When the flat, tight, exhausting version of normal has gone on long enough

The work

Most people wait far too long, because nothing is technically wrong

Anxiety and depression rarely announce themselves. More often they arrive slowly enough that they get mistaken for personality. You are just a worrier. You have always been a bit flat. You are fine, you are just tired, and you have been tired for about three years.

Then somebody asks how you are and you notice you cannot remember the last time you looked forward to something. That is usually the moment people ring.

You do not need a diagnosis or a crisis to justify coming. If the way you are living has quietly narrowed, that is enough of a reason.

What tends to help

• Working out the actual shape of it, because anxiety and depression usually feed each other and the mix matters
• Finding the avoidance. Anxiety shrinks a life quietly, one avoided thing at a time, and the relief is what keeps it going
• Looking at the thoughts closely enough to test them, rather than arguing with them or believing them wholesale
• Rebuilding the boring foundations: sleep, food, movement, daylight, other people. Unglamorous, and they carry a lot of the load
• Understanding where the pattern came from, when that turns out to be relevant
• Working out what you have been carrying that was never yours to carry

Counselling, medication, or both

Both is a perfectly reasonable answer and there is nothing weak about it. Medication is prescribed by your GP or a psychiatrist, not by me, and I have no position for or against it in principle. What I will do is help you think it through properly and work well alongside whatever you and your doctor decide.

If what you are describing sounds like something that needs a medical assessment, or a psychologist, or a psychiatrist, I will tell you plainly and help you get there.