The Hidden Side of Depression

The most common symptoms of depression – and the ones that most people and health care providers immediately recognize include:

• Persistent sadness or anxious mood
• Feelings of hopelessness, irritability, or frustration
• Feelings of guilt, worthlessness or helplessness
• Loss of interest or pleasure in hobbies and activities
• Difficulty concentrating or making decisions
• Difficulty sleeping
• Decreased energy or feeling fatigued
• Loss of appetite and weight changes

If you or a loved one have experienced any of those symptoms for two weeks or more, it’s important to talk to your doctor immediately to get a proper diagnosis and begin treatment.

Typical vs. Atypical Depression

Sometimes, depression presents differently, with symptoms that stray from the traditional criteria. Typically, when a depressed person exhibits symptoms from above, they tend to be constant. With atypical depression, however, your mood often temporarily improves based on events or circumstances, such as a fun event or weekend away. Many people look at this temporary improvement as “getting back to my old self” – and believe it means depression isn’t a concern. But in reality, it’s still depression that just presents in an “atypical” fashion, and the low mood and other symptoms will soon reappear. Other common atypical depression symptoms include increased appetite and sleeping too much (vs. loss of appetite and insomnia typically seen in typical depression.) It is estimated that between 15 and 36% of people with depression have atypical symptoms, which can also include a heavy feeling in arms or legs and an increased sensitivity to criticism or rejections, which can lead to serious social and professional problems.

Atypical depression is still depression, and usually responds to the same treatment options generally recommended for any depression, including lifestyle modifications, therapy, and medication when appropriate. Understanding the differences in the way symptoms present and not dismissing them is the key to getting a diagnosis and effective treatment plan.

Another less common presentation of depression is often called “smiling” depression. Smiling depression isn’t a different kind of depression – it just means that the person suffering might look and act happy and even continue to function normally. This makes it harder for family and friends to realize that the sufferer may need help. In fact, you may be seriously depressed, but keep up a good appearance and continue to function as normal, while feeling ashamed, anxious, or even like a fraud on the inside. This depression is often invisible because others don’t know you are depressed, and you may not even realize it yourself. In fact, it’s not uncommon to keep up the false front even with a therapist, so it can be more difficult to get the help needed to recover. Being honest and open with your loved ones, doctor, and therapist is the first and most important step. This is especially critical as the National Alliance on Mental Illness (NAMI) says that suicide is a particular risk for those suffering from smiling depression.

Other Less Common Symptoms of Depression

Even when depression is recognized or suspected, there are usually physical or behavioral symptoms that will start to show through. Depression looks different for everyone, but other signs could include:

• Substance abuse. Drinking more frequently or in excess, or using drugs is a frequent way people (particularly men) self-medicate their undiagnosed depression.
• Perfectionism. Perfectionism and depression have long been linked and believing that you must be perfect to be accepted or love is a clear sign. Irritability, anger and impatience. Frequent outbursts, lashing out, or other angry reactions stem from rejection, hopelessness and fear often felt by those with depression.
• Inability to concentrate. A frequent inability to focus on work or concentrate on the task in front of you can quickly impact your productivity and lead to work setbacks or difficulties. This symptom is often mistaken for other things (including ADHD) but is often the catalyst for seeking help.
• Pessimism. You don’t necessarily need to be a “glass half full” kind of person, but if you have moved from being a realist to only seeing the negative side of things, it may be a sign of depression. In fact, studies have shown that depressed individuals are even more likely to notice people who are frowning rather than those who are smiling.
• Physical pain. Serotonin and norepinephrine are chemicals that affect our mood and how we feel pain, which is why depression can often manifest as vague aches and pains – or simply “not feeling good”.

During the pandemic, depression rates soared to unprecedented levels. And now, as we all navigate our various paths in an increasingly stressful and complex world, it’s clear that depression will continue to be a huge issue. The reality is that depression will impact virtually all of us – whether we suffer from it individually or are supporting someone else who does. Recognizing the symptoms and getting appropriate help has never been more important. If you think that you or a loved one might be depressed, contact your doctor immediately. For help in finding a doctor, click here. If you have thoughts of suicide, call 911 immediately.

This article first appeared in the October 2023 edition of the HealthPerks newsletter.