When you think of depression, what comes to mind? If you are like most people, you probably imagine someone who is sad all the time. However, depression can look very different depending on the individual. The symptoms might be subtle or look like another problem, and these differences can also depend on your age, gender, or culture. The problem with this is that many people don't recognize these issues as symptoms of depression, leading them to get help for the wrong issue. Or worse, not doing anything about it at all. Here I list some common, yet little-known symptoms of depression.
1. Irritability
For some, their predominant mood isn't sadness, it's irritability and anger. A depressed person might have very low tolerance to deal with the typical up's and down's that happen in life. They might feel frustrated and angry all of the time, without the self-regulation needed to avoid lashing out at others. Unfortunately, this can have a major impact on their ability to hold down a job and maintain good relationships with loved ones. Family and friends often find themselves confused at the seemingly aggressive behavior and distance themselves as a result. This leads to increased social isolation for the depressed person, which often makes their symptoms worse.
2. Changes in Movement
Fatigue and low energy is a common symptom of depression, but did you know that literally moving more slowly is a symptom too? Often the depressed person doesn't even realize that they are moving as slow as molasses compared to everyone else. In more rare and extreme cases of severe depression, the slow movement turns into not moving at all. This type of depression is known as "catatonic depression," and can result in very little movement and even an inability to eat or drink.
On the flip side, fast, agitated, and purposeless movements are also a hallmark of movement-related depressive symptoms. Think leg shaking, pacing, hand-wringing, and fidgeting in general.
3. Difficulty Sleeping
People with depression run the gamut of sleep problems—everything from difficulty getting to sleep (insomnia), sleeping too much (hypersomnia), and unrestful sleep. On one end, it is very common for depressed people to have difficulty getting to sleep at night, leading to spending hours in bed tossing and turning. This is often where anxiety seeps in to create more chaos, a common co-occurring condition with depression. On the other end of the spectrum, many depressed individuals over-sleep to excess. For example, getting 16 hours of sleep and still not feeling rested. Moreover, many depressed persons report problems with not feeling refreshed upon waking. This is because depression can have a very negative impact on a person's sleep cycles. Unfortunately, some people may began utilizing unhealthy coping mechanisms in an attempt to compensate. However, these methods, such as drinking alcohol, can hurt more in the long run. While a nightcap may help you feel sleepy, alcohol ultimately interferes with your ability to get restful sleep.
4. Disinterest
Think about your favorite things to do. Maybe it's curling up in bed with a good book. Or going to concerts. Or running, perhaps. Everyone has different things to do that they love to unwind or have fun. Now imagine if you suddenly didn't care about them any more. As if the effort of doing them was simply too much. You now feel apathetic about the things you once looked forward to doing. This phenomenon is a common issue for people with depression, called "loss of pleasure" or the more fancy term of anhedonia. For many, depression sucks away the joy in life by replacing it with apathy.
5. Impaired Thinking
This next one is tricky because difficulties with thinking occur with many other issues, such as anxiety or ADHD. But depression often has a significant impact on our thinking, leading to a slew of difficulties. This phenomenon is also sometimes referred to as "cognitive dysfunction." For instance, depression can make a person more forgetful or absent-minded. It can lead to difficulties with attention and concentration as well as interfere with the ability to make decisions. And just as depression can make you physically slow down and feel drained, it can also lead to slow, sluggish thinking. The more severe your depression, the more severe your cognitive dysfunction.
6. Weight Changes
Depression can cause two opposite orientations to eating—either eating very little or eating too much. Both of these changes in eating habits lead to unhealthy changes in weight. Similarly to the loss of pleasure and apathy towards activities, some depressed people experience a low appetite. This may lead to poor nutrition, causing greater difficulties with low energy, impaired thinking, and problems with mood. Others still struggle with gaining weight while depressed. When we feel bad, we tend to crave fatty or sugary foods that give us a temporary rush of feel-good endorphins. Unfortunately, many feel guilty or have a negative body image from eating a large amount of unhealthy foods, which further fuels the depressed mood and self-criticism.
7. Emptiness or Numbness
For many with more severe depression, difficulties with mood can go beyond just sadness. A severely depressed person may describe feeling empty or even numb. Often the feeling of emptiness stems from a web of other depression symptoms, such as apathy, fatigue, and hopelessness. Some people describe feeling numbed to emotions, both negative and positive. This response occurs from extreme amounts of emotional pain, just like our skin feels numb after being exposed to bitter cold.
8. Lowered Sex Drive
It is normal for libido to fluctuate over time, but lowered sex drive may also be a symptom of depression. Again, this seems to be related to the overall lack of interest and pleasure in activities. Frustratingly, many antidepressant medications commonly have lowered libido as a side effect. This side effect can have a major impact on any existing sexual relationships that the depressed person may have, and many don't assume that depression is the reason that a person is no longer interested in them sexually. The depressed person may also blame themselves, instead of recognizing the impact that their depression is having on their behavior.
9. Poor Hygiene
Self-neglect stems from the overall apathy that many depressed people experience. For some, these may be simple acts of self-care that fall by the wayside as the depression sits in. For those with more severe forms of depression, even basic acts of hygiene can be a struggle. For those intensely suffering from depression, not showering and having a noticeably bad smell or not brushing hair until it becomes matted is not unheard of. Many people suffering from this symptom are often very reluctant to admit this particular struggle due to the social stigma that goes along with it.
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I hope after reading this list you have a better sense of some of the lesser-known symptoms of depression. Please be aware that many of these symptoms can also be caused by other conditions. If you believe you may have depression, please seek an evaluation from a therapist, psychiatrist, or your primary care physician. If you are experiencing suicidal thoughts, please call the national hotline at 1-800-273-TALK or message the crisis text line at 741741. If you are thinking of killing yourself, please call 911 or have someone take you to the E.R. immediately.
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Dr. Amber Sylvan is a therapist in Ann Arbor who helps adults overcome the struggles of depression.