This is one of the most common questions I hear — and one of the most important to answer carefully, because the distinction matters clinically. Difficult periods are a normal part of life, and sadness, grief, and low mood in response to hard circumstances are not depression. It is characterized by a persistent low mood or loss of interest that extends beyond what the circumstances alone would explain, lasts more than two weeks, and begins to impair your ability to function — in your work, your relationships, your daily life, and your sense of yourself. If you are asking this question, it is worth taking seriously. In my 20+ years of clinical experience, the people who are “just going through something” rarely lie awake wondering if what they feel is real.

Depression is one of the most misrepresented conditions in the cultural conversation about mental health — and the gap between how it is portrayed and how it actually feels keeps many people from recognizing it in themselves. Yes, sadness is part of it for many people. But it also presents as numbness — a flat, colorless quality to experience where nothing feels meaningful or worth engaging with. It presents as exhaustion that sleep doesn’t fix. As irritability and a short fuse that feels alien to who you know yourself to be. As a loss of interest in things that used to matter. As the quiet, persistent sense that you are going through the motions of your life without actually being present in it. In my clinical work, I always assess for the full picture — because treating it effectively starts with understanding how it is actually showing up for you specifically.

It depends significantly on the nature and history of the depression. For a first episode with identifiable precipitating factors, meaningful relief is often achievable within twelve to sixteen sessions of consistent work. For recurrent depression, dysthymia — the low-grade, chronic form that many people have lived with so long they mistake it for personality — or depression with significant trauma roots, the timeline is longer and the work is deeper. What I can tell you from 20+ years of practice is that it is one of the most treatment-responsive conditions I work with. The prognosis for people who engage seriously with therapy is genuinely good — and I want you to know that from the outset.

I draw primarily from Cognitive Behavioral Therapy (CBT) — which has the strongest evidence base for depression and directly addresses the distorted thinking patterns that both cause and maintain depressive episodes — alongside psychodynamic approaches that help us understand the deeper roots of the depression, and behavioral activation strategies that interrupt the withdrawal and inactivity that makes it self-perpetuating. Where trauma is a contributing factor, I integrate EMDR. Where relationship dynamics are fueling it, I bring in the Gottman Method and EFT. The approach is always tailored to you — because depression rarely has a single cause and rarely responds to a single method.

For mild to moderate depression, therapy alone is often highly effective — and there is substantial research supporting CBT and other evidence-based approaches as first-line treatments. For moderate to severe depression, the combination of therapy and medication is generally more effective than either alone, and I work collaboratively with psychiatrists and prescribers when medication is clinically indicated. I never advocate for or against medication categorically — I advocate for the approach that is most likely to help you specifically, based on an honest clinical assessment of what you are experiencing.