Changes in mood, energy, and motivation are more likely to signal depression than sadness.
Many people associate depression with a prevailing sense of sadness or despondency, but those actually aren’t always present, according to Scott Dehorty, LCSW-C, a social worker at Delphi Behavioral Health. In fact, anxiety and fatigue are much more common symptoms, he says.
“Depression is a poor term for this illness, because people do correlate that with feeling sad,” he says. “But feeling really down isn’t all that common for someone with depression.”
Here are some of the hallmarks mental health professionals evaluate when trying to determine if their patients and clients are struggling with depression:
Absence of Joy or Pleasure
For many individuals who face depression, there’s often a lack of emotion altogether, Dehorty says. They may feel “blah” about life, with a distinct absence of joy, especially for activities that used to make their hearts sing. For example, someone who used to love working out or playing music may feel like those pursuits aren’t worth doing anymore because they don’t bring the same level of pleasure as they once did.
“The difficulty with feeling a lack of joy is that it can also bring on anxiety,” says Dehorty. About 80 percent of people with depression report high levels of anxiety, and it can be particularly prevalent in people dealing with chronic illness, he believes. Someone may be so focused on a larger health condition that he or she “pushes away” anxiety and mood changes, which can worsen depression, because then it goes untreated.
Fatigue and Pain
Another possible sign of depression is what mental health professionals call “vital sense change.” This means people might actually feel sensations differently in their body than they did in the past, Dehorty says. Aches and pains may bother them more, there could be significantly more fatigue, and they tend to feel generally uncomfortable in their bodies.
Pain and fatigue become magnified when depression causes a cascade of brain chemical changes that block release of feel-good hormones including dopamine and serotonin, , notes Dehorty. That can affect rest levels and stress management, making depression feel more acute if there’s lack of good sleep and lower resilience.
Lower Level of Self-Care
Because depression can negatively affect motivation, self-care tends to be affected, according to Jennifer Gentile, PsyD., who treats patients virtually using the telehealth app LiveHealth Online.
This might mean someone lets personal hygiene lapse, bows out of social events that they once would have been excited to attend, and doesn’t feel interested in maintaining health through nutritious foods and exercise.
When this happens, the lack of self-care can become more acute if the person struggling with depression feels bad about what they’re doing.
“They may feel guilty, hopeless, helpless, or that the symptoms are their own fault,” says Gentile.
When to Get Help
Any change in mood, behavior, sleep, or appetite that persists for more than two weeks should be considered a warning sign that warrants further investigation, says Gentile. Any primary care doctor or mental health clinician can do a formal assessment for depression.
Dehorty adds that depression tends to be cyclical for many people — rather than persistent symptoms, the signs tend to ebb and flow on their own. That can make it even more challenging to handle, because someone might feel the depression has lifted, only to feel it creep back again days or weeks later.
The good news is that depression is highly treatable, Dehorty says. There are behavioral therapies and medications, and many people with depression combine those to find relief, he notes.
Sometimes, taking a first step toward getting help is prompted by a gentle, kind expression of concern from a friend or family member.
“Provide examples of how they seem uninterested in doing things they used to enjoy,” Gentile suggests, adding that it’s possible to lower the stigma attached to depression by equating the need for intervention to a diabetic needing insulin.
“This can be a scary, serious illness,” Dehorty says. “But we know a great deal about how to address it and treat it. No one should feel hopeless; there is help available.”
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