People frequently overlook depression in others, as we think about the big dramatic stuff that can be very obvious.
People come in crying, they say morbid awful things, they can’t get themselves out of bed. Depression can be like that, but sometimes it’s just that someone goes to work, gets through the day and then has nothing left.
He stops preparing meals. She no longer calls her friends. The gym card goes on, but they don’t turn up. Life shrinks a little at a time.
That change can be easily attributed to the stresses of the moment or to laziness or just one of those phases. What is different about depression is that the pattern persists and it starts interfering with your usual life.
Losing interest can be more telling than sadness
A person doesn’t have to feel sad to be depressed.
Sometimes the biggest sign is that nothing feels rewarding. Music is noise, sex feels like a chore, a meal is just something you have to eat. Even good news barely raises your spirits.
Doctors call this loss of pleasure anhedonia. It might look to your friends like a series of small refusals to engage: not tonight, maybe next week, I’m too tired.
Until eventually you don’t get invited along, because the person has lost touch with the idea that they even want to care anymore. They may still care, but they can’t feel that care in response to normal things, which can be really scary, especially if affection for a partner or children seems dulled. It doesn’t necessarily mean the love has gone.
Sleep, appetite and energy often change
Depression can keep you awake for ages, but it can also make you sleep for ages. It can stop you sleeping at all during the week but you sleep until eight in the morning on Saturdays and Sundays.
It can wake you up at four in the morning worrying about the next day. It can make you sleep for ten hours and then you’re washed up, have a huge breakfast and want to go back to sleep.
The drive to eat can change too; disappear along with your weight or bulge out. For some of us, food is the only comfort left, so they gain weight. Then there is the exhaustion.
It’s not always the lack of sleep, because sometimes you need more sleep. It’s that you feel absolutely leaden, and every menial task takes an extraordinary effort. You can’t wash your hair without postponing it for a couple of days and a trip to the shops is an adventure.
Depression can manifest as headaches, stomach upsets, backaches, but it tends to have aches that keep coming back that you can’t quite shake off.
The mind slows down
You can’t read any more, because you’ve finished a paragraph and you’ve not taken any of it in. You open emails, close them, open them again, can’t type out three sentences, because your mind is in a mangle. Decisions begin to feel extraordinarily tiring. What shall I eat? Should I answer this call? What’s more important. Your thoughts are all muddled up. Every choice you make is more work than it’s ever been. Sometimes the issue isn’t your memory, it’s that you can’t concentrate properly, so the information has never stuck in the first place.
Work starts to suffer. You begin to make mistakes. Deadlines pass. You start to describe yourself as useless, because depression is very good at convincing you that one of your symptoms is your personality. It all seems very unfair.
It can also be anger
Not everyone is silent and withdrawn.
Some people become short-tempered, aggressive, permanently irritated. Often men find it easier to admit they’re stressed, angry, burnt out, rather than depressed. They start drinking more. They start working too much. They risk their health, but depression can be a risk factor for engaging in dangerous behaviors.
In teenagers, depression can appear as anger, bad grades, loss of interest in seeing family. In older people, it might come out as tiredness, sleeping badly, concerns about memory, not as low mood.
None of these things are signs of depression by themselves. What is important is how these things are changed from the person’s usual life and how long they persist.
When does a bad period become depression?
A diagnosis of major depression usually requires you to have several of the symptoms that come with it, for most of the day, almost every day, for at least two weeks. One of the symptoms is being in a depressed mood or having lost interest and pleasure in things.
Symptoms tend to include changes in sleep patterns and appetite, loss of energy, poor concentration, slowed movements or restlessness, feelings of worthlessness, and thoughts of death or suicide.
Two weeks is a diagnostic tool, not an instruction manual.
If someone is having thoughts of suicide, can’t eat or drink, hears voices, or can’t care for themselves, they need help now. If there is an immediate danger, contact your local emergency services or your local crisis support hotline and stay with the person if you can.
It’s perfectly fine to ask them directly, Are you thinking about killing yourself? It won’t put suicidal ideas into their head, it gives them the opportunity to give a straightforward answer.
Other health problems can mimic similar things, like thyroid problems, anaemia, sleeping disorders, chronic pain, and medication side-effects, can leave you tired, unable to concentrate, with low mood.
Alcohol can be a blurring influence. It may help depression in the short term, but it can make you sleep badly and depression worse in the long term.
Bipolar disorder is another thing to consider, because someone who comes in with depression may forget to mention the times that they couldn’t sleep, thought very quickly, spent too much money, or felt invincible before. This can be critical to determining the safest treatment.
A medical appointment is not just about getting an antidepressant; it is about figuring out what else is going on.
Sometimes talking therapy is a really good option, especially for milder depression or depression that is really tied to losing something or a relationship. Medication is usually something we consider for moderate, severe depression or persistent depression. A lot of the time people use both medication and conversation.
Our guide to whether antidepressants may be appropriate for you, talks about what getting onto antidepressants involves. Different antidepressants have different benefits and side effects, and it might take some time to find the right one.
Depression rarely announces itself, more often it’s that someone has realised they’ve been living like this for several weeks. That is a good enough reason to speak to someone.
