Depression & Low Mood.

Not sadness. Sadness has a shape and a reason and it moves. This is flatter than that: the colour drained out, the things you used to want no longer registering as wanting, and a tiredness that sleep does not touch. Major Depressive Disorder (MDD), or depression, is also very treatable, which is the part that gets said least often. In person in Prahran, Melbourne, and online anywhere in Australia.

tl;dr

At a glance.

Who it is for: Adults in a depressive episode, in a long low-grade version of it, or somewhere in the flat middle that has never quite had a name
What we offer: Therapy that starts with what is reachable today rather than what you would manage on a good week
Approaches: Behavioural activation, CBT, Schema Therapy and ACT, matched to what is actually keeping it going
Referral: You can contact us to start the process. You need a GP referral before your first appointment, like every client. A Mental Health Treatment Plan is a separate thing again, and it is what brings the Medicare rebate
Medication: We are psychologists, not prescribers. Medication and therapy work well together and we liaise with your GP or psychiatrist
If it is urgent: We are not a crisis service and we do not answer after hours. Our crisis support page lists the lines that answer around the clock
Telehealth: Everything on this page can be done by video, which matters on the days leaving the house is the obstacle

What it looks like

What depression can look like in adults.

The stereotype is crying and staying in bed. Plenty of depression looks nothing like that. It looks like getting to work, doing the job adequately, coming home, and having nothing left for anyone including yourself. It looks like irritability rather than sadness. It looks like a person who is functioning, and who privately cannot find the point of any of it.

The mechanism that keeps it running is quietly cruel. Depression removes the anticipation of reward, so the things that would actually help stop looking worth doing. You withdraw, you do less, there is less to feel good about, and the evidence that you are failing accumulates. Motivation does not return first and then you act. It is the other way round, which is why advice to simply do the things you enjoy lands so badly.

For some people it arrives after something identifiable: a loss, a diagnosis, a birth, a redundancy, the end of something. For others it arrives without a reason attached, which is its own kind of difficult, because there is nothing to point at when people ask what is wrong.

And some people have never known anything else. A low, grey baseline present since adolescence gets mistaken for personality, by everyone including the person living it. It is not personality. It is treatable, even after decades.

Does any of this sound like you?

The everyday version.

These are the things people describe to us, in their words rather than the manual's. You do not need all of them, and functioning well on the outside does not disqualify you.

Mood and interest

Flat rather than sad

Not crying. Just nothing much, about anything, including the things that should land.

The things you liked do not work

You still do them sometimes. They just do not give anything back, which is worse than not doing them.

Irritable with everyone

Short with people you love, then the guilt afterwards. Depression presents as irritability far more often than people expect.

Body and energy

Tired in a way sleep does not fix

Nine hours and still heavy. The exhaustion is not about sleep debt.

Everything takes more

Showering. Replying to a message. Deciding what to eat. Tasks that used to be automatic now need deciding about.

Sleeping wrong

Awake at three, or sleeping through the afternoon, or both in the same week.

Appetite has changed

Eating far less and not noticing, or eating for something other than hunger. Either direction counts.

Thinking

Your head is slower

Reading the same paragraph. Losing the thread mid-sentence. Forgetting what you walked in for.

Deciding is impossible

Even small choices. The effort of weighing anything is out of proportion to what is at stake.

A commentary that never lets up

A running internal account of your failures, delivered in a voice you would never use on anyone else.

Self and worth

Guilt with no object

Not about a specific thing. A general sense of having let everyone down and being a burden by existing.

Worthlessness

Not low confidence. A settled belief that you are fundamentally less than other people.

Shame about being depressed

The extra layer: you have a decent life, so what right do you have. That logic has never once helped anyone.

Other people

Withdrawing quietly

Not answering. Cancelling. Letting things lapse, then feeling too far gone to reach back.

Performing fine

Getting through the day convincingly, and the exhaustion of the performance itself.

Nobody has noticed

Which is often true, and often the loneliest part.

The far end

Wishing you were not here

Wanting it to stop, not necessarily wanting to die. Very common in depression and very rarely said out loud.

Thinking about death

If this is where you are, please tell someone today. Our crisis support page has lines that answer around the clock, and you can say it here too.

Feeling nothing at all

Numbness rather than pain. Some people find this the most frightening part, and it is still depression.

The criteria

What the diagnosis actually requires, in plain language.

Australian psychologists work from the DSM-5-TR. In plain terms, a major depressive episode means five or more of the following, most of the day, nearly every day, for at least two weeks. At least one of them has to be low mood or loss of interest:

Depressed mood most of the day. In adults this often reads as empty, flat or irritable rather than sad
Markedly reduced interest or pleasure in nearly everything
A significant change in appetite or weight, in either direction
Sleeping too little or too much
Being visibly slowed down, or visibly agitated, in a way other people could notice
Fatigue or loss of energy
Feelings of worthlessness, or guilt that is excessive or inappropriate
Reduced ability to think, concentrate or make decisions
Recurrent thoughts of death, or thoughts of not wanting to be alive

They also have to cause real distress or get in the way of your life, and not be better explained by a medical condition or a substance.

When it is long rather than sharp

Persistent depressive disorder describes low mood present more days than not for at least two years, with a smaller set of symptoms. It is less intense and far more corrosive, because it stops looking like an illness and starts looking like who you are. People with it often say they have never really felt well, and many never seek help because there was no obvious point at which something went wrong.

Specifiers that change what helps

The manual also adds descriptions that change treatment. These include a seasonal pattern, peripartum onset (during pregnancy or after birth), anxious distress, and melancholic features, where the flatness is worst in the morning and pleasure feels out of reach.

The question your GP will ask, and why it matters

Have you ever had a stretch of days where the opposite was true: needing much less sleep, thinking and talking faster than usual, spending or risk-taking out of character, feeling unusually capable? If so, say it clearly. A history of elevated mood points toward bipolar disorder, where some antidepressants used alone can make things worse. This is one of the few places where getting the history right changes the treatment substantially.

A threshold, not a verdict

Four symptoms instead of five does not mean you are fine. Plenty of people sit under the line, have done for years, and get a great deal from treatment. We work with what is happening in your life, not with whether it clears a bar.

Co-occurring

What often travels with depression.

Depression is rarely the only thing in the room, and it is very often downstream of something else. Every new client here is screened for trauma and for neurodivergency as standard, because treating the depression alone tends to stall when something underneath is driving it.

Anxiety

The most common companion by a distance. Many people have both at once, and the mix needs treating as a mix rather than in sequence.

Anxiety →

Trauma and PTSD

Depression is one of the most common long-term presentations of untreated trauma. If the history is there, treating only the mood tends to plateau.

Trauma & PTSD →

ADHD

Years of missed deadlines, broken systems and being told you are not trying hard enough produce a demoralisation that looks exactly like depression, and sometimes is.

ADHD →

Autism

Autistic burnout and autistic depression are common, often follow years of masking, and respond to different things than standard depression protocols.

Autism →

Eating and body concerns

Mood and eating influence each other in both directions. Where both are present we address them together.

Eating & body →

Alcohol and other drugs

A reliable short-term lift with a reliable next-day cost. Depression and drinking escalate each other quietly.

Sleep disorders

Insomnia is both a symptom and a driver. Treating the sleep directly often lifts mood before anything else does.

Chronic illness, pain and fatigue

Depression rates are substantially higher alongside persistent physical conditions. That is not a character response to bad luck; it is partly physiological, and it deserves treating in its own right.

Grief

Grief is not depression, and pathologising it does harm. But they can co-exist, and prolonged grief has its own shape and its own treatment.

Hormonal and reproductive events

Premenstrual, perinatal, postnatal and perimenopausal mood changes are real, under-recognised and worth naming with your GP.

Thyroid, iron and B12

Ordinary, common, and all capable of producing something that looks convincingly like depression. This is one reason the GP visit first is not a formality.

Thoughts of not wanting to be here

Common in depression and safe to say here. If it is urgent right now, please use our crisis support page.

Crisis support →

Words you will hear

A short glossary.

Terms that come up in appointments, on referrals and online. Some are clinical, some are shorthand. Knowing which is which helps.

Anhedonia

Loss of pleasure or of the anticipation of pleasure. Often the symptom people find hardest to describe and hardest to live with.

Behavioural activation

Rebuilding activity deliberately and in small steps, because action restores motivation rather than waiting for it. One of the best-evidenced treatments there is.

Bipolar disorder

A different condition involving episodes of elevated as well as low mood. It matters because the treatment differs, which is why your history gets asked about.

Cognitive distortion

A habitual thinking shortcut that skews the picture: all-or-nothing, mind reading, catastrophising, discounting the positive.

Major depressive episode

The DSM-5-TR term for a distinct period meeting the full criteria. Episode, not identity, and most episodes end.

Melancholic features

A particular pattern: worse in the morning, early waking, pleasure completely unreachable, marked physical slowing.

MHTP

Mental Health Treatment Plan. The GP referral that brings a Medicare rebate on eligible therapy sessions.

Perinatal depression

Depression during pregnancy or in the year after birth. Affects birthing and non-birthing parents both.

Persistent depressive disorder

Low mood more days than not for at least two years. Previously called dysthymia. Less intense, more entrenched.

Psychomotor retardation

Visibly slowed movement, speech or thought. Something an observer could see, not just an internal feeling.

Relapse prevention

The last phase of treatment: knowing your own early signs and having a written plan for them. It measurably reduces the odds of a next episode.

Rumination

Going over the same ground without resolution. Distinct from problem-solving, and a strong predictor of episodes continuing.

SAD

Seasonal affective disorder. A depressive pattern tied to time of year. Less common in most of Australia than in the northern hemisphere, but real.

SSRI and SNRI

The two most commonly prescribed antidepressant families. Prescribed by a GP or psychiatrist. We do not prescribe, but we work alongside those who do.

Treatment-resistant

A clinical shorthand for not having responded to two adequate medication trials. It describes a treatment history, not a person, and it is not a dead end.

What we do

Starting from what is reachable today.

Therapy for depression fails when it is pitched at the person you are on a good week. We pitch it at today.

We start with movement, not insight

Behavioural activation is unglamorous and among the best-evidenced things we can offer. It means slowly getting back into activity, in steps small enough to actually happen. You choose them for what they give back, not for what you think you ought to be doing. It works before motivation returns, which is the entire point.

Then the thinking

CBT for the commentary: the all-or-nothing readings, the certainty about how things will go, the discounting of anything that goes well. Not positive thinking, which is useless here. Accurate thinking, which is testable.

Then the older layer, if it is there

Schema Therapy for depression that has been present since adolescence, or that keeps returning to the same beliefs about being defective, unlovable or a failure. This is slower work and it is where the long-standing versions tend to shift.

ACT where the fight against the feeling has become its own problem, and the useful move is toward what matters rather than away from what hurts.

The physical basics, without moralising

Sleep, movement, alcohol and daylight all have real effects on mood, and being told so by someone who is not depressed is infuriating. We work on them as levers you can pull, not as a verdict on your discipline.

Medication

For moderate to severe depression the evidence supports medication and therapy together more strongly than either on its own. For milder depression, therapy alone does well. We do not prescribe. We can help you prepare for that conversation with your GP, make sense of what follows, and keep working alongside it.

Finishing properly

The last phase is relapse prevention: your own early warning signs, written down, with a plan attached. It is the part most likely to be skipped and the part that most reduces the chance of a next episode.

Getting started

How we begin.

Depression makes starting things hard, and starting therapy is a thing. We have tried to make this the least demanding version we can.

01 Before we meet
You see your GP for the referral we need before your first appointment. If you want the Medicare rebate, ask about a Mental Health Treatment Plan while you are there, since it is a separate document from the referral. They will usually check the physical things that can mimic depression, which is worth doing.
02 The first session
What is happening, how long it has been happening, and what a better week would actually contain. We ask about trauma and about neurodivergency with everyone.
03 Something small, immediately
You leave the first session with one concrete thing, sized to what is possible now rather than what would be impressive. Early momentum matters more here than in most things we treat.
04 The work
Activity first, then thinking, then the older patterns if they are there. We review whether it is working rather than assuming it is.
05 Finishing
Spacing sessions out, writing down your early signs, and agreeing what you would do if they showed up again.

Questions

Questions people ask about depression.

My life is fine. Can I still be depressed?

Yes. Depression is not proportional to circumstances and does not require a justification. The belief that you have to earn the right to struggle is itself a common symptom.

Should I be on medication?

That is your GP's or psychiatrist's call, not ours, and it depends heavily on severity. For moderate to severe depression the evidence favours medication and therapy together. For milder depression, therapy alone does well. We will give you our honest read and support either choice.

I have been like this for twenty years. Is it too late?

No. Long-standing depression responds more slowly, not less. People who have never known a different baseline often get the most out of treatment, precisely because nobody has ever addressed it.

What if I cannot manage the between-session tasks?

Then they were the wrong size and we make them smaller. Not completing something is information about the plan, not evidence about you.

How long until something shifts?

Behavioural work often produces some movement within a few weeks. The deeper patterns take longer. If nothing has changed after a reasonable stretch, we change the approach rather than repeating it.

Is it depression or burnout?

They overlap and the distinction matters. Burnout is tied to a context and tends to lift when the context changes; depression travels with you. Autistic burnout is different again. We work this out with you rather than guessing.

Can therapy work over video?

Yes, and for depression it removes a real barrier. Getting out of the house is often the hardest part of the week.

What if I am having thoughts of not wanting to be here?

Tell us. It is more common than people think and saying it does not end the conversation or trigger anything automatic. We will talk about it directly and make a plan with you. If it is urgent right now, please use our crisis support page or call Lifeline on 13 11 14. In an emergency, call 000.

Do you have a psychologist for depression in Melbourne?

Yes. We work with depression and low mood in adults, in person at our Prahran clinic in Melbourne and online anywhere in Australia. You can contact us to start the process, and you need a GP referral before your first appointment.

Nearby in the manual

Related conditions in the DSM-5-TR.

Depression sits among a group of mood conditions that overlap at the edges. We list them because people often recognise themselves in a neighbour rather than in major depression itself.

Major Depressive Disorder
Persistent Depressive Disorder
Premenstrual Dysphoric Disorder
Disruptive Mood Dysregulation Disorder
Bipolar I Disorder and Bipolar II Disorder
Cyclothymic Disorder
Prolonged Grief Disorder
Depressive Disorder Due to Another Medical Condition

Naming them is not diagnosing them. If one of these fits better, that is a conversation for your first session, and the bipolar ones in particular change what treatment is safe.

Beyond us

Further information and support.

These organisations publish plain-language information, run helplines and offer peer support, independently of us. We list them properly, with links, on our resources page.