Depression is more than feeling sad
Most people picture depression as crying, or as someone who cannot get out of bed. That happens. But many adults with depression are still going to work, answering email and making dinner, and what they notice first is something else: a short temper, a flat feeling, a body that aches, or a sense that everything takes three times the effort it used to.
The National Institute of Mental Health (NIMH) describes depression as more than the ordinary low feelings that pass. It can cause symptoms that affect how a person feels, thinks and handles daily activities such as sleeping, eating or working. NIMH also notes that not everyone has every symptom. Some people have only a few, others many.
How it can show up in mood
NIMH's list of common signs includes a persistent sad, anxious or "empty" mood, feelings of hopelessness or pessimism, and feelings of guilt, worthlessness or helplessness. It also lists irritability, frustration and restlessness, which many people do not connect with depression at all.
The NHS adds a few that people describe in their own words: feeling tearful, feeling irritable and intolerant of others, having no motivation, and not getting any enjoyment out of life. That last one, a loss of interest or pleasure, is central enough that a diagnosis requires either it or a depressed mood. Anhedonia: When Nothing Feels Enjoyable Anymore looks at it in more detail.
How it can show up in the body
Depression is not only in the mind. NIMH lists fatigue, lack of energy or feeling slowed down; trouble sleeping, waking too early or oversleeping; changes in appetite or unplanned weight changes; and aches, headaches, cramps or digestive problems without a clear physical cause that do not ease with treatment.
The NHS also mentions moving or speaking more slowly than usual and a lower sex drive. Some people first bring these changes to a primary care doctor without realizing they could be linked to mood. That is a reasonable place to start, as long as mood is part of the conversation.
How it can show up in thinking
Difficulty concentrating, remembering or making decisions is on NIMH's list. In daily life that can look like rereading the same paragraph, missing details at work, or standing in front of an open refrigerator unable to choose anything. Thoughts may also turn harsh and repetitive: replaying mistakes, assuming the worst about the future, or feeling like a burden.
Thoughts of death or suicide are also a symptom of depression. They are a reason to reach out now rather than wait. The crisis numbers at the end of this page are available at any hour.
How it can show up in behavior
Sometimes the clearest signs are changes other people can see. NIMH notes that depression can involve:
- Increased anger or irritability, or feeling restless and on edge
- Becoming withdrawn, negative or detached, and isolating from family and friends
- More high-risk activities or greater impulsivity
- Increased use of alcohol or drugs
- Not meeting responsibilities, or ignoring other important roles
- Problems with sexual desire and performance
The NHS describes the social side in similar terms: avoiding friends, taking part in fewer social activities, neglecting hobbies, and having difficulties at home, at work or in the family. A canceled lunch here and an unanswered text there can add up quietly over a few months.
It can look different at different ages
NIMH describes how depression can shift across adulthood. Young adults are more likely to be irritable, to complain of weight gain and sleeping too much, and to have a negative view of life and the future. Middle-aged adults may have more depressive episodes, lower libido, insomnia in the middle of the night or early-morning waking, and stomach problems. Older adults often feel sadness or grief, but some report a lack of emotions rather than a depressed mood.
NIMH also notes that men, and women too, may seem angry or irritable rather than sad, and that men are more likely to use alcohol or drugs to cope. How Depression Can Look Different in Men covers that pattern.
Why it is easy to miss in yourself
The NHS points out that depression often comes on gradually, so it can be hard to notice that something is wrong. Many people try to cope without realizing they are unwell, and sometimes a friend or family member is the one who says something. If someone close to you has commented that you seem different, it is worth taking seriously, even if you feel you are just tired or busy.
This is not a checklist to score yourself against. A clinician looks at how long changes have lasted, how much they interfere with your life, and what else might explain them. NIMH notes that people with only a few symptoms may still benefit from treatment.
Rule out medical causes
NIMH notes that certain medications and medical conditions, such as viruses or thyroid disorders, can cause the same symptoms as depression, and that a provider can rule these out with a physical exam, an interview and lab tests. The American Psychiatric Association also lists hormonal imbalances, vitamin deficiencies, neurological problems and drug or alcohol use among conditions that can mimic depression. A checkup is a sensible step, especially if the change came on with new physical symptoms.
What to bring to an appointment
NIMH suggests that a provider may ask when symptoms began, how long they have lasted, how often they occur and whether they keep you from your usual activities, and that taking notes beforehand may help. A few lines on your phone are enough:
- Roughly when you started feeling different, and anything that was happening at the time
- Changes in sleep, appetite, weight, energy and concentration
- Things you have stopped doing, or that now feel like a chore
- Alcohol, cannabis or other substances, and any new medications
- Any thoughts of death or not wanting to be here, even fleeting ones
- Family history of depression or other mood conditions, if you know it
A clinician may also use a standard questionnaire such as the PHQ-9 as part of an evaluation. Cleveland Clinic notes that no lab test or scan diagnoses depression, so questionnaires and conversation do much of the work.
Depression is treatable, usually with psychotherapy, medication or both, according to NIMH. Dr. Lehmann offers depression therapy for adults in person in Franklin or by telehealth for clients in Michigan. She does not prescribe; medication questions go to a physician, psychiatrist or psychiatric nurse practitioner.