The Complexity of Depression

Over my eleven years working in psychological therapy roles providing support for people with depression, I have increasingly grown to view it as a complex condition. There are certain symptoms that pretty much everyone with depression will have: low mood, lack of energy, tiredness, lack of interest and/or pleasure in doing things, difficulty concentrating and negative thinking. However, there are also many differences in how individuals experience it. Some people will become tearful over many more things than they normally would, while others experience an emotional numbness and are unable to really contact their feelings. Some people will struggle to sleep at all, while others sleep much more than they usually would. Some people lack appetite while others find themselves frequently comfort eating. A number of people will experience anxiety alongside depression while others will solely have depression.

People also have varying responses to treatment for depression. Different antidepressants work for different people. Some people find antidepressants numb all their feelings, others find that taking antidepressants for a period of time helps the numbness to go and gives them access to their feelings again.

And as you might imagine, with so many differences in how people experience depression, there is significant variation in how people respond to various psychological approaches as well. The main treatment offered by the NHS for depression is Cognitive Behavioural Therapy (CBT), and more specifically, usually Behavioural Activation. This involves looking at what activities people have stopped doing or reduced doing since feeling depressed and gradually building these back in systematically to help people to regain their sense of pleasure and achievement from engaging with these activities. The recovery target is 50% and this is usually reached by most services using this technique.

However, there are people who have continued to do their usual activities but still don’t gain any sense of pleasure or achievement from them. In which case a different approach is likely to be beneficial. What this approach might be will vary depending on the way depression is presenting for the individual. Sometimes it might be helpful to find new ways of thinking, a different perspective on a situation if thoughts are very negatively skewed compared with reality. When there are ruminative thought patterns around it can be helpful to look at triggers for this starting and alternative things to do at these times. It will be important to try to be as present as possible whilst doing these other activities, and using strategies to distance from any thoughts that do continue to arise might be necessary. If most of the thoughts are self-critical or related to feelings of shame or self-dislike or low self-esteem then developing greater kindness and compassion towards oneself is highly beneficial.

The underlying causes of depression also make a difference in terms of what psychological approaches or style of counselling are likely to be most effective. If someone has experienced a relatively recent significant bereavement, then they might need a space to grieve; to talk about and process their loss. If there are relational difficulties these may need to be explored and ways forward found. If someone feels lacking in direction in their life or is having to re-evaluate their life in relation to a significant change, then looking at what they value and finding ways to orient their life more in that direction is incredibly beneficial. If there were pre-existing problems with anxiety, these might need to be addressed to reduce the low mood e.g. if someone is socially anxious then increasing their engagement with social activities may not improve their depression without also focusing on decreasing their anxiety. If stress has brought on depression, then finding a different balance in life may be important. Sometimes people need to learn to put in more boundaries for themselves or be more assertive so that they don’t feel taken advantage of by others and that their own needs are being neglected.

Depression is also often a recurrent condition, having an episode makes it more likely that another will be experienced. Research shows that learning mindfulness significantly reduces the chances of having a further episode of depression for people who’ve had three or more already.

This complexity is why I appreciate the integrative approach to counselling so much when working with depression. It can help to reduce low mood by drawing on the relevant ways described above depending on the specific needs of the individual.

If you are experiencing depression and would like to try this integrative counselling approach, I offer one-to-one sessions in central Exeter and Newton Abbot with a free initial consultation.

If you are experiencing suicidal ideation, please contact your own GP or Devon Doctors on 08456 710270 or The Mooring at St Leonards, Athelstan Rd, Exeter EX1 1SB, 07799 0790920 or 07484 061675 (open 6pm – midnight, every night including holidays, out of hours mental health support for anyone aged over 16 – no appointment or referral needed) or The Samaritans on 116 123 free, or email

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