Depression is one of the most common mental health conditions I encounter in my practice. It affects how you feel, how you think, and how you act, touching every corner of daily life. Yet despite its prevalence, many people spend months or years struggling before seeking help, often because they believe their suffering isn't "bad enough," or because they hope it will simply pass. If you have found this page, I want you to know: what you are experiencing is real, it is treatable, and you do not have to navigate it alone.
We all feel sad from time to time. Grief, disappointment, and periods of low mood are a normal part of being human. Depression is something categorically different. It is a persistent state — lasting weeks, months, or longer — characterised by a pervasive sense of hopelessness, emptiness, and a loss of interest or pleasure in activities that once felt meaningful. It does not lift with a change of scenery or a kind word, and it is not something you can simply "snap out of."
Where ordinary sadness tends to be linked to a recognisable cause and eases as circumstances change, depression can feel unmoored from any particular event — or it can take hold after a major life change and simply refuse to leave. It colours everything: the way you interpret other people's behaviour, your expectations for the future, your sense of your own worth. That persistent negativity bias is not a character flaw or a failure of willpower. It reflects measurable changes in the way the brain processes emotion, stress, and reward.
Depression is not one-size-fits-all. In clinical practice, I see a wide spectrum of presentations, and understanding where you sit on that spectrum is one of the first steps toward effective depression treatment.
Mild to moderate depression may allow you to keep working and maintaining relationships, but at significant personal cost — exhaustion, irritability, a sense of going through the motions. Many people in this group carry their depression invisibly for years.
Severe depression can be profoundly disabling. Concentration becomes almost impossible. Getting out of bed feels insurmountable. In the most serious cases, thoughts of self-harm or suicide can emerge — something I address directly in the section below on when to seek urgent help.
Atypical depression presents with features that might seem to contradict the "classic" picture: mood that temporarily lifts in response to positive events, increased sleep rather than insomnia, increased appetite (often with a craving for carbohydrates), and a heavy, leaden feeling in the limbs. It is often underrecognised, and responds better to certain treatments than others.
Postnatal depression affects approximately one in ten mothers (and a significant number of fathers) in the weeks and months after birth. Hormonal shifts, sleep deprivation, identity change, and the sheer weight of new responsibility can combine to create a depressive episode that is frequently dismissed as "baby blues" or maternal ambivalence. It deserves proper assessment and support.
Seasonal affective disorder (SAD) is a recurrent form of depression that follows a seasonal pattern — typically emerging in autumn and winter as daylight hours shorten, and lifting in spring. Light therapy, lifestyle adjustments, and in some cases medication can be highly effective.
One of the reasons depression goes undetected — by patients and sometimes by clinicians — is that it frequently presents through the body rather than the mind. People come to me having spent months investigating fatigue, headaches, or digestive problems, without ever having considered that depression might be the common thread.
Unexplained fatigue that persists despite adequate sleep is one of the most common physical symptoms. Others include changes in appetite and weight (in either direction), psychomotor slowing — where thinking and movement feel physically sluggish — muscle aches, disrupted sleep (whether insomnia, early morning waking, or oversleeping), and a dulled libido. For some, physical pain is the primary complaint, and the emotional dimension of their depression remains almost entirely hidden.
Recognising these somatic symptoms matters, because treating the underlying depression often resolves physical complaints that no amount of physical investigation has been able to explain.
Depression does not affect everyone in the same way, and gender plays a meaningful role in how it is experienced and expressed. Women are roughly twice as likely to receive a diagnosis of depression, in part because hormonal factors — the menstrual cycle, pregnancy, the postnatal period, perimenopause — create specific vulnerabilities at different life stages.
Men, by contrast, are less likely to present with the classic picture of tearfulness and low mood. They are more likely to express depression through irritability, risk-taking behaviour, increased alcohol use, withdrawal from relationships, or a driven busyness that keeps difficult feelings at bay. This means depression in men is systematically underdiagnosed, and men are statistically more likely to reach crisis before seeking help. I want to be direct: if you are a man reading this and you recognise those patterns in yourself, they matter, and help is available.
In private psychiatric practice, I rarely see depression in isolation. The majority of people I treat have at least one co-occurring condition, and failing to identify and address these alongside depression is one of the most common reasons treatment fails.
Anxiety and depression co-occur in around 50% of cases. They share biological underpinnings — particularly involving the neurotransmitters serotonin and noradrenaline — but they require nuanced treatment planning, because approaches that help one can sometimes exacerbate the other if not carefully calibrated.
ADHD is frequently undiagnosed in adults who present with depression. The chronic experience of underachievement, disorganisation, and relational difficulty that untreated ADHD produces can drive a secondary depression that lifts only partially without addressing the underlying ADHD. A thorough psychiatric assessment can distinguish between the two — and identify when both are present.
Alcohol and substance use are both causes and consequences of depression. People often self-medicate low mood with alcohol, which in turn worsens depression through its effects on sleep, brain chemistry, and social functioning. Untangling this relationship requires careful, non-judgmental assessment — something a private psychiatric consultation is particularly well-placed to offer, without the time pressures that constrain NHS appointments.
If your depression has brought you to a place where you are having thoughts of ending your life, or where you feel you cannot keep yourself safe, please do not wait for a private appointment. Contact your GP urgently, call 111, attend your nearest A&E, or call the Samaritans on 116 123. These are not signs of weakness — they are signals that your brain is in crisis and that you need immediate support.
For everyone else: if your low mood has persisted for more than two weeks, if it is interfering with your ability to work or maintain relationships, or if you simply feel that something is not right, that is reason enough to seek a professional assessment. You do not need to reach rock bottom before asking for help.
When you come to see me for the first time, my priority is to listen. A first consultation at Pankhurst Psychiatry typically lasts 75 to 90 minutes — time I use to understand not just your symptoms, but your history, your circumstances, your relationships, and what has or hasn't helped in the past. I will ask about your sleep, your physical health, your family history, and your own sense of what is driving your difficulties.
At the end of that appointment, I will share my formulation with you: a clinical picture of what I believe is happening and why, alongside a treatment plan that we agree on together. Nothing is imposed. You leave with a clear understanding of your diagnosis, your options, and the next steps.
Antidepressants are among the most researched treatments in medicine, and the evidence for their effectiveness in moderate to severe depression is robust. They work primarily by modulating the availability of neurotransmitters — serotonin, noradrenaline, and dopamine — in the brain, helping to restore the chemical environment in which more normal mood regulation becomes possible.
The most important thing to understand about antidepressants is that they take time. Most people begin to notice an effect after two to four weeks, and the full benefit may not be apparent for six to eight weeks. This delay is one of the most clinically significant features of antidepressant treatment — and one of the most common reasons people stop prematurely, just as the medication is beginning to work.
I prescribe carefully and collaboratively. We will discuss the options, the expected timeline, the potential side effects (which are often transient), and the evidence for your specific presentation. If a first medication does not suit you, there are others — and adjusting the approach is a normal part of good psychiatric care, not a failure.
Medication is often one part of a broader treatment picture. Cognitive behavioural therapy (CBT) has the strongest evidence base for depression and works by helping you identify and shift the patterns of thinking and behaviour that maintain low mood. Interpersonal therapy (IPT) focuses on the relational context of depression — grief, conflict, role transitions — and can be particularly helpful when life circumstances have played a significant role.
In my view, the most effective approach for many people is a combination: medication to create the neurological stability in which therapeutic work becomes possible, and therapy to build the skills and insights that support lasting recovery. I work with a network of experienced therapists and can make recommendations tailored to your needs.
Clinical treatment works best when it is supported by the foundations of physical and mental wellbeing. The evidence for exercise as a co-intervention in depression is particularly strong — regular aerobic activity has effects on brain-derived neurotrophic factor (BDNF) that meaningfully support mood regulation. Sleep hygiene, nutrition, reducing alcohol, and maintaining social connection all contribute to recovery in ways that are often underestimated.
I do not prescribe lifestyle changes as platitudes. Depression makes every one of these things harder. But small, sustainable steps — a short walk, a regular bedtime, one honest conversation — can create the conditions in which recovery takes hold.
Recovery from depression is rarely a straight line. Most people experience gradual improvement punctuated by setbacks, and it is important to understand that a difficult day or week does not mean treatment has failed. What changes, over time, is the floor: the baseline from which the difficult days occur becomes higher, the good stretches become longer, and the capacity to tolerate and recover from low periods grows.
For some people, depression is a single episode. For others, it is a recurrent condition that benefits from longer-term support and, in some cases, maintenance treatment. Understanding your personal pattern — and building a plan that reflects it — is part of what good psychiatric care provides.
Accessing depression help in Berkshire, Surrey, or London through the NHS can mean long waits, time-limited appointments, and a level of complexity that the NHS, through no fault of its own, is not always resourced to manage. Private psychiatric care with Dr Pankhurst offers something different: extended appointments, direct consultant-level care throughout your treatment (not a different clinician at each visit), and the time and continuity to truly understand your situation.
As a private psychiatrist for assessing and treating depression, with over 20 years of clinical experience, I have worked with people at every stage of the journey — from first-ever depressive episodes to complex, treatment-resistant conditions.
If you recognise yourself in what you have read here, I would encourage you to make contact. A single conversation can clarify a great deal — and starting the process of getting the right support is, in itself, a meaningful step toward feeling better.
Contact me directly to arrange an assessment — most patients are seen within four weeks, and a full written report is provided after the first appointment.
Dr. Kevin Pankhurst
Private Consultant Psychiatrist
Surrey, Berkshire & London
MB ChB; MMed (Psychiatry)
Esher: Esher Groves, 13–17 Church Street, Esher, Surrey, KT108QS
Maidenhead: Berkshire Grove Hospital, White Waltham, Maidenhead, SL6 3TN
Guildford: 3 Saxton, Guildford, Surrey, GU2 9JX
