How do I know if I am depressed?

The question is almost never asked out of curiosity. It gets asked at eleven at night by somebody who has been quietly unwell for a while and is trying to work out whether what they have is a real thing with a name, or whether they are simply failing at ordinary life.

I want to say the useful part first. I cannot diagnose you and neither can this page. I am a counsellor, not a psychologist or a doctor, and diagnosis belongs to them. What I can do is describe what people actually report, set out the one principle that most of the recovery rests on, and give you the techniques that actually move it, rather than another hour of searching.

What depression tends to look like from the inside

It is worth saying that it is often not sadness. People expect sadness, do not find it, and conclude it must be something else.

What people describe far more often is flatness. The volume turned down on everything, good and bad alike. Things that used to matter no longer landing. Going through the day competently and feeling almost nothing about any of it.

Alongside that, some combination of these tends to show up:

• Sleep changes. Waking at three or four and not getting back. Or sleeping heavily and waking unrefreshed.
• Energy that does not match effort. Ordinary tasks costing far more than they should. A shower becoming a decision.
• Interest draining out. Not just from difficult things, but from the things you used to look forward to.
• Concentration going. Reading a page three times. Conversations you cannot follow.
• The internal voice turning hostile. A running commentary about yourself that you would never use about anybody else.
• Irritability, which surprises people, because it is not in the stereotype. In many people, particularly men, it is the most visible sign.
• Physical symptoms with no clear cause. Headaches, gut trouble, aching, a heaviness in the chest.
• Withdrawing, and then feeling worse about having withdrawn, which makes withdrawing easier next time.

The part that matters is not the list. It is duration and reach. Feeling low for a fortnight after something hard is being a person. Most of the day, most days, for a couple of weeks or more, spreading into work and relationships and sleep, is the pattern clinicians look at.

The principle underneath all of it

If there is one idea worth taking from this page, it is this. Depression narrows what you can reach, and then tells you the narrowing is your fault.

It shrinks the list of things that feel possible, then supplies a reason for each one: too tired, no point, not today. And because doing less genuinely does make you feel worse, the next day the list is shorter again. That loop is the illness working exactly as it works. It is not evidence about your character.

Which matters, because it tells you where the leverage is. Almost nothing that helps starts with feeling better. It starts with doing slightly more than the flatness wants, badly, before any motivation has arrived, and letting the feeling catch up afterwards. Waiting to feel like it is the one strategy that reliably does not work, because feeling like it is the thing that has gone missing.

Techniques that actually shift it

These are the ones with real evidence behind them and they are all small on purpose. Big plans are a symptom of wanting this over with, and they fail in a way that costs you more than doing nothing.

• Put back one thing, not ten. This is the core of behavioural activation, which performs about as well as talking therapy for depression on its own. Pick one activity that used to matter and schedule it at a specific time, not when you feel up to it. Fifteen minutes counts. The point is not enjoyment, which may not turn up for weeks. The point is breaking the loop.
• Anchor the day at the front. Get up at roughly the same time regardless of the night, and get outside into daylight within an hour or so. Sleep and mood hold each other up, and the morning is the lever with the least effort attached.
• Move, at a level you would describe as unimpressive. A walk around the block. Regular movement has a measurable effect on depressive symptoms, and the intensity matters far less than the regularity.
• Catch one thought and check it. The cognitive part, in its simplest usable form. When you notice a harsh line about yourself, write it down as a sentence, then ask what you would say if a friend said it about themselves. You are not arguing yourself out of it. You are noticing it is a thought rather than a report.
• Halve the task. Then halve it again. Not the dishes, one plate. Not the email, the first line. Depression makes ordinary tasks cost three times what they should, so the answer is a task a third of the size.
• Keep one contact a week that is not optional. A standing coffee, a walk, a call at the same time on the same day. Withdrawal accelerates everything else here, and a fixed arrangement survives a bad week in a way that good intentions do not.
• Treat alcohol as part of the picture. It reliably makes the second half of the night worse and the following day lower, which is difficult to notice from inside.
• Write down the day, briefly. One line, each evening: what you did, and how the day scored out of ten. Depression edits memory towards the worst of it. A fortnight of notes is often the first evidence a person has that the days are not all identical.

What not to do

Three things people try first, all of which make it worse.

Waiting for motivation. Covered above, and worth repeating, because it is the single most common way people lose a year.

Trying to think your way out. Analysis feels like progress and is usually rumination in better clothing. If half an hour of thinking has produced no action you could take today, it was not problem-solving.

Cancelling everything until you are better. Understandable, and it removes the exact things that were holding the week's shape. Keep one or two, even at reduced size.

Getting it properly looked at

Self-help has a ceiling and it is worth knowing where yours is.

A good first move is a validated self-check. The K10 is the one most used in Australia: ten questions about the past four weeks, about two minutes, free through Beyond Blue. It cannot be failed and it is not a diagnosis. What it gives you is a number, which is considerably easier to hand to somebody than a feeling you cannot describe.

Beyond that, a doctor or a psychologist is the one who can assess and diagnose, and a medical check is genuinely worth doing, because thyroid problems, low iron, low vitamin D, sleep apnoea and some medications produce something almost indistinguishable from depression and are treatable in their own right. That is not a detour. It is ruling out the simple explanation first.

Where counselling fits

Counselling is not a substitute for assessment or medication where those are what is needed, and I will say so plainly if that is what I think.

Where it earns its place is on the part that no test explains: what the flatness is attached to. The loss, the relationship, the work that stopped fitting, the long-running thing underneath. Building back the small structures that hold a week together once they have quietly collapsed, with somebody keeping track of it with you so it does not rest entirely on a week when you have least to give.

Plenty of people do both at once, and they are not competing.

If it has gone further than low

If you have been having thoughts of not being here, that is not a sign you have gone too far to be helped, and it is much more common than the silence around it suggests. Please tell someone tonight rather than waiting for an appointment. Lifeline on 13 11 14 and the Suicide Call Back Service on 1300 659 467 are free and open at every hour. If you are not safe right now, call 000.

And if you have read all of this thinking it sounds a bit like you but probably not seriously enough to bother anyone: that thought is worth noticing. It is one of the most reliable things depression says.