Depression is not sadness
The most common misconception about depression is that it is an intense form of sadness. In fact, many depressed people feel nothing at all. And that is the problem.
“But I have no reason to be sad, I have everything I need.” It is one of the most frequent sentences we hear at the first consultation. It comes from a misunderstanding of what depression is.
Sadness has an object. Depression does not
Sadness is a normal and necessary emotion: it appears in response to a loss, it has an identifiable reason and it fades with time. You can be sad and, at the same time, laugh at a good joke.
Depression is something else. It is a condition that changes the way the brain works: the ability to feel pleasure, energy, sleep, appetite, concentration. It can appear without any external reason, and the presence of a reason does not make it “justified”.
The central sign: you no longer feel anything
The clinical term is anhedonia: the inability to feel pleasure from activities that used to produce it. Music sounds the same, but no longer does anything. Food has taste, but no longer matters. The people you love are still there, but meeting them feels like an effort.
Many patients do not describe pain. They describe a distance, as if they were watching their own life through a window.
What it actually looks like
For a diagnosis, the symptoms must last at least two weeks and affect daily functioning:
- Tiredness that does not go away with rest
- Waking very early, unable to get back to sleep
- Changes in appetite, in either direction
- Difficulty concentrating: you reread the same paragraph three times
- Visible slowing of movement and speech, or, on the contrary, agitation
- Disproportionate feelings of guilt
- Thoughts about death or about no longer being here
Why “get up and do something” does not help
The advice assumes the problem is willpower. But depression affects precisely the circuits that generate motivation. It is like telling someone with a broken leg to walk with more determination.
The paradox is that behavioural activation (the gradual reintroduction of activities) does work, but as part of a structured plan, in very small steps, not as an exhortation.
What we do at the clinic
We assess the severity, rule out medical causes (thyroid, vitamin D or B12 deficiency, anaemia) and set the plan. In mild forms, psychotherapy alone has good results. In moderate and severe forms, the combination of medication and psychotherapy is superior to either taken separately.
If you have thoughts of harming yourself, do not wait for an appointment: call 112 or go to the nearest emergency department.
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