Depression

You may still be getting through the day. You answer the emails, you sound normal on the calls, you turn up where you are meant to turn up. Then you are alone, and the effort drops out of you, and the post stays unopened on the table.

Depression is often described as sadness, but many people do not feel sad in any simple way. They feel flat, slowed, heavy, guilty, or oddly absent from their own life. Things that used to reach you do not reach you. Food is just food. Music is noise. A message from someone you love can sit unanswered for days, not because you do not care, but because replying has become one more thing you cannot start.

Why it does not lift on its own

Depression maintains itself. When mood drops, the natural response is to do less, to withdraw, to let the smaller things slide. That is understandable, and it brings short relief, but doing less removes the ordinary sources of reward and contact that would otherwise lift mood, and so the mood drops further. The world gets smaller. The smaller it gets, the more effort each remaining task seems to demand. This is the cycle that keeps depression in place, and it is a cycle, not a character flaw.

Alongside it runs the thinking. Depression speaks in conclusions and presents them as facts. I am a burden. I have wasted my life. Nothing will change. Other people cope and I do not. These thoughts feel true precisely because you are low, and then they lower you further. Rumination, the long circling over what is wrong with you and your life, feels like problem-solving but functions as fuel.

People around you may suggest exercise, fresh air, routine, a holiday. These are not foolish, but they miss what depression actually takes away, which is the starting mechanism itself. You can know exactly what would help and still be unable to begin. That gap between knowing and doing is not weakness. It is one of the core features of the condition.

How I work with depression

I am Henry Adu Bobi, and much of my grounding, as a Consultant Cognitive Behavioural Psychotherapist, comes from work with depression across settings. I bring further training in REBT, which I use where a person has built rigid rules about what they must be and must achieve. Twenty-five years of practice stand behind this work, and depression is the condition I see most often. I work online with adults and adolescents across the UK.

NICE guidelines place individual cognitive behavioural therapy among the first-line treatments for more severe depression, either on its own or combined with an antidepressant, and list it as one of the treatment options for less severe depression. In practice, the work often begins with what is called behavioural activation, which is the deliberate, planned reintroduction of activity, starting from wherever you actually are. That sometimes means steps that look almost too small to count, because small is the only honest starting point when your system is depleted. We do not wait for motivation to return before acting, because with depression the motivation tends to follow the activity rather than precede it.

From there we look at the thinking. We take the harshest conclusions seriously enough to examine them, rather than either believing them outright or trying to argue them away. Some of what surfaces is grief, loss, disappointment, or years of having to be the competent one. Some of it is old rules that have turned punishing. I must not need help. I must never fall behind. I must always be useful. Using CBT and REBT, we test the predictions depression makes and loosen the rules that keep you locked in self-attack.

If you have been reading this at one in the morning, weighing up whether you are really bad enough to bother anyone, that weighing is itself something depression does.

Before you get in touch

Depression can sit alongside physical illness, poor sleep, pain, alcohol use, bereavement, and long-term stress. Medical assessment and treatment stay with your GP or medical clinician. I do not diagnose and I do not prescribe. If medication or a medical review is part of the picture, that remains a conversation for you and your doctor, and therapy sits well alongside it.

Sessions are fifty minutes, online, usually weekly to begin with.

We start with what is happening now, what depression is costing you, and what feels possible from here.