Not the same as feeling low. Persistent, treatable, and worth being honest about.
Assessed and treated by a GMC-registered GP
Prescriptions, sick notes and referral letters included
A written treatment plan after every appointment
Your NHS records in the room, with your consent
Care led personally by Dr Khan
Attentive, unhurried care that listens properly
Five-star Google reviews from the people we have looked after
Registered with the Care Quality Commission
Depression is not sadness, and it is not a reaction that people should be able to reason themselves out of. It is a persistent change in mood and function lasting at least two weeks, with physical effects on sleep, appetite, energy and concentration that are as real as the emotional ones.
The two core features are persistent low mood and loss of interest or pleasure in things you normally enjoy. The second — anhedonia — is often the more telling, and the one people describe as feeling flat or numb rather than sad.
Around one in six adults experiences depression at some point. It is treatable, and treatment works — but two things routinely go wrong at the outset, and both are covered properly here.
The first is missing a physical cause. Thyroid disease, iron deficiency, B12 deficiency, sleep apnoea and — very commonly — perimenopause all produce exactly this picture, and all are treated differently.
The second is treatment failing for avoidable reasons. Antidepressants take four to six weeks and often feel worse for the first fortnight. Most people who conclude they do not work stopped during that window. Our article on the first two weeks on an antidepressant covers this in detail.
Diurnal variation — feeling at your worst in the morning and gradually improving through the day — is characteristic of depression and is a useful thing to mention.
Depression frequently presents differently in men, as irritability, anger, risk-taking or increased drinking rather than visible sadness — which is one reason it is under-diagnosed in men.
Depression is almost never a single cause. It emerges from a combination of predisposition, circumstance and biology.
These produce a picture indistinguishable from depression, and treating the wrong one wastes months:
Low mood, anxiety, irritability, poor sleep and brain fog in a woman in her forties are frequently perimenopause rather than depression — and current guidance is clear that antidepressants should not be offered first-line for low mood arising from the menopause. HRT is often the more appropriate treatment. A great many women spend years on antidepressants that were never going to address the cause, and this is a well-documented failure worth naming.
Depression is diagnosed clinically — there is no blood test for it. But blood tests matter, because they exclude the physical causes that imitate it.
Our fatigue and mood panel covers the core set.
This is one of the areas where twenty minutes rather than ten makes the most difference. The first answer to "how have you been" is rarely the true one, and a ten-minute appointment often ends before the second.
You can refer yourself to NHS Talking Therapies directly, without going through any GP, and it is free. Waiting times vary but self-referral is usually faster than being referred. For mild to moderate depression, therapy is at least as effective as medication and its benefits last longer after it stops.
We will tell you this even though it is not something we provide, because it is frequently the right answer.
Appropriate for moderate to severe depression, and for milder depression that has not responded to other measures.
Not a token suggestion. Structured exercise has good trial evidence in mild to moderate depression, comparable in effect to medication for some people. It is worth treating as a prescription rather than advice.
Thyroid treatment, iron replacement, sleep apnoea treatment, or HRT where perimenopause is the driver. Getting this right avoids years of the wrong treatment.
We do not provide therapy itself, we do not manage severe depression, psychosis, bipolar disorder or complex risk remotely, and where you are already under a mental health team, changes go through them rather than around them. We refer and support rather than duplicate.
Call 999 or go to A&E now if:
If you need to talk to someone right now: Samaritans on 116 123 — free, 24 hours. Or text SHOUT to 85258. Or call 111 and choose the mental health option.
Seek same-day help for:
Book a consultation if: low mood has persisted more than two weeks; it is affecting work, relationships or daily function; you are drinking more to cope; you have had previous episodes and recognise the pattern returning; or an antidepressant has not helped after six weeks at an adequate dose.
Depression tells you to wait until you feel like doing something. The evidence points the other way: doing comes first, and the feeling follows. Scheduling small specific activities regardless of motivation is a core component of effective therapy, and it can be started without a therapist.
Start smaller than seems worthwhile. Getting dressed, going outside, one phone call.
St John's Wort has some evidence in mild depression but interacts dangerously with many medicines, including the contraceptive pill and antidepressants. Tell us if you take it. Broadly, avoid making major life decisions during a severe episode — judgement is genuinely affected, and it recovers.
NHS Talking Therapies takes self-referrals without a GP appointment, and it is free. For mild to moderate depression, psychological therapy has an evidence base equal to medication, and for many people it is the better first step. That route is available to you today.
Your NHS GP treats depression free, and antidepressants are very cheap generics.
Where a private consultation genuinely earns its fee is the twenty minutes. Depression assessed properly involves risk, duration, function, what has been tried, and what you actually want — and a ten-minute appointment does not allow it.
It also allows physical causes to be excluded: thyroid disease, B12 and iron deficiency, and vitamin D deficiency all produce symptoms indistinguishable from depression, and are worth a blood test.
The most valuable practical thing is knowing what the first fortnight feels like. SSRIs commonly make anxiety and sleep worse before they help, and take four to six weeks to work — and day ten, when side effects peak and benefit has not arrived, is when most people stop. Knowing that in advance is the single biggest predictor of getting through it.
Where money is wasted: pharmacogenomic testing to “choose your antidepressant”, which is heavily marketed with weak real-world evidence.
If you need help now: 999 or A&E if you are in immediate danger, 111 for urgent advice, Samaritans free on 116 123 at any hour.
NICE NG222, Depression in adults: treatment and management, is the governing guideline. It recommends a menu of treatment options matched to severity and patient preference, with psychological therapy and medication both offered for less severe depression rather than medication by default.
NG222 recommends against routinely offering antidepressants as first-line for less severe depression unless that is the person's preference.
NG222 recommends SSRIs as first-line where medication is used, with review within one to two weeks — and within one week for people under 25, given the increased risk of suicidal ideation early in treatment.
NG222 covers stopping antidepressants, recommending gradual tapering over weeks to months and distinguishing withdrawal symptoms from relapse.
NG222 also recommends assessing for physical causes and comorbidities, which underpins the blood tests named above.
A useful distinction is function and duration. Sadness in response to something difficult is normal, moves with circumstances, and does not stop you living. Depression persists for weeks regardless of what is happening, flattens enjoyment of everything, and affects sleep, appetite, energy and concentration. If it has been two weeks and you are not functioning as you were, it is worth a conversation.
No. They should return you to yourself, not produce someone different. Some people describe feeling emotionally flattened, particularly at higher doses — that is a recognised effect and a reason to adjust the dose or switch, not something to accept indefinitely.
No, and the distinction matters. They do not cause cravings or require escalating doses. What they do cause, if stopped abruptly, is discontinuation symptoms — dizziness, electric-shock sensations, flu-like feelings, irritability. That is a withdrawal effect, not dependence, and it is why they are tapered rather than stopped.
At least six months after you feel well, because stopping at the point of recovery strongly predicts relapse. For repeated episodes, longer is often sensible. It is a decision to make together when you are well — not one to make in the middle of an episode.
Quite possibly, and it is important. Low mood, anxiety, irritability, poor sleep and brain fog in a woman in her forties frequently reflect perimenopause. Guidance is explicit that antidepressants should not be first-line for low mood related to the menopause, and HRT may be the better treatment. If that fits you, say so.
No. For mild to moderate depression, talking therapy works at least as well and its benefits persist longer after stopping. You can self-refer to NHS Talking Therapies free, without a GP. Medication is one option among several, and the choice is yours.
Yes — with real trial evidence, not as a way of minimising the problem. For mild to moderate depression the effect is comparable to medication for many people. The difficulty is that depression removes the motivation to do the thing that helps, which is why starting far smaller than feels meaningful is the practical answer.
Diurnal variation is characteristic of depression — worst on waking, easing through the day. It is a recognised feature rather than anything you are doing wrong, and it is worth mentioning because it supports the diagnosis.
August 23, 2026
Ongoing
Time to be seen
Appointment length
Your NHS record in the room
Written treatment plan
Told when a test isn’t needed
Cost
Same day, usually
20 minutes
Yes, with your consent
Included
Yes, and told why
£40 for 20 minutes
Varies by practice
Typically 10 minutes
Yes, your full record
Not routinely
Usually
Free
Same day
Often 10 to 15 minutes
Usually not
Sometimes charged
Varies by provider
Often a subscription
Same-day access is usually available, from 6am to 10pm, seven days a week. You choose a time that suits you rather than waiting on hold at 8am.
Yes. Care is led personally by Dr Mohammad Khan, so you are not passed between clinicians. Continuity is the point of a small practice: someone who knows your history and is listening attentively rather than working through a checklist.
Yes, with your consent. We can access your Summary Care Record during the consultation, so your current medications, allergies and significant history are in the room. That means fewer questions you have already answered elsewhere, and safer prescribing.
No. We are not here to replace GPs, only to support them. Your NHS practice remains responsible for your ongoing care, and with your consent we write to them after the consultation. We are useful when you need to be seen sooner, or want more time than a standard appointment allows.
Twenty unhurried minutes and a comprehensive assessment. A written treatment plan is included, along with any prescription, sick note or referral letter arising from the consultation, at no extra charge.
£40 for 20 minutes, self-pay. Membership is optional and never required. Priced for fairness, because we are not here to charge extortionate amounts for access to a doctor.
It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
Yes, where there is a genuine bacterial infection — cellulitis, impetigo, bacterial urine infections, confirmed strep throat. We will also frequently tell you that you do not need one. Most sore throats, coughs, colds and earaches are viral, and an antibiotic gives you the side effects with none of the benefit.
If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
Patient reviews
