# Depression and mood > How depression and low mood can show up, and how clinical psychologist Jess Chadakorn approaches assessment and therapy in Rosanna and Warrandyte. Source: https://jess.ac/areas-of-support/depression-mood/ Low days usually pass. Depression tends to persist for weeks or months and rarely has a single cause. Stress, loss, physical health and family history can all play a part. Over time it can make ordinary days feel heavy and take the colour out of things you once enjoyed. ## What depression can feel like Depression affects about one in seven people in Australia, according to Beyond Blue. For some it is a sadness that won’t lift. For others it is a flatness, where things that used to bring pleasure barely register. Irritability, or a short fuse you don’t recognise in yourself, can be part of it too. Sleep and appetite may change, thinking can slow, and small tasks can take real effort. Many people also notice a harsh inner voice that blames them for how they feel. If low mood or a loss of interest has been present on most days for two weeks or more (the period recognised diagnostic criteria use), an assessment is worthwhile. If you are having thoughts of ending your life or feel unsafe, call Lifeline at any hour on 13 11 14, or 000 in an emergency. ## Other ways mood can change Some people live with a milder low mood that lasts two years or more, until it feels like part of who they are (persistent depressive disorder, or dysthymia). Perinatal depression can begin during pregnancy or in the year after a birth, and can affect partners too. A major change or loss can also bring a period of low mood. Less commonly, mood moves in both directions, with periods of unusually high energy and little need for sleep alongside the lows. This can be part of bipolar disorder, which usually calls for medical care alongside therapy, so it is worth raising with Jess and with your doctor. ## Assessment and therapy for low mood A diagnosis may be part of the assessment, though you do not need one to start. Before you and Jess agree a treatment plan, her formulation looks at what keeps your mood low. Withdrawing from activity when mood drops can lower it further. Behavioural activation, a well-studied part of CBT, works on this cycle. Because motivation often builds once you begin, you and Jess might plan one or two manageable activities each week and track how your mood responds. In therapy you also practise noticing the inner critic and answering it with the fairness you would offer a friend. ## Physical health, medication and how to start Some physical conditions, such as an underactive thyroid or low iron, and some medicines can affect mood, so a medical check-up can be useful. Psychologists do not prescribe medication. If it is part of your care, Jess can work alongside your prescribing doctor with your consent. You can start without a referral or with a Medicare referral, and the What to expect page explains both. ## Things people often notice - Low or flat mood on most days - Less interest or pleasure in everyday things - Changes in sleep or appetite - Tiredness and difficulty concentrating - Harsh self-criticism or guilt - Withdrawing from friends and family ## Approaches Jess may draw on - **[Cognitive Behaviour Therapy (CBT)](https://jess.ac/approaches/cbt.md).** CBT grew partly out of Aaron Beck’s work on depression in the 1960s. For low mood it often combines behavioural activation with examining the thoughts that keep mood low and how accurate they are. - **[Acceptance and Commitment Therapy (ACT)](https://jess.ac/approaches/act.md).** ACT, developed by Steven Hayes and colleagues from the 1980s, involves noticing thoughts like ‘what’s the point’ as passing thoughts, which can loosen their hold. It pairs this with practical steps towards what matters to you. - **[Schema Therapy](https://jess.ac/approaches/schema-therapy.md).** Schema therapy, developed by psychologist Jeffrey Young, addresses long-standing patterns (schemas) that often begin early in life. It can be useful when low mood keeps returning or self-criticism has been present for as long as you can remember. - **[Psychodynamic therapy](https://jess.ac/approaches/psychodynamic-therapy.md).** Psychodynamic therapy has its roots in Freud’s ideas, though it has changed a great deal since. It explores how earlier experiences and relationships shape how you feel now, which can help make sense of low moods that seem to come from nowhere. ## For children and teenagers Low mood in children and teenagers can be mistaken for a phase. A child may seem irritable or tired, and a teenager may drop a hobby they loved while saying little about feeling sad. Parents of younger children usually take part in therapy with Jess. ## Questions ### How is depression different from feeling sad? Sadness is a normal response to loss or disappointment. It usually eases with time, and you can often still enjoy things in between. Depression lasts longer, weighs on most of the day and often changes sleep, energy and concentration. If you are unsure which it is, an assessment can clarify it. ### Can I see Jess if I’m already taking antidepressants? Yes, and many people do. Research suggests that for some people, therapy and medication together are more helpful than either alone. Any change to a dose, including stopping, should be discussed with your prescribing doctor first. ### What if I feel too flat to talk much? Low energy and having little to say are common with depression, and Jess takes this into account. She can lead the conversation, often starting with what an ordinary day looks like for you. ## Further reading - [Depression](https://www.healthdirect.gov.au/depression) (healthdirect) - [Understand depression](https://www.beyondblue.org.au/mental-health/depression) (Beyond Blue) - [Depression](https://www.blackdoginstitute.org.au/resources-support/depression/) (Black Dog Institute)