Why people wait, and why you do not have to
Depression has a way of arguing against getting help. It drains the energy needed to make a phone call, and it tells you that you should be able to snap out of it, or that other people have it worse. Many adults keep going to work and caring for others while feeling flat inside, so no one around them notices.
You do not need to prove anything before reaching out. Deciding whether this is depression, grief, burnout or a hard season is part of what a clinician helps with. Your job is only to notice that something has changed and stayed changed.
The two-week mark
Clinicians pay attention to time. NIMH explains that depression is diagnosed when symptoms are present most of the day, nearly every day, for at least two weeks, and one of them is a depressed mood or a loss of interest or pleasure in most activities.
NIMH's "Do I Need Help?" guide puts this in practical terms. If you have felt sad, tired or less interested for less than two weeks but can still take care of yourself and others, it suggests trying regular exercise, healthy meals, 7 to 9 hours of sleep, time with people you trust and low-stress activities you enjoy. If those steps do not help or things get worse, talk to a health care provider. If more severe symptoms have lasted two weeks or more, NIMH's advice is to seek professional help.
Signs that are easy to miss
Sadness is only one way depression shows up. NIMH lists a wider range of signs, and the APA suggests considering therapy when a heavy sense of sadness or helplessness lasts and does not improve despite your efforts and help from family and friends. Watch for:
- Feeling empty, numb or hopeless rather than sad
- Irritability, frustration or a shorter temper with people you love
- Losing interest in hobbies, friends or sex
- Fatigue, or feeling slowed down, even after sleep
- Sleeping much more or much less, or waking too early
- Trouble concentrating, remembering or making simple decisions
- Aches, headaches or digestive problems without a clear physical cause
- Drinking more, withdrawing from people, or letting important roles slide
If you recognize several of these and they have lasted, that is enough reason to call. What Depression Can Look Like in Adults goes through the signs in more detail.
When everyday life starts to slip
The APA names difficulty carrying out everyday activities as a reason to consider therapy, for example being unable to concentrate at work so that your performance suffers. Concrete markers can help you see it:
- Bills, emails or texts piling up because each one feels like too much
- Calling in sick, or getting through the workday and collapsing at home
- Skipping meals, showers or plans you used to look forward to
- Someone close to you saying they are worried
If a hard season is not easing even as circumstances improve, Depression vs. a Difficult Season may help you think it through.
Who to talk to first
NIMH suggests starting with a health care provider such as a primary care doctor, psychologist or psychiatrist. A primary care visit is a good first step if you have not had a checkup recently, because some medical conditions and medications can affect mood. A psychologist or other licensed therapist provides talk therapy. A psychiatrist or psychiatric nurse practitioner can evaluate whether medication might help. Some people see more than one. Psychologist, Psychiatrist or Counselor? explains who does what in Michigan.
If you already take an antidepressant or another medication for mood, keep taking it as prescribed. Talk with your prescriber before changing anything.
What to say, and what to bring
NIMH suggests taking a few notes about your symptoms before the visit: when they began, how long they have lasted, how often they occur and whether they keep you from your usual activities. Its tips for talking with a provider also recommend bringing a list of all medications and supplements, thinking about family mental health history, and mentioning any major stressors or recent changes. A first call can be as short as:
- "For the last couple of months I've felt flat and tired, and I've stopped doing things I used to enjoy."
- "It's starting to affect my work and my marriage."
- "I'd like to start therapy. Do you see adults for depression, and what are your fees?"
If making the call feels like too much, it is fine to ask a partner or friend to sit with you while you do it. NIMH notes that some people bring a trusted person to appointments for support.
If you are having thoughts of suicide
Thoughts of death or suicide are a sign to get help today, not at your next appointment. They are common in depression, they are not a sign of weakness, and help is available. You do not have to be sure you would act on them to reach out. Call or text 988 at any hour to talk with a trained counselor.
Seeing Dr. Lehmann for depression
Dr. Lehmann is a licensed clinical psychologist in Franklin who has worked with adults since 1997. In depression therapy she pairs practical support for getting through the week with insight-oriented work on the history, relationships and self-critical patterns that can keep low mood in place. She sees adults in person in Oakland County or by telehealth when you are in Michigan, during daytime hours Monday through Thursday. She does not prescribe, and with your written permission she can coordinate with the physician or psychiatrist who manages your medication.