By Diana Ghelber, MD · October 23, 2026
Understanding what you want to change and having the energy to change it are not always the same.
You may leave a therapy session with a clearer understanding of yourself and still find that, once you get home, even a small next step feels difficult.
You know that connection matters, but answering a message feels exhausting. You want to return to an activity you once enjoyed, but the interest is missing. You understand a pattern and still struggle to interrupt it.
That gap deserves attention, rather than another reason to criticize yourself.
Depression can affect the ability to participate
Depression can interfere with energy, concentration, sleep, motivation, and the ability to experience pleasure. These are also capacities we draw on when reflecting, practicing a new skill, or making a change.
Understanding something intellectually does not automatically make it possible to act on it when symptoms are severe.
A reason to reassess
Feeling stuck does not automatically mean that therapy is wrong for you, or that you need a procedure. It is a reason to talk openly with your therapist and, when appropriate, seek a psychiatric evaluation.
We look at the whole picture: symptoms, sleep, medical conditions, medications, previous treatments, and what has become difficult in everyday life.
Depending on that evaluation, treatment may involve medication management or consideration of an interventional treatment such as Deep TMS or IV ketamine. IV ketamine for depression is used off-label. Each option has benefits, limitations, and risks.
Making room for the work you are already doing
The aim is to help you become more able to use what you are learning. Improvement may show up in an ordinary moment: responding to someone, completing a task, or feeling present enough to try again.
If you already work with a therapist, we can coordinate care with your permission. Our psychiatric care can support that ongoing relationship.
You can tell your clinician both things: “I understand what I need to do” and “I am having trouble doing it.” Both belong in the conversation.
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