6 Unexpected Signs of Depression

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What is MDD?

Major Depressive Disorder (MDD) is a mood disorder that impacts millions of Americans every year. According to the Substance Abuse and Mental Health Services Administration¹:

• 21 million adults in the U.S. had at least one major depressive episode over the past year. (8.4% of all adults). Of those, 66% received treatment.
• 4 million adolescents aged 12 to 17 had at least one major depressive episode over the past year (17% of all teens). Of those, 41.6% received treatment.

Among people diagnosed with ADHD, however, rates of MDD are far higher. It’s estimated that half of people with ADHD will experience a depressive episode in their lives. Because symptoms of ADHD and depression often overlap, one or the other condition commonly goes undiagnosed. For this reason, it’s critical to debunk myths and clear up misconceptions about what depression looks like. To that end, here are six unexpected and/or misunderstood signs of depression.

1. People with depression aren’t always sad.

The word “depressed” is often used casually to refer to a state of being sad, blue, or down in the dumps. In reality, only about 60% of people with depression actually report any sadness. You don’t have to be sad to be depressed.

Most people with depression report a marked inability to experience pleasure from things that used to be pleasurable. Life just feels empty and unfulfilling. Nothing is engaging. This leads to a tremendous amount of futility. When faced with the prospect of doing something that might make them feel better, people with depression feel like: “Why bother? Nothing’s going to feel good.” They think only of negative outcomes, which is a serious obstacle to beginning treatment.

[Read: Depression – When It’s More Than a Symptom of ADHD]

2. Depression moves slowly and sticks around.

All of us have good days and bad days for no particular reason. In some cases, our “mood thermostat,” which typically allows only a fairly narrow range, breaks down and our mood just keeps going up, with increased energy, decreased need for sleep, and wonderful feelings. This is called mania. When the bottom end of the thermostat gives way, we have no energy, we become negative, and we can’t experience pleasure. We call this depression. The change in mood usually happens slowly and imperceptibly over weeks to months and then stays for years-long episodes. If one of these down episodes hits suddenly and lasts less than two weeks, it is probably not depression.

3. The most common emotional symptom of depression is irritability.

Only 60% of people with depression report sadness, but 95% of them report feeling exceedingly, but uncharacteristically, irritable. Little things get under their skin and they have explosive outbursts. This is especially true for children under the age of 12. These children present with a lot of irritability, and tend to experience what’s called “affective storms.” When they explode, it goes on for hours sometimes. Often, you’ll find that everybody in the family walks on eggshells, for fear of setting off the child. Irritability is also a common symptom of ADHD, which helps to explain how and why sadness may be masked by irritability that isolates the individual and pushes away people who might be helpful.

4. If you’re feeling bad because of a bad situation, it’s “reactive depression.”

In MDD, the depressed mood has no trigger and isn’t related to a situation. People will search for some cause, but usually there’s no event, scenario, or relationship that would cause the depth of impairment seen with depression. This is very different from “reactive depression” or “situational depression,” wherein someone feels bad because bad things are happening in their life.

Feeling down because you’ve had a setback or loss is sadness, and it is normal. Reactive depressions don’t respond to medication, but they do respond to steps taken to improve the situation. Counseling can help to make that process go faster.

[Read: Is it ADHD, Depression, or Both?]

5. Depression in teens often looks completely different.

Most people with MDD experience their first depressive episode in late high school or early college, between the age of 16 and 19. That said, depressive episodes in children and adolescents don’t look like depressive episodes in adults. Whereas most people stop eating, teens will eat everything in sight. Where most people sleep more, an adolescent will sleep less. Where most people lose an interest in sex, adolescents will become hypersexual. It’s critical to understand the difference in the way MDD manifests in teens, so as not to miss an important diagnosis.

6. There is no such thing as a “minor” depression.

The term Major Depressive Disorder was coined in the 1970s, with the idea that we might find minor depression, but we never have. What we have found, instead, is that every depression is a major one. The World Health Organization ranks depression as the single largest contributor to global disability.² Half of all depressive cases are rated both by the patient and by the clinician as being severe to extreme. MDD affects every aspect of a person’s life and makes it seem as though life is not worth living. It’s a serious problem that needs to be addressed.

Thankfully, it is highly treatable. About 70% of people get a good response to practically any antidepressant out there, and for the 30% who don’t, the solution is to try another class of medication. Adding in cognitive therapy to the treatment is important, too, as we know that a combination of medication and therapy is the most effective course of action, by far.

Signs of Depression: Next Steps

• Read: What Is a Mood Disorder? Recognizing and Treating Depression
• Self-Test: Depression in Adults
• Read: The ADHD – Depression Link: Symptom Parallels and Distinctions
• Read: Treatment for Depression and ADHD – Treating Comorbid Mood Disorders Safely]

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