Depression: Recognising the Signs and How Counselling Can Help

"It's not that I'm sad. I just don't feel anything."

Many people describe it this way: the things they used to enjoy no longer hold any interest; getting out of bed takes everything they have; nothing in particular has happened, yet everything feels heavy. Others say "look on the bright side" or "just get out more," and you want to, but you cannot.

Depression is one of the most common reasons people come to counselling. This page explains what depression is, how it usually shows up, how counselling can help, and when it may be time to reach out.

What is depression?

Low mood is a normal part of being human. Feeling sad after a loss, a setback, a breakup or a plan that fell through is a sign of a healthy mind, not a problem. Low mood slows us down, gives us time to absorb what has happened, and then gradually lifts.

It becomes a problem when the low mood persists, is out of proportion to what is happening, and is no longer just "feeling down" but comes with a loss of interest and drive. When it starts to affect sleep, appetite, work, studies, relationships or daily life, and you cannot feel good even when good things happen, it is worth paying attention to.

Everyday low mood versus troubling depression

What is the difference between low mood and clinical depression?

Low mood is a feeling that everyone experiences. Depression as a disorder is a medical diagnosis made by a doctor or clinical psychologist after an assessment, meaning the low mood has persisted for some time, involves changes across several areas, and is clearly affecting daily functioning. The most common diagnosis is major depressive disorder; others include persistent depressive disorder (milder symptoms lasting two years or more) and postpartum depression. The Hospital Authority's Smart Patient site and Taiwan's John Tung Foundation mental health site both have detailed introductions to depression in Chinese.

Major depressive disorder is marked by depressed mood, or loss of interest and pleasure in almost everything, for most of the day nearly every day over at least two weeks, together with other changes such as a noticeable shift in appetite or weight, insomnia or oversleeping, fatigue, trouble concentrating or making decisions, feelings of worthlessness or excessive guilt, visibly slowed movement or thinking, and sometimes thoughts of not wanting to be alive. Put simply, everyday low mood is feeling sad; depression is the whole system slowing down, and it is very hard to restart on your own.

You do not need to know whether you "have depression" before seeking counselling. Counsellors do not diagnose, but whether or not your low mood reaches the threshold for a diagnosis, counselling can help you understand and work with it. If your counsellor feels a medical assessment would help, they will discuss a referral with you. The PHQ-9 questionnaire further down this page is a screening tool that gives an initial picture of your mood, but the result is not a diagnosis.

How Does Depression Develop and Persist?

Depression is rarely caused by one single factor. It often develops through a combination of life stress, relationships, physical health, thinking patterns, coping habits, and past experiences. Over time, these factors can interact and create a cycle that becomes increasingly difficult to break.

• Long term stress:Ongoing pressure from work, school, finances, caregiving, or other responsibilities can gradually drain your emotional and physical energy.
• Loss and major life changes:Bereavement, relationship breakdown, job loss, migration, illness, or changes in your role or identity can disrupt your sense of stability and connection.
• Isolation and relationship difficulties:Ongoing conflict, feeling unsupported, or becoming increasingly disconnected from other people can make low mood harder to recover from.
• Self criticism and negative thinking patterns:Depression can make people focus more strongly on perceived failures, shortcomings, or things that have gone wrong. Over time, these thoughts can reinforce feelings of hopelessness and worthlessness.
• Withdrawing from everyday life:When people feel depressed, they often stop doing activities, seeing friends, or taking part in things they once enjoyed. This can reduce opportunities for pleasure, achievement, and connection, which may deepen the depression further.
• Past experiences:Difficult childhood experiences, repeated criticism, trauma, or long standing feelings of not being good enough can sometimes influence how a person responds to stress later in life.
• Physical and biological factors:Sleep problems, chronic illness, hormonal changes, certain medications, and other physical health factors can also affect mood and energy.

This is why understanding depression is often about more than asking what caused it. It can also be helpful to look at what started the low mood, what is keeping it going, and which parts of the cycle may be possible to change.

Common signs of depression

Depression is more than "feeling sad." It shows up in thoughts, emotions, the body and behaviour at the same time. Some common signs include:

In Hong Kong, depression is often written off as "dwelling on things" or "not being strong enough," and many people feel they have no right to be unhappy because "others have it worse." But depression is not weakness, and it is not a failure of willpower. It is what happens when a person's energy system has been running on empty for too long. The more you tell yourself you should be fine, and the more you hide it, the harder it is for depression to lift.

Long hours, academic competition, caring for family, cramped living conditions, financial pressure and an uncertain future are all common sources of depression here. Some people can point to a clear event, such as losing a loved one, losing a job or the end of a relationship. Many others cannot name a cause; it simply built up until one day they realised they had not felt truly happy in a very long time. Both deserve to be taken seriously.

How counselling can help

Counselling is not about being told to "look on the bright side." It is about understanding how depression took shape in you and what keeps it going, and then, at your own pace, finding ways to slowly come out of it. Depending on your situation and your counsellor's approach, the work may include:

• Recognizing your depression pattern: mapping the cycle of life events, thoughts, physical state and behaviour, so you can see how depression has boxed you in step by step.
• Restarting your life: depression makes you withdraw, and withdrawing deepens depression. Counselling starts with very small steps to rebuild daily rhythm and activities that let you feel something again.
• Examining and adjusting thinking habits: for example, through Cognitive Behavioural Therapy (CBT), identifying the thoughts that tell you that you are worthless or that the future is hopeless, and testing more realistic ways of seeing things.
• Working on difficulties in relationships: for example, through Interpersonal Therapy (IPT), exploring whether depression is tied to loss, conflict, role changes or isolation, and making changes within your relationships.
• Learning to be gentler with yourself: depression usually comes with harsh self-criticism. Counselling helps you recognise that voice and practise treating yourself the way you would treat a friend.
• Working on what lies beneath: depression is sometimes tied to unresolved grief, trauma, upbringing or long-standing demands you place on yourself, and counselling can explore these deeper layers together.

Counselling approaches for depression

Different counsellors work with depression in different ways, and most blend approaches depending on your situation. These are the ones you are most likely to encounter. Open any of them to see how the approach works and what a session looks like.

When to reach out

No one has to wait until they are at breaking point. If several of the following sound like you, it may be worth talking to a counsellor:

• Low mood, emptiness or numbness has lasted two weeks or more and is present most of the time
• You have completely lost interest in things you used to enjoy
• Your sleep, appetite or energy has clearly changed
• Your work or studies are slipping, and even basic tasks feel hard to finish
• You have started avoiding the people around you, or feel like a burden to them
• People around you have noticed you are not yourself
• You have started using alcohol, drugs or other means to stop feeling
• You have had thoughts of not wanting to be alive, even fleeting ones

Frequently asked questions about depression

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