Signs of depression people often miss
Depression does not always look like sadness. It can show up as irritability, physical aches with no clear cause, sleeping or eating more or less than usual, trouble concentrating, or losing interest in things you used to enjoy. When several of these last most of the day, nearly every day, for two weeks or more, talk with a provider.
Key points
Depression symptoms vary and do not always appear as sadness.
Irritability, aches and pains, and sleep or appetite changes are listed signs.
Signs can look different in children, teens, adults and older adults.
Men may seem angry or irritable instead of sad.
Symptoms that persist are a reason to talk with a health care provider.
What are the less obvious signs of depression?
MedlinePlus puts it plainly: depression does not look the same on everyone, and the symptoms do not always appear like sadness. That is one reason it gets missed, both by the person living with it and by the people around them.
The National Institute of Mental Health (NIMH) lists a persistent sad, anxious or empty mood among the common signs. The same list includes many symptoms that people tend to blame on a busy season, a bad mattress or getting older:
Feelings of irritability, frustration or restlessness
Loss of interest or pleasure in hobbies and activities
Fatigue, lack of energy, or feeling slowed down
Difficulty concentrating, remembering or making decisions
Difficulty sleeping, waking too early in the morning, or oversleeping
Changes in appetite or unplanned weight changes
Physical aches or pains, headaches, cramps or digestive problems without a clear physical cause that do not go away with treatment
Feelings of guilt, worthlessness or helplessness
What behavior changes can be signs of depression?
Depression can also change how a person acts. NIMH notes that it can involve changes in mood or behavior such as these. Family members and friends are often the first to notice them.
Increased anger or irritability
Becoming withdrawn, negative or detached
Isolating from family and friends
Increased use of alcohol or drugs
Greater impulsivity or more high-risk activities
Not being able to meet responsibilities, or ignoring other important roles
Problems with sexual desire and performance
How long do symptoms last before it may be depression?
Everyone has low days. According to NIMH, a diagnosis of depression requires symptoms most of the day, nearly every day, for at least 2 weeks, and one of the symptoms must be a depressed mood or a loss of interest or pleasure in most activities. Not everyone has every symptom. Some people have only a few, and NIMH notes that people with only a few symptoms may still benefit from treatment.
A list like this cannot tell you whether you have depression. Certain medications and medical conditions, such as thyroid disorders, can cause the same symptoms, and a provider can rule those out. What the list can do is help you describe what you have noticed.
If you or someone you know is in crisis or having thoughts of suicide, call or text 988 (Suicide & Crisis Lifeline) or call 911. Our office does not provide emergency services. More options are on our crisis resources page.
Does depression look different in men and women?
It can. NIMH explains that men, as well as women, may show symptoms other than sadness and may seem angry or irritable instead. Men may also be less likely to recognize, talk about and seek help for their negative feelings, which puts them at greater risk of depression going undiagnosed and undertreated.
Women are diagnosed with depression more often than men. NIMH also describes types of depression tied to specific stages of a woman's life, when physical and hormonal changes can bring on a depressive episode in some women. These include premenstrual dysphoric disorder, perinatal depression during pregnancy or after childbirth, and perimenopausal depression during the transition to menopause.
How do signs of depression differ by age?
NIMH describes how depression can affect people differently depending on their age.
Children. May be anxious or cranky, pretend to be sick, refuse to go to school, cling to a parent, or worry that a parent may die. Children and adolescents may be irritable rather than sad.
Older children and teens. May get into trouble at school, sulk, be easily frustrated, feel restless, or have low self-esteem. They are also more likely to sleep excessively and have an increased appetite. An NIMH fact sheet for teens adds dropping grades and withdrawing from friends and family.
Young adults. Are more likely to be irritable, to complain of weight gain and excessive sleepiness, and to have a negative view of life and the future.
Middle-aged adults. May have decreased libido, middle-of-the-night insomnia or early morning waking. They often report stomach problems, such as diarrhea or constipation.
Older adults. Often feel sadness, grief or other less obvious symptoms, and may report a lack of emotions rather than a depressed mood. They are also more likely to have other medical conditions or pain that can cause or contribute to depression.
What should you do if you notice these signs?
NIMH advises talking to a health care provider if signs or symptoms of depression persist or do not go away. It can help to jot down when the symptoms began, how often they occur, and whether they keep you from your usual activities. If you see the signs in someone you care about, encourage them to seek help from a mental health professional.
Depression is treatable. NIMH describes treatment as typically involving psychotherapy, medication, or both. Our article on therapy and medication together lists questions to bring to those conversations. If your mood seems to follow the calendar or a big life change, see seasonal and life transition low mood.
How Balanced Life can help
Balanced Life Counseling Services provides depression counseling and individual counseling for adults, along with teen counseling, at our Salisbury and Bethesda offices and by telehealth.
You do not have to be sure it is depression to call. In a first session, your therapist invites you to share what has been going on and any goals you have. Start on our new patients page or call 443-978-8688.
Frequently asked questions
Can depression cause physical pain?
Physical symptoms are on the list. NIMH includes physical aches or pains, headaches, cramps or digestive problems without a clear physical cause that do not go away with treatment among the common signs of depression. Because pain has many possible causes, bring it up with a health care provider, who can check for other explanations.
Is irritability a sign of depression?
It can be. NIMH lists feelings of irritability, frustration or restlessness among common symptoms, and increased anger or irritability among possible behavior changes. Irritability can stand out more than sadness in children and adolescents, and men may seem angry or irritable instead of sad. On its own, irritability does not mean a person has depression.
Can you have depression without feeling sad?
Some people do not describe sadness. For a diagnosis, NIMH says one symptom must be either a depressed mood or a loss of interest or pleasure in most activities. Older adults may report a lack of emotions, and others notice mostly fatigue, sleep changes or irritability. A provider can help sort out what the symptoms mean.
How do I bring up depression with someone I am worried about?
Pick a calm, private moment and describe what you have noticed without labeling it, such as changes in sleep, energy or interest. NIMH suggests encouraging the person to seek help from a mental health professional. If they mention thoughts of suicide, call or text 988 with them, or call 911 in an emergency.
Sources
If you are in crisis or thinking about suicide, call or text 988 (Suicide and Crisis Lifeline). In an emergency, call 911.