In my office, I so often hear the following statements:

“I know I should feel good, but I just don’t.”
“I feel so overwhelmed and I can’t get anything done.”
“I know I should do…..but I just don’t have the energy or motivation.”
“She just doesn’t seem herself. She doesn’t even want to be with her friends.”

Each time, I am reminded that depression is often undiagnosed or unrecognized because symptoms can be more subtle in their manifestations and ignored or disguised. So often one associates depression with the disheveled, tearful individual who can’t get out of bed. However, depression does not always present with such obvious symptoms.

The following is a list of DSM V criteria for depression.

  • Depressed mood (such as feelings of sadness or emptiness).
  • Reduced interest in activities that used to be enjoyed.
  • Change in appetite or weight increase/decrease.
  • Sleep disturbances (either not being able to sleep well or sleeping too much).
  • Feeling agitated or slowed down.
  • Fatigue or loss of energy.
  • Feeling worthless or excessive guilt.
  • Difficulty thinking, concentrating or troubles making decisions.
  • Suicidal thoughts or intentions

Yet, as Joel L. Young, M.D  indicates, it is important to note that clinicians recognize additional symptoms that include:

Dramatic, ongoing trouble in relationships. Those struggling with depression may seek an external source to blame, and that source is often their spouse or their children. Some people with depression have affairs or file for divorce, even if their relationships are solid and healthy, because they have to find something to blame other than depression for their struggles.

Anger. Men are particularly susceptible to anger during bouts of depression, but both men and women may experience rage. This kind of anger isn’t the kind we all experience when we’re annoyed, though. Depression can lead to serious, sudden, and pronounced anger. This anger may be externalized and directed at a loved one, or it could be turned inward.

Sleeping all the time or very little. You’ve probably heard that depression interferes with sleep, but you may not know how much. People struggling with depression may be so beaten down that they sleep for two or three days straight without ever getting a burst of energy. Others may be so anxious that they can’t sleep for weeks. Many people with depression struggle with disturbed sleep and terrible nightmares.

Difficulty with work. Depression causes self-loathing, guilt, insecurity, and chronic sadness. These emotions can make even the simplest task feel overwhelming. Some people with depression may just stop showing up for work entirely, get fired from their jobs because of bad performance, or stop looking for a job while out of work.

Distorted thinking. People with depression have a strong negativity bias. This can distort their thinking and lead to cognitive challenges.  Negative thinking isn’t just an emotional challenge; it’s something that touches everything you do, and it has the potential to undermine both the confidence and competence of those struggling with depression.

The cause of depression can vary from a hereditary chemical imbalance to significant environmental stressors or a combination of the two.

The treatment can also vary, but on the most fundamental level, the goal is to address coping mechanisms to improve one’s quality of life.

The prognosis is good when an individual incorporates an interdisciplinary team (which may include health care professionals, therapists, psychiatrists, dietitians) to support the healing process and to ensure long-term success.

Staci J. Connolly, LCSW

Depression: An Underestimated Illness. Understanding the impact and prevalence.
Published on June 9, 2014 by Joel L. Young, M.D. in When Your Adult Child Breaks Your Heart