Things that used to interest you may have started to feel like more effort than they’re worth. You put off answering messages, struggle to concentrate, or come home from work with little energy left for anything else. You may feel sad, irritable, empty, or simply disconnected from what’s happening around you.
Perhaps you’re still doing what other people need from you. You get to work, care for your family, and seem reasonably cheerful when someone asks how you’re doing. But keeping that going takes more out of you than anyone realizes.
You may have tried resting, making plans, exercising, or talking yourself into a better frame of mind. When those efforts haven’t brought much relief, it can be difficult to imagine what another conversation could accomplish.
That’s a reasonable question to bring to therapy. Understanding what you’re experiencing matters, and so does finding ways to help your life become more manageable and meaningful.
Depression can involve more than sadness
Some people experience depression as persistent sadness. For others, the more troubling change is that they don’t seem to feel much at all. An activity they used to enjoy has lost its appeal. This reduced ability to experience pleasure is called anhedonia. Time with people they care about feels strangely distant. Even when something good happens, the feeling doesn’t seem to reach them.
Depression can also involve changes in sleep, appetite, energy, and concentration. Ordinary decisions may become difficult. You might find yourself more easily frustrated, increasingly withdrawn, or spending a great deal of time criticizing yourself.
These experiences deserve attention even if you’re still meeting your responsibilities.
They also need to be understood in context. Grief, anxiety, exhaustion, physical health problems, and difficult circumstances can overlap with depression. Part of getting help is considering that fuller picture rather than trying to settle the question from a checklist.
When struggling becomes a judgment about yourself
One of the more painful parts of depression can be what you make of the difficulty.
You haven’t replied to a friend, so you decide you’re a bad friend. Work is piling up, and you take that as evidence that you’re incompetent. You look around at things you haven’t done and conclude that you must be lazy.
Those judgments can make it harder to respond to what is actually happening.
You may also keep returning to the same painful questions: Why am I like this? How did I let things get this bad? What does this say about me? This repetitive thinking is called rumination. It can feel like an effort to understand yourself while leaving you increasingly discouraged and no closer to a useful next step.
Perhaps you’re exhausted. Perhaps starting something brings up a sense that you’ll fail anyway. You may be able to give considerable energy to caring for someone else while finding it difficult to take care of yourself. Understanding those differences gives us more useful information than a verdict about your character.
That understanding can help us find a way to act. If the difficulty involves exhaustion, fear, hopelessness, or a combination of them, we need to take those obstacles into account when deciding what might help.
Where we would begin in therapy
When I work with someone who is experiencing depression, I want to understand what their days are like.
What has changed? What feels particularly difficult? Are there times when the heaviness lifts, even a little? What are you managing to do, and what does it cost you to keep doing it?
We would also talk about relationships, pressures, losses, health concerns, and your previous experiences with treatment. There may be a clear event connected to how you’re feeling, or the change may have developed gradually.
Sometimes a person says, “I don’t know why I’m depressed. My life should be fine.”
We can explore that without requiring you to justify how you feel. The fact that parts of your life are going well doesn’t make your distress less important. At the same time, I would want to understand whether there are needs, conflicts, or circumstances that have become difficult to recognize or discuss.
That gives us a starting point for deciding what to work on together.
What can talking accomplish?
You may wonder what you’re supposed to say in therapy, especially if your days have become repetitive or you don’t have a clear explanation for feeling depressed.
An ordinary experience can give us something useful to explore.
Suppose a friend sends you a message. You’d like to reply, but you feel depleted and unsure what to say. After a few days, you become embarrassed about the delay. Now answering seems even harder, so you leave it. Eventually, you feel more alone and take the silence as further evidence that your friendships are slipping away.
In therapy, we can slow down that sequence. What made the first reply difficult? What did you expect your friend would think? How did the delay become a reason to withdraw further? What might make reconnecting possible?
I take an active role in that work. I ask questions, share observations, and help us look for connections. Your perspective matters throughout, including when my understanding doesn’t fit.
The conversation becomes useful when it helps us understand something more clearly and consider what to do with that understanding.
Working with thoughts through CBT
I often use cognitive behavioral therapy, or CBT, when treating depression. We examine how thoughts, emotions, and behavior affect one another.
Depression may be accompanied by conclusions that feel settled: you always disappoint people, nothing you try makes a difference, or the future will be more of the same.
In CBT, these quick, familiar interpretations are often called automatic thoughts. They can arise so readily that they feel like facts rather than something your mind has concluded.
We can look carefully at those conclusions. What experiences support them? What has been left out? Are you turning a setback into a judgment about your whole life? Would you interpret someone else’s circumstances as harshly as you interpret your own?
Some of what you’re facing may be genuinely painful or unfair. CBT gives us a way to examine your understanding of those circumstances while also considering responses that could help.
A more balanced perspective may take time to develop. We would connect that work to specific situations in your life, rather than ask you to adopt reassuring statements that don’t feel believable.
Looking at what may be contributing to depression
CBT is one approach I use, and we may also need to explore experiences that continue to affect how you feel. Trauma, loss, or painful relationship experiences can sometimes be part of what is contributing to depression.
For example, someone may understand that they judge themselves harshly but still feel deeply unworthy or unsafe. We may need to work with the experiences connected to those feelings as well as the thoughts themselves. Depending on what we discover, that could include EMDR or other therapeutic work.
Addressing those underlying experiences can sometimes help ease depressive symptoms. Depression can have several contributing factors, so we would explore what seems relevant to you rather than assume there is one root cause.
Re-engaging through behavioral activation
I also use behavioral activation. This involves looking at how depression has affected your activities, routines, and contact with people, then finding manageable ways to re-engage.
When interest and energy are low, activities can fall away. Your days may contain fewer opportunities for connection, satisfaction, or a sense of accomplishment. That can leave you feeling increasingly stuck.
We would look together at what has become difficult and choose a starting point that fits your current capacity. That might involve making a necessary task more manageable, contacting someone, or returning to a part of your life that used to matter to you.
We would also pay attention to what happens when you try. Was the step too demanding? Did anxiety or self-criticism get in the way? Did you complete it but feel very little afterward?
Those details help us adjust. The work should make room for the reality of depression, including the fact that an activity may not immediately feel rewarding. We’re looking for useful changes over time, with support and review along the way.
Your circumstances matter too
Sometimes depression develops alongside a life that has become difficult to sustain.
You may be carrying responsibilities with little support, feeling isolated, grieving a loss, or trying to meet expectations that leave little room for your own needs. A relationship or work situation may be contributing to how depleted you feel.
Therapy can give us room to consider those circumstances directly. We may need to explore a decision, a boundary, a difficult conversation, or ways to seek additional support.
We can also consider patterns that have developed over time: putting everyone else first, withdrawing when you feel hurt, or treating your own needs as an inconvenience.
Understanding those patterns and addressing present circumstances can both be important parts of the work.
Medication and collaborative care
I’m not a prescriber, but I recognize that medication can have a helpful role for some people experiencing depression. Psychotherapy, medication, or a combination may be appropriate depending on the person’s needs and circumstances.
When appropriate and with your permission, I collaborate with prescribers so that we can work together in supporting your treatment. Questions about a medication’s effects, side effects, or changes to a prescription belong with the professional providing that medical care.
Your preferences and previous experiences deserve attention. If a treatment hasn’t helped, that is something to discuss and reassess. Some situations also call for additional or more intensive support than routine outpatient therapy can provide.
What improvement might look like
Progress may first become noticeable in ordinary parts of your life. You find it easier to begin a task. You have more energy available after work. You answer someone’s message, feel interested in something again, or spend less time attacking yourself after a difficult day.
We would pay attention to those changes together, along with what remains difficult. Feeling understood in a session matters, and I also want us to consider whether our work is making a useful difference outside it.
If you’re unsure about that, we should discuss it. I’ve written more about how to tell whether therapy is helping.
Symptoms can also return after a period of improvement. That deserves attention and may call for renewed support or a change in the treatment plan. It doesn’t erase what you learned or accomplished before.
When hopelessness includes thoughts of suicide
Thoughts about death or suicide are important to discuss directly in treatment. You may feel ashamed, worry about someone’s reaction, or find it difficult to describe how serious things have become.
Talking openly helps us understand what you’re experiencing and consider the support you need.
If you think you may act on suicidal thoughts or cannot keep yourself safe, call 911 or go to the nearest hospital emergency department (ER). Do not wait for a routine appointment or a response to a website message. My contact form and email are not emergency services.
For immediate support by phone, text, or chat, see the crisis support and additional resources below.
One small step: contacting me
When you’re depressed, seeking help can feel like another demanding task. A first step can be simply to contact me.
An initial conversation gives us a chance to talk about what has been happening, what you would like help with, and whether working together might be a good fit. I provide online psychotherapy for adults in Massachusetts and Maine.
Crisis support and additional resources
If you need help now
If there is immediate danger, you may act on suicidal thoughts, or you cannot keep yourself safe, call 911 or go to the nearest hospital emergency department (ER).
For crisis support and help finding appropriate services:
- United States — 988 Suicide & Crisis Lifeline: Call or text 988, or use the website’s online chat. Available 24 hours a day.
- Massachusetts — Behavioral Health Help Line: Call or text 833-773-2445 for support and connections to mental health and substance use services. Available 24 hours a day.
- Maine — Maine Crisis Line / 988 Maine: Call or text 988 for crisis support and connections to local services. Available 24 hours a day.
Additional support and information
- Veterans Crisis Line: Veterans, service members, and their loved ones can call 988, then press 1, for crisis support. Enrollment in VA health care is not required.
- The Trevor Project: Crisis support for LGBTQ+ young people, available through phone, text, and online chat.
- BeThe1To: Practical guidance on helping someone who may be thinking about suicide.
- CDC suicide prevention resources: Additional support services, information, and suicide prevention resources.