Depression is often described as sadness, but that is not usually how people experience it. More often it is an absence: of energy, of interest, of the sense that anything much matters.

People describe feeling flat rather than sad. Going through the day at a distance. Doing what needs to be done and feeling nothing about any of it. Being unable to imagine that this will ever be different, which is one of depression’s more convincing lies.

It also shows up in the body. Waking early. Sleeping too much. Eating too much or not at all. A tiredness that rest does not touch.

It is frequently accompanied by a harsh internal commentary: that you are failing, that others manage, that you have no right to feel this way. That voice is a symptom, not an accurate assessment.

Why the usual advice is so hard to follow

The standard advice is to exercise, see people, get outside. There is good evidence behind it. Gradually rebuilding activity is one of the better-supported treatments for depression, and it works.

The problem is that depression removes exactly the motivation the advice requires. Being told to do something you cannot make yourself do adds failure to the original problem, and most people have already tried and already concluded that they are the reason it did not work.

What makes the difference is not the instruction but the support around it. In therapy we work out what a genuinely achievable next step looks like, which is usually much smaller than the advice suggests, and what happens when you try.

How I work with depression

We start with what is happening now, including sleep, eating and structure, because those affect mood directly and are often the first place any change is possible.

Alongside that we look at what is underneath. Depression is frequently connected to loss that was never fully grieved, to anger that has nowhere to go, or to a conclusion you reached about yourself a long time ago and have not revisited since. That work is slower, and it is usually what makes the difference last.

I will not rush you and I will not require you to be optimistic. Being able to sit with someone who is not trying to cheer you up is, for many people, the beginning.

Therapy alongside other help

Therapy and medication are not alternatives, and some people benefit from both. If you have not spoken to your GP, that is worth doing alongside rather than instead of therapy.

If you are having thoughts of ending your life, please contact your GP, call 111, or call the Samaritans free on 116 123. They answer at any hour.

What to expect

Sessions are 50 or 75 minutes, in Wimbledon or online, beginning with a free fifteen-minute conversation.