Depression

What is Depression?

Depression is more than a period of feeling down. It's a persistent low mood, an emptiness or flatness, and often a loss of interest or pleasure in things you used to enjoy.

Some common symptoms include:

• In the body: changes in appetite (eating more or much less), changes in sleep (sleeping too much, or struggling to sleep at all), and fatigue that rest doesn't seem to fix.

• In behaviour: pulling away from people, doing less, struggling with basic self-care, putting things off, and sometimes irritability or aggression. For some people, depression brings thoughts of self-harm.

• In your mind and feelings: guilt that feels disproportionate, low confidence, agitation, a stream of negative thoughts about yourself, the world, and the future, and sometimes thoughts of suicide or not wanting to be here.

People experience depression very differently, and you don't need every symptom on this list to be struggling with it. Depression often begins between early adolescence and adulthood, although not always. Life events, relationships, health, and stress can all play a part in when and how it shows up.

How we assess.

In your first session, we'll talk through the symptoms you're noticing, how long they've been there, how they're affecting your day-to-day life, and what you'd like to change. We may also discuss your history, and see if there are any patterns that might be coming up.

We may also use brief screening questionnaires to build a clearer picture and give us a baseline we can track progress against.

Assessment continues throughout therapy. As we get to know each other and the sessions continue, more comes to light, and we adjust the focus of therapy accordingly.

What therapies we offer:

For depression, Cognitive Behavioural Therapy (CBT) is recommended by National Institute for Health and Care Excellence (NICE guidelines), with a particular focus on behavioural activation. A major 2024 review published in The Lancetfound that CBT is among the most effective first-line treatments for depression and informed the latest NICE guidelines on depression. For more severe depression, CBT can be effective on its own or we may think about seeking medication to help you feel able to put the strategies we discuss in place.

Behavioural activation focuses on doing more of what matters: increasing meaningful activity, reducing withdrawal and avoidance, and rebuilding a sense of reward and routine. Depression has a way of getting int he way of things you care about, which then deepens the low mood. Gently reconnecting with what's important to you, and building that back up step by step, often brings a sense of achievement, connection, and enjoyment that lifts wellbeing.

CBT for depression can include:

• Psychoeducation, so you understand how depression works

• Noticing and challenging negative thoughts

• Activity scheduling

• Reconnecting with your values

• Sleep hygiene and building routine

• Strengthening social support

What a typical course of treatment may look like

How long therapy takes depends on you. For depression, a typical course is somewhere in the region of 8 to 16 sessions. 

The structure of therapy at Harper is goal-led. Your first session is about meeting your therapist, talking through your history, and getting clear on what you'd like therapy to help with. From there, sessions typically blend discussion, practical activities, and introducing skills and coping mechanisms, shaped by what you're working towards. You'll often try things out in everyday life between sessions too, since CBT tends to work best when put into practice outside of the clinic.

Throughout the course of therapy, we'll check in on how it's going and keep the focus on what matters to you, and we'll talk openly about when ending feels right. Before we finish, we'll consolidate the skills you've built and put together a plan to help you handle future triggers with confidence.

What results might I see?

Results vary from person to person, and we won't promise a fixed outcome. What we work towards is a better quality of life, a greater sense of understanding and mastery over your depression, and improved day-to-day functioning, so that low mood and worry take up less space, and you feel more in control.

Co-occurring difficulties

Depression frequently occurs in conjunction with other symptoms. Anxiety, sleep problems, difficulties with alcohol or substances, and the impact of past life experiences often come into the picture. We work with the whole picture rather than treating any one symptom in isolation, and we'll shape therapy around what's most pressing for you.

For extra information on depression please see the following blogs as well as the resources page on our website:

Depression: Like Walking Through Setting Concrete

CBASP: A Tool for More Than Just Depression