How to tell a bad week from something that needs help

The commonest reason people delay getting help is not stigma. It is uncertainty about whether what they are experiencing counts.

There is no bright line, but there are three questions clinicians use, and they are more useful than waiting to feel bad enough.

Duration

Low mood for a few days is part of ordinary life. The diagnostic threshold for depression is symptoms present most of the day, nearly every day, for at least two weeks. Generalised anxiety uses a longer window — six months of excessive worry more days than not.

Those thresholds exist because mood fluctuates, and the difference between a rough patch and a disorder is largely persistence. If you are two weeks in and it has not lifted, that is the signal, not the severity on any given day.

Function

The second criterion, and the one that carries the most weight in practice: is it interfering with work, relationships or daily life?

This is deliberately about behaviour rather than feeling, because behaviour is more visible and less subject to minimisation. Concretely: are you meeting deadlines, or missing them? Answering messages, or letting them stack up? Eating properly? Still doing the things you used to do for pleasure, or has that list quietly shortened to nothing?

People are consistently better at noticing what they have stopped doing than at rating how they feel.

Change from baseline

The third question is the one that catches what the first two miss: is this different from how you usually are?

Someone who has always been anxious and is now slightly more so is a different situation from someone who has never been anxious and suddenly cannot get on a train. And someone with a long-standing low baseline may be living with untreated persistent depressive disorder that never got flagged because it never acutely worsened.

This is also where the cyclical question sits. If low mood arrives reliably in the week before your period and lifts within a day or two of bleeding, that is a specific pattern with specific treatments — see PMS and PMDD are not the same thing. If it is present all month and worsens premenstrually, that is something else and needs continuous treatment. You cannot tell these apart from memory, which is the practical argument for tracking.

The things that mean sooner, not later

Some situations should not wait for a two-week threshold:

• Thoughts of suicide or self-harm, including passive thoughts like wishing you would not wake up
• Being unable to care for yourself or for people who depend on you
• New symptoms after childbirth — postpartum depression, anxiety and intrusive thoughts need early attention, and postpartum depression, anxiety and rage covers what to look for
• Escalating alcohol or drug use to cope
• Psychotic symptoms
• Rapid, marked deterioration

If any of these apply, contact a doctor or a crisis service now rather than reading further.

Check the physical causes too

A meaningful proportion of what presents as depression or anxiety has a contributing physical cause that is straightforward to test for.

Thyroid dysfunction. Iron deficiency, which frequently sits below the threshold labs flag as abnormal — low ferritin and low mood. Vitamin B12 and vitamin D deficiency. Sleep apnoea, under-diagnosed in women. Perimenopause, where mood changes are common and often mistaken for a primary depressive episode — perimenopause can start in your late thirties.

Asking for a basic panel is reasonable and cheap. It does not replace mental health treatment; it removes a confound.

What happens if you go

A first appointment is usually a conversation and a questionnaire — commonly the PHQ-9 for depression and GAD-7 for anxiety. Neither is a diagnosis; both are structured ways of describing severity.

The likely outcomes are talking therapy, medication, or both, plus follow-up. You are not committing to anything by attending, and you can decline any specific treatment.

Two things worth knowing. Therapy waiting lists are often long, so asking to be added early matters even if you are unsure. And if the first clinician does not take you seriously, that is a reason to see someone else rather than to conclude you were wrong — how to prepare for a ten-minute appointment covers making the case efficiently.

The record makes the case for you

Depression and anxiety both distort recall — when you are low, the past looks uniformly low; when you recover, the severity fades. Both directions make it hard to answer the question a clinician will ask, which is "how long has this been going on and what has it stopped you doing?"

A simple daily record of mood, sleep and whether you did the things you meant to do answers that precisely. It also shows the shape — steadily worsening, fluctuating with your cycle, or triggered by something specific — and that shape often points at the treatment.

Naked is designed to hold that record without it becoming another task you fail at: a few seconds a day, logged against your cycle, sleep and life, so that when you do decide to ask for help you can show three months of evidence instead of trying to remember a fortnight.