Depression is one of the most common reasons adults come into therapy, and one of the most under-recognized in the people most affected. About half of the people we see for social anxiety also meet criteria for some form of depression — they often arrive thinking the issue is the anxiety, and discover that the depression is doing as much of the daily work.
What this can feel like.
- Flat, not sad. You're not crying. Things just feel less colorful. The dial got turned down.
- Loss of motivation, not laziness. The thing you used to do without thinking takes a Herculean effort, and you can't explain why.
- Sleep that's wrong. Either too much, too little, or technically enough but not restorative.
- Anhedonia. The clinical word for the things you used to enjoy not landing the way they used to.
- The harsh inner voice. The one that calls you lazy, weak, ungrateful — usually in your own voice, sometimes in someone else's from your past.
- Withdrawal. Canceling on friends. Not opening texts. Saying you're too busy when you actually have nothing on the calendar.
- Foggy cognition. Trouble concentrating, decisions taking longer, the sense that your mind is moving through gauze.
- Sometimes: thoughts of not being here. Not necessarily a plan — sometimes a quiet "what if I just didn't wake up tomorrow." If those thoughts are there, please call 988 or reach out to us directly. They are a medical symptom, not a verdict.
How therapy can help.
Depression has some of the strongest treatment evidence in mental health. Cognitive Behavioral Therapy (CBT), Behavioral Activation, and Interpersonal Therapy (IPT) are all well-supported, and most clients improve meaningfully with one or a blend of them. We tailor the approach to who you are and what's running underneath the symptoms.
Concretely, the work usually includes:
- Behavioral activation first. Counter-intuitively, the path out of depression is rarely "wait until you feel better, then do things." It's "do things, gradually, even when you don't feel like it" — and treatment teaches you how to do that without forcing it.
- Cognitive work on the inner critic. Catching and de-fusing the voice that calls you lazy or hopeless. This is more practical than it sounds.
- Sleep, food, movement. The boring parts that almost always need attention.
- Relationship work. Depression often hides interpersonal patterns — IPT addresses these directly.
- Coordinating with prescribers. For some clients, an SSRI or SNRI added in helps the floor come up while therapy does the work. We coordinate; we don't prescribe.
Most clients see meaningful change within 12–20 weekly sessions. For chronic or recurrent depression, the work is sometimes longer and includes relapse-prevention skills.
You don't have to figure this out alone.
The hardest thing about depression is that it usually convinces you that nothing — including therapy — will help. That's the depression talking; it's also a symptom we can work with directly. If you can take one small step, taking it with someone makes the next steps easier.
Book your first session Call (626) 354-6440