In my practice, I often hear clients say they didn't realize they were depressed because they weren't crying every day or feeling overwhelmingly sad. Depression, however, rarely announces itself clearly.
Many people don't realize they have depression because their symptoms don't match what they expect. They come in saying things like, 'I don't feel like doing anything,' 'I have no energy,' or 'I am angry all the time.'
The most common symptoms of depression include sadness, isolation, fatigue, loss of interest and enjoyment, cognitive issues, and changes in appetite and sleep. However, commonly dismissed symptoms include anger and irritability, physical aches and pains, brain fog, emotional numbness, risky behaviors, and significant changes in weight.
In fact, many of my clients initially come to therapy thinking they have a 'motivation problem' or that they're just 'getting older' and naturally slowing down. The gradual onset of depression can make it feel like these changes are simply part of life rather than symptoms of a treatable condition. For instance, a teenager might present with increased irritability and risk-taking behaviors rather than classic sadness, while an older adult might focus primarily on physical complaints like headaches or digestive issues. This is why I always encourage clients to share the full picture of what they're experiencing, even symptoms that seem unrelated to mood—sometimes these 'secondary' concerns are actually the key to understanding what's really going on.
Depression can co-occur with several medical conditions, including neurological disorders, thyroid issues, chronic pain, chronic illnesses, nutritional deficiencies, and immune problems. It may also present alongside other mental health conditions such as anxiety, substance use disorders, obsessive compulsive disorder, post-traumatic stress disorder, attention deficit hyperactivity disorder, and bipolar disorder.
When multiple conditions are present, symptoms can overlap and interact in ways that make it challenging to identify depression as a distinct issue. For example, a client with chronic pain may attribute their fatigue and withdrawal to their physical condition, while both they and their medical providers might overlook that depression has also developed as a response to living with persistent pain.
When you start your therapeutic journey, it's important to share everything you're experiencing with your clinician and other mental health practitioners. During your intake, you'll be asked about various symptoms and experiences, which can help prompt you to report what you've been going through. It can be helpful to write down a list of concerns you want to discuss before your appointment.
In my therapeutic approach, I focus on symptoms rather than diagnosis. When diagnosis becomes the primary focus, treatment can become too "textbook" and important symptoms may be overlooked. By centering on symptoms, I ensure I'm addressing what my clients actually need to feel better. This approach has proven effective—my clients consistently feel heard and understood.
For example, while traditional protocols might focus primarily on mood symptoms, I pay equal attention to the physical manifestations, sleep disruptions, or cognitive changes that are often dismissed as 'separate issues.' This comprehensive view means we're not just treating depression as a checklist of criteria, but addressing how it's actually showing up in your daily life—whether that's through unexplained body aches, difficulty concentrating at work, or that persistent feeling of being disconnected from activities you once enjoyed.
Many clients wonder what to expect when starting therapy for depression. Common therapeutic approaches include cognitive behavioral therapy, interpersonal therapy, behavioral activation, and mindfulness-based cognitive therapy. We'll also focus on lifestyle changes that can significantly impact mood—such as exercise, sleep habits, personal care routines, and nutrition. For some clients, medications or brain stimulation approaches may be helpful as well.
The specific approach we choose together will depend on your unique symptoms and what resonates with you—for example, if you're experiencing a lot of 'brain fog' or negative thought patterns, cognitive behavioral therapy might be particularly helpful, while if you've withdrawn from activities and relationships, we might start with behavioral activation to gradually re-engage with meaningful parts of your life. I'll explain each approach as we go, so you understand not just what we're doing, but why it's likely to help with the specific ways depression is showing up for you.
When should you seek help? You don't need a diagnosis or to feel terrible to seek help. In my view, everyone can benefit from talking to someone.
Therapy can be valuable whether you're navigating a major life transition, wanting to understand patterns in your relationships, or simply seeking a space to process your thoughts with someone trained to listen. The goal isn't always to 'fix' something—sometimes it's about gaining insight, developing coping strategies, or having support during challenging times.