wade through treacle with a brain that tells you there’s no point in getting to the other side.

Your body starts responding to this sense of helplessness. You might stay in bed long after you’ve woken up, not because you’re tired, but because it feels safer than facing the world. You cancel plans, not because you don’t care, but because the energy it would take to pretend you're okay feels unbearable. Even small tasks brushing your teeth, replying to a message, making a cup of tea become mountains instead of molehills. The longer this goes on, the more your brain begins to believe that this is just how things are.

I have known, and worked with people who have literally spent years in their bedroom, barely washing, not engaging with the world. They don't want to let life pass them by, their brains are simply telling them to stay there because there is nothing better out there for them.

Some common behavioural hijacks of depression:

• Avoiding social contact, even when lonely.

• Withdrawing from activities that once brought joy or pride.

• Spending long periods in bed, not resting, just avoiding.

• Neglecting basic self-care, eating irregularly, not washing, letting routines slide.

• Delaying or avoiding responsibilities until they feel overwhelming.

• Pacing or agitation without a sense of direction or relief.

What’s most devastating is that these behaviours then reinforce the depression: the more you withdraw, the less positive feedback your brain gets, the more it concludes that life has nothing to offer, and the cycle deepens. But these behaviours aren’t signs of weakness. They’re symptoms. Signals that something inside is depleted, not defective.

So if we know what makes it worse, what 'causes' depression.

The Serotonin Story: How a Catchy Hypothesis Became a Cultural Myth

In the 1960s and 70s, early antidepressants (MAOIs and tricyclics) were noticed to alter monoamine neurotransmitters like serotonin, norepinephrine, and dopamine. The narrative that was inferred was that depression must be caused by low serotonin, and therefore drugs boosting serotonin should fix it. You’ve probably seen the “depression is a chemical imbalance” line trotted out in pharma ads and well‑meaning explanations. It’s understandable as it offers a clear, non‑shaming narrative. But it’s inaccurate and I don’t think it helps.  If we use the analogy that increasing serotonin helps and therefore depression must be a lack of it, is almost the same as saying a headache is caused by lack of paracetamol because the headache gets better when we take one.  Doesn’t make sense when you look at it like that does it?.

Here’s what we know now:

• Antidepressants do influence serotonin signalling (and other systems), but they start changing neurotransmitter levels within hours while mood improvements usually take weeks. Therefore, it isn’t a direct result of the increased serotonin.

• Meta‑analyses have not found consistent evidence that depressed people have lower serotonin levels or fewer serotonin receptors than non‑depressed people. In fact, the exact opposite can sometimes be true. 

• Serotonin is involved in many processes such as mood regulation, gut motility, platelet function. It is not the “happiness chemical” that we have been led to believe.

So, if not “low serotonin,” then what? Depression likely emerges from multiple interacting systems: stress physiology (HPA axis leading to activation and dysregulation of the central nervous system), inflammation, circadian rhythms, reward circuitry, learning and memory, attachment patterns, social stressors, trauma exposure, and yes, genetics.

The serotonin hypothesis wasn’t entirely wrong to look at biology; it was just too simple and too confident to think it was just one thing. We can retire the myth about it being all about serotonin without abandoning the useful ideas that came out of that era.

A Bio‑Psycho‑Social Model – where the social is often the key

George Engel’s biopsychosocial model is decades old, but still fresh: he stated that illness is best understood by considering biological vulnerability, psychological processes, and social context.

• Biological: Genes, hormones, inflammation, sleep, nutrition, chronic illness.

• Psychological: Beliefs about self/world, coping styles, attachment templates, emotion regulation skills.

• Social: Relationships, community, work conditions, discrimination, poverty, housing insecurity, war, pandemics.

One way to understand depression is to think of the brain as a prediction machine. It doesn’t just react to the world, it constantly scans, anticipates, and prepares based on what it’s learned from the past, or even how it is wired to respond. In many ways, your brain is trying to protect you. If it’s been taught (through experience, trauma, stress, or loss) that the world is harsh or unrewarding, it may begin to predict pain, disconnection, or failure even when those things aren’t actually happening right now.

Over time, depression can become the brain’s way of adapting to what it expects will be overwhelming, disappointing, or futile. Not because it’s broken, but because it’s doing its best to shield you. Unfortunately, that protective mechanism can become the very thing that keeps you stuck.

What about the neuro:

As always if you read my blogs, you will know that I think how the brain works is fundamental to your understanding of the psychological. Now we can add “neuro” to the biopsychosocial approach as our understanding in what is happening in the brain has grown. 

From a neuroscience perspective, several brain systems are involved in depression:

• The prefrontal cortex, which helps with planning, decision-making, and emotional regulation, often becomes underactive or poorly connected to emotional centres. This can make it harder to shift out of a low mood or think flexibly.

• The amygdala and other limbic structures, parts of the brain involved in detecting threat and emotional salience, tend to go into overdrive. It’s not that you’re imagining danger, it’s that your brain is tuned to notice what might hurt. Threats feel louder. Loss feels heavier.

• The reward system, especially the ventral striatum, can become blunted. This means things that would usually spark motivation or pleasure (like a walk, a message from a friend, or even an achievement) just don’t register in the same way. You might still want to enjoy things, but the “spark” is missing.  This is a particular area of research at the moment with the use of drugs such as ‘magic mushrooms, ketamine, or ecstasy, that target the reward centre to treat long term depressive disorders.

• The default mode network, which is active when we’re not focused on a task and often associated with self-reflection or daydreaming, becomes sticky. That means rumination, the kind of repetitive, self-critical, circular thinking that feels impossible to stop, is more likely to dominate.

Importantly, none of this means the brain is fixed forever in a depressive state. Neuroplasticity, the brain’s ability to change and adapt still works. But during depression, it often works in a biased way, reinforcing patterns that maintain low mood, withdrawal, or hopelessness and only seeing the negative. This is why recovery isn’t just about thinking positive, it’s about giving the brain new experiences that gradually shift those patterns.

Things like therapy, medication, movement, social connection, meaningful routines - they’re not just “nice ideas.” They’re biologically active. They send new signals to your nervous system. They literally give your brain something different to learn from. Healing is both biological and experiential and your brain is always listening to what you tell it. 

When Should Depression Be Diagnosed?

A diagnosis of depression can be incredibly validating and necessary when someone is genuinely experiencing this cluster of symptoms, consistently and intensely, with clear disruption to their life. It can guide access to treatment like CBT, medication, or specialist support. It can help someone feel seen and understood, instead of just being told to “snap out of it.” It can also open up support at work or university under disability protections.

Quick screening tools like the PHQ-9 can flag risk of depression but they were never designed to confirm diagnosis in isolation. Context, history, and clinical judgment matter and should all be taken into consideration, but many clinicians use these screening tools as the basis for their diagnosis. Diagnosing depression is appropriate when:

• The full criteria are met, and symptoms have persisted beyond temporary stress.

• The person is significantly struggling to function at work, socially, or in daily life.

• Symptoms are not better explained by a bereavement, trauma response, or another mental or physical health condition.

• There is a clear pattern of cognitive, emotional, and behavioural changes potentially related to an event or situation that suggest more than “just a bad patch.”

When Shouldn’t It Be Diagnosed?

This part matters just as much, if not more. Over-diagnosing depression risks turning natural, situational, or contextual emotional responses into medical problems and actually undervaluing the diagnosis for people who do have a depressive disorder. Not every experience of sadness, grief, or low motivation is a disorder and sometimes we pathologise normal human pain when we’re too quick to label it.

It should not be diagnosed when:

• The person is grieving as bereavement can mimic depressive symptoms but is not the same thing.  There is some controversy as grief did make it into the diagnostic manuals but this still isn’t the same as depression.

• The symptoms are short-lived, mild, and clearly tied to a specific stressor or adjustment (in these cases, something like adjustment disorder may be more appropriate), or diagnosing situational depression so the person clearly understands the link to what is happening to how they are feeling.

• There’s an underlying physical illness or medication side effect causing the symptoms.

• There’s a better explanation such as burnout, trauma, ADHD, sleep deprivation, or chronic stress that needs addressing first as we often see depression with these conditions.

One helpful question to ask yourself is:

Can I identify what’s making me unhappy?

If the answer is yes, if you can point to your relationship, your job, your loneliness, or your financial situation then it’s more likely that what you’re experiencing is a normal (though painful) emotional response to your circumstances, rather than a depressive disorder.

That doesn’t mean it isn’t serious or valid.

Feeling stuck, chronically stressed, or disconnected still deserves attention and support. But when sadness has a clear and understandable cause, it points us toward making changes (even hard ones) as a treatment whereas clinical depression often feels like a fog without edges, a loss of interest or pleasure even when nothing is obviously wrong and as I said before the bit that is often missed a clinically significant impairment to your life.

Understanding the difference between sadness and depression can shape how we respond, whether the focus needs to be on emotional healing, life changes, medication, therapy or all of the above. Sadly, I think how we respond to emotional struggles is shaping the increase in diagnosis.

When “Sad” Isn’t Enough: The Unspoken Need for a Diagnosis

Life is full of quietly painful realities - relationships that don’t feel close or fulfilling anymore, financial pressure that never quite lets up, jobs that drain rather than energise, or friendships that start to feel one-sided or distant. These are real stressors, and over time, they can wear people down. It’s not unusual for someone to feel persistently low, unmotivated, or even emotionally flat in the face of these issues, and yet we often leap to calling it “depression” because the word has become shorthand for any prolonged sadness or discontent. 

Misusing the term ‘depression’ doesn’t just dilute its meaning, it risks people not receiving the support they actually need. If someone’s pain is rooted in burnout, grief, or relationship issues, calling it depression might lead to medication rather than the relational, structural, or lifestyle changes that would actually help.”

On the other hand, in a world that rushes past quiet suffering, many people find themselves reaching for the word depression not just to describe how they feel, but to legitimise it. When words like fed up, sad, or low are brushed aside or met with “well, everyone feels like that sometimes,” it can start to feel like only a diagnosis will make others take your pain seriously.

It’s not that people are faking, or attention-seeking. Quite the opposite. They may have been quietly struggling for weeks, months, even years. But “sad” doesn’t get sick notes. “Fed up” doesn’t bring compassion. “Feeling low” doesn’t open the door to support. So, the language escalates. Depression becomes the vessel that might finally make someone stop and say, “That sounds hard, how can I help?”

This is where over-diagnosis becomes a social issue, not just a clinical one. If we only respond to human distress when it’s wrapped in a clinical label, we risk medicalising normal emotional pain and pushing people into identifying with a disorder just to feel heard.

The answer isn’t to deny people the use of the word depression. It’s to make more room for sadness, for overwhelm, for grief, for fed-up-ness. To validate the in-between states of being human, and to meet suffering with empathy before it has to wear a label.

Treatment Options: Finding What Works for You

The NICE (National Institute for Health and Care Excellence) guidelines provide evidence-based recommendations for the treatment and management of depression in adults. The most recent comprehensive guidelines are from 2022 and offer a stepped-care approach, meaning treatment should be tailored to the severity of the depression and the individual’s needs.

First-Line Treatments for Less Severe Depression

For new or less severe cases, people should be offered one or more of the following first:

• Behavioural activation (BA) - Behavioural activation is a therapeutic approach that helps individuals with depression re-engage with meaningful and enjoyable activities, even when motivation is low. By breaking the cycle of avoidance and inactivity, it aims to lift mood through action first, rather than waiting to feel better before doing things. Behavioural activation isn't just a nice idea, it really is the way to re-wiring that sense of learned helplessness.

• Group or individual cognitive behavioural therapy (CBT) - Cognitive Behavioural Therapy (CBT) is the most widely researched and therefore the most recommended treatment for depression; it’s structured, relatively brief, cost-effective to deliver, and focuses on changing unhelpful thought patterns and behaviours. 

• Counselling - Counselling for depression provides a supportive space to explore difficult emotions and life experiences, helping individuals make sense of their struggles and find ways to cope, though it may be less structured than other approaches like CBT.

• Group exercise programmes - Regular exercise has been shown to reduce symptoms of depression by boosting mood, energy, and brain chemistry in a natural, accessible way.

• Mindfulness or meditation-based approaches (with evidence) - Mindfulness-based approaches help individuals with depression become more aware of their thoughts and feelings without getting caught up in them. Practices like meditation and mindful breathing can reduce rumination and promote a greater sense of calm and presence.

There are other therapeutic approaches available and a trained clinician will help you choose what works for you. 

Anti-depressants

It is interesting to note that antidepressants are not routinely recommended as a first-line treatment for less severe depression but so many people I talk to leave their doctors office with either a prescription or the offer of one after the first time they visit.  This certainly isn’t a bash at our great doctors because I know from talking to them that very often access to the recommended treatments are limited, or quite often declined by people wanting more immediate relief.

Antidepressants can be effective, particularly for moderate to severe depression, where their impact tends to be more noticeable. For mild depression, research shows they often offer little more benefit than placebo, and many people improve over time due to natural fluctuations in mood, life changes, or support alone meaning they are taking drugs with no real benefit. Anti-depressants are meant for people with depressive disorders, not necessarily for people who feel 'depressed'. A BIG difference often overlooked, and probably why last year in the U.K. there were 91 million antidepressant prescription items, prescribed to approximately 8.7 million individuals.

That said, for those experiencing persistent or debilitating symptoms, antidepressants may offer relief, especially when combined with therapy. They usually take 2–4 weeks to begin working, and current guidelines suggest continuing them for at least six months after feeling better to reduce the risk of relapse.

I will talk about anti-depressants, types, uses and withdrawals etc in more depth in a later blog. Am I a fan? They have their place in my opinion, that place has become to broad in its use.

Lifestyle and Body‑Based Tweaks: Biology You Can Influence

Sleep, movement, nutrition, sunlight, and rhythm are not “nice add‑ons” they are pillars. Depression often derails them; rebuilding them is part of treatment.

• Sleep: Regular wake‑up times anchor circadian cues. Sleep restriction (counterintuitive but evidence‑based) can help some. Avoid doom‑scrolling in bed; your cortex learns the bed is for rumination, not rest.

• Movement: Exercise rivals antidepressants in some trials for mild to moderate depression. Start with what’s tolerable 5 minutes counts.

• Light: Morning light is a free antidepressant. Open blinds, step outside, even on cloudy days. Light therapy boxes can help winter depression.

• Nutrition: Not a cure, but patterns like Mediterranean‑style eating support brain health. Don’t moralise food eating consistently matters more than chasing superfoods.

• Substances: Alcohol is a depressant (chemically and mood‑wise). Cannabis can numb but often rebounds into reducing motivation. Caffeine can both help and hinder dose and timing matter.

• Breath & Body Awareness: Practices that engage the vagus nerve slow breathing, humming, gentle yoga can shift your autonomic state.

Relationships and Meaning: The Social Antidepressants

Humans heal in connection. Depression can stem from isolation or disconnection from others and relationships and then ironically whispers “isolate more” exactly when we need others most. Reaching out feels risky, but micro‑connections (a text, a shared meme, a nod to a neighbour) matter. Deeper work might involve setting boundaries, grieving old roles, or cultivating communities that reflect your values.

Meaning, too, is medicine. Viktor Frankl noted that suffering stops being suffering when it finds meaning. That doesn’t mean romanticising pain; it means situating your struggle in a story where you have agency, dignity, and purpose. Volunteering, creative projects, activism these can restore a sense of “I matter, ” as can being employed.

Employment, when well-matched to a person’s strengths and needs, can be a powerful protective factor for mental health. It provides not only financial stability but also daily structure, social connection, a sense of identity, and opportunities for achievement and growth. For many, work offers a reason to get up in the morning and a sense of contribution to something beyond themselves, both of which are deeply grounding when struggling with depression or other mental health difficulties.

Schemes like Individual Placement and Support (IPS) are built on the evidence that people don’t need to be ‘fully better’ to benefit from employment, in fact, access to meaningful work can actively support recovery. This is why, counterintuitively, simply taking time off work or stepping away from stress isn’t always helpful in the long term as it increase learned helplessness. While rest has its place, extended withdrawal from structure and responsibility can sometimes deepen the depression, not relieve it. In depression, avoiding activity and social contact might feel safer, but over time it teaches the brain that life is unmanageable.

Beyond First-Line Treatments.

For more severe depression or when these first line approaches don’t work then higher intensity therapy and antidepressant medication (usually an SSRI as first choice) or a combination of the two is recommended.

If a person has not responded to multiple treatments or presents with high levels of risk or functional impairment and has complex, severe, or treatment-resistant depression, then referrals into secondary mental health teams, longer term therapy, combining drugs or even ECT (Electroconvulsive Therapy) is recommended (and no its not like you see in the movies, and yes it can be effective).

Caring for Someone with Depression

Living with someone who has depression can feel like carrying a quiet, constant weight. You may find yourself tiptoeing around moods, absorbing emotional shifts, and taking on more of the daily load without acknowledgement. The house may feel quieter, flatter, plans go unmade, laughter fades, and the emotional temperature of the home changes.

Depression doesn’t just affect the person experiencing it; it alters the dynamic of relationships and can leave you feeling isolated, frustrated, or even guilty for having your own emotional responses. You might miss who they used to be and feel torn between compassion and exhaustion.

This kind of ongoing emotional labour can be deeply draining. Emotions are actually catching, and if they are short lived that can be overridden but long term it can have a deep impact on our own mood.  Caring for someone in pain pulls at your nervous system, without meaning to, and your body starts to carry the stress too. You might feel anxious, low, or physically worn down, even though you’re not the one formally diagnosed. And yet, so often, this experience remains invisible.

Partners, parents, and close friends often mask their own distress, trying to stay strong and supportive. But the truth is, loving someone with depression can be profoundly lonely, a quiet grief for a relationship that now feels paused, a weight carried in silence.

Supporting Someone with Depression: Walking the Line Between Compassion and Collusion

Helping someone with depression can be emotionally complex. It's important to offer genuine empathy, saying things like “That sounds really hard” or “I’m here with you”, without minimising their experience.

Avoid platitudes like “Just cheer up” or comparisons such as “Other people have it worse,” which can feel invalidating.

Instead, acknowledge their pain while gently encouraging activity and connection, even if it’s small steps like going for a walk or having a shower. It's ok to acknowledge two things are true at the same time - this is hard for you, and yet it will help you.

One of the trickiest parts is recognising the fine line between being supportive and unintentionally reinforcing learned helplessness, where someone starts to believe they are incapable of change or action. It can feel kind to take over tasks or excuse total withdrawal but doing so over time risks disempowering the person further. Instead, affirm their capacity: “I know this feels impossible right now, but I believe you can do it and I’ll help you take the first step.”

Small, consistent nudges toward action, balanced with warmth and patience, are often more helpful than either pushing too hard or backing off completely. 

Sadness, Depression, and Finding Your Way Forward

Not all sadness is depression, and not all depression looks the same. Feeling low, overwhelmed, or lost is part of being human, especially when life throws grief, pressure, loneliness, or unmet needs our way. These feelings matter, and they deserve compassion and attention, but they don't always mean you have a depressive disorder.

When you can trace your sadness to something specific like a difficult relationship, job stress, financial insecurity, or isolation it may be a sign that your distress is a natural response to your circumstances, rather than a medical condition. That doesn’t make it any less real or worthy of support. But it does suggest that the path forward may lie not in a label, but in change, healing, or connection. 

True depression, though, often feels like something else entirely.  Foggy, stuck, out of reach. It dulls joy, shrinks your world, and can quietly convince you that nothing will help and it will never be the same again. And yet, it’s also deeply treatable. We now understand that depression is never just about one thing. It’s biological and social, emotional and neurological. Your brain, your history, your habits, your hormones, your relationships - they all play a part. This is why an integrated approach works best.

As a clinical psychologist, I work with people experiencing the whole spectrum of sadness and depression, from situational sadness and burnout to complex, long-standing depressive disorders. I won’t rush to diagnose you, but I also won’t dismiss what you’re feeling. My job is to help you understand what’s going on, why it might be happening, and what you can do about it. That means untangling your biology, your psychology, your social world, and your nervous system and not to reduce you to a diagnosis, but to restore your sense of agency.

Whether you need help challenging thoughts, making sense of your emotions, regulating your nervous system, or rebuilding a meaningful life, there are tools, insights, and strategies that can help. Depression is not a life sentence, and you're not broken. You might be exhausted, overwhelmed, unsupported, or stuck, but that’s exactly where change can begin. If you’re ready to explore what’s going on and what might help, I’m here to walk that road with you.

You don’t have to wait until you believe it. You don’t have to feel ready. You just have to begin.

As always until next time

Carla