Depression

Very few people arrive at PHC saying the word depression. They say they are tired in a way that sleep does not touch. They say the things that used to matter have gone quiet — food, work, friends, a programme they used to wait all week for. Nothing is wrong, exactly. Nothing is right either.

Some describe it as weight. Getting out of bed takes a negotiation. A shower takes an hour. A message sits unanswered for four days and then feels too late to answer at all. Others describe irritability rather than sadness — snapping at a spouse, at a child, at the driver — and then the guilt afterwards, which is heavier than the snapping was.

In Karachi we hear it framed as failure more often than as illness. A man still going to the office every day who cannot understand why that is taking everything he has. A student who was near the top of the class and now reads the same page three times. A mother who has run a household for fifteen years and has stopped being able to decide what to cook.

Some people describe it arriving after something — a death, a loss, a move, a marriage that changed. Others cannot point to anything at all, which they often find harder to explain to the people around them.

Recognising yourself in a paragraph on a website is not the same as knowing what is going on. This page describes; it does not assess you, and there is nothing here for you to score yourself against.

There is no threshold you have to cross before you are allowed to ask. People book at PHC after a bad fortnight and after a bad decade, and neither is too small nor too late.

What a clinician pays attention to is duration and cost. Low mood on most days for two weeks or longer, rather than a hard week that has now passed. Low mood that has changed what you do — the work you are managing, the people you still reply to, what you eat, when you sleep. Low mood that stayed long after the event that seemed to start it had ended.

It is also worth speaking to someone when the people close to you have started to notice, or when you have begun to think about not being here at all. If that second one is where you are today, there are faster routes than us and they are worth using first.

Only a qualified clinician can tell you what is going on — a website cannot. What a page like this can tell you is that the question is a reasonable one to bring, and that bringing it earlier usually leaves more to work with.

PHC is an assessment-first practice. Before anyone begins therapy for low mood there is an initial session, and its job is to work out what is actually happening rather than to start treating it.

1. An initial sessionWe ask what has been going on, for how long, and what it is costing you. Nothing is administered before this conversation.
2. Emotional assessment and symptom screeningA structured screening of emotional functioning and what you are presenting with, using internationally validated instruments. Its purpose is to decide which further tests, if any, are clinically warranted — you will not be given tests you do not need. It is also what separates low mood from the things that can sit underneath it or alongside it.
3. A psychologist matched to what the assessment foundPsychologists at PHC are not assigned on availability. Assignment is based on speciality, your presenting needs and clinical fit.
4. Therapy, reviewed as it goesFor low mood the modality most often indicated is Cognitive Behavioural Therapy (CBT), which PHC uses for depression, anxiety and negative thought patterns. Where the difficulty is less about thoughts and more about managing emotion and relationships, DBT may be used instead or alongside. Sessions are 50 minutes, in clinic at our PECHS clinic or in DHA, or online.

Confidentiality, session length, fees and choosing your psychologist are answered in full in questions people ask before booking.

• Anxiety
• Sleep disturbance
• Frequent crying
• Emotional assessment
• CBT at PHC