Can you be depressed and not know it? A look into the subtlety of depression

Do Some People Not Realize They Are Depressed? Can You Not Be Aware of Depression?

Some people don’t realize they’re depressed, as it can come on slowly and sometimes with no identifiable reason. There are a multitude of reasons why someone doesn’t realize they’re depressed, unique to each individual. However, here are some common factors that could be making your depression hard to identify.

1. Co-occurring conditions: One of the things that makes depression easy to miss is if you have a co-occurring condition. There are many conditions that frequently happen alongside depression, or even cause your depression to be confused for something else. If you’re told you have conditions like an anxiety disorder or ADHD, you likely wouldn’t assume that you’re also depressed, since they share many of their symptoms.
2. Stress: Another common reason for overlooking depression symptoms is everyday stress. “Pushing through” in order to reach our goals can cause us to ignore stress or sadness in favor of being “strong” or “tough.” However, pushing down or ignoring stress can lead to depression. Not everyone knows how to destress and unwind when they’re overworked, causing people to continue to bear their stress and ignore the warning signs of depression in order to keep functioning as they are.
3. Stigma: This can cause people to feel uncomfortable acknowledging their depression, or even refuse to acknowledge their depression. They might not seek help or may try to push it out of their mind due to fear of backlash or judgment. Sometimes, this avoidance can happen unconsciously, as stigma often can be felt inwardly as well as from others. 
4. Gradual progression of symptoms: As stated above, depression and its symptoms can come on quite gradually. Sometimes, it’s so slow that you don’t notice the small changes in your daily mood until the symptoms become more intense, even unbearable.

Logically, it might seem like being depressed for the first time might make the symptoms more noticeable, but in fact, it can be easier to pinpoint red flag behaviors if you know what you’re looking for. Since depression symptoms can vary and develop very slowly, it might not be clear that these new behaviors are signs of a larger problem. 

It might start with negative self-talk, or evolve into a lack of joy and loss of motivation. Especially if work, school, or life expectations are high and you have never been diagnosed with depression, symptoms like pessimism, negativity, or exhaustion might not seem that out of the ordinary. They might even convince you that what you’re feeling is valid and deserved.

However you’re feeling, it’s not your fault. Depression is pervasive and can be subtle, with symptoms that compile on themselves and make it hard to seek help.

This is why it’s so important to check in with yourself. It can be easy to not register how you’re feeling, especially if you’re someone who shies away from feelings like anger, frustration, or sadness. When everything feels like it’s falling apart, when even small things feel like too much, it can be hard to do anything beyond function, to see or feel anything beyond what’s right in front of us. 

Be mindful of your self-talk, and try to notice any patterns that come up with your depressive behaviors. This can help you gauge how you’re feeling and make depression easier to spot if it troubles you again in the future.

Is Consistent Sadness a Sign of Depression?

Many people see depression as intense sadness or dejection, but in reality, sadness is not a required feeling in order to be depressed. In fact, the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, also known as the DSM-5, only requires diminished interest or pleasure or feelings of sadness in order to consider someone depressed. To you, it might feel more like loneliness, or simply a lack of joy and pleasure.

People can feel persistent sadness due to loss or changes in circumstance and not necessarily be depressed. However, if feelings of sadness or low mood are persistent, or they make it hard for you to enjoy or participate in your daily life, talk to a mental health professional about what you’re feeling. Even if they don’t give you a diagnosis, they can give you helpful tools to boost your mood and process your emotions.

What Is Undiagnosed Depression?

Undiagnosed depression is depression that has not been diagnosed, and therefore hasn’t been treated either, by a mental health professional. 

Depression can go undiagnosed for many different reasons, including:

• Lack of access to healthcare
• Misutilization or underutilization of healthcare
• Being distrustful of healthcare professionals
• Lack of awareness that symptoms are treatable or even present, if baseline has been depressed for a long time
• Being concerned that disclosing your symptoms may result in negative outcome (for example, concern that disclosure of suicidal thoughts would result in getting ‘locked up’)
• Fear of embarrassment, shame, or being seen as a burden (often due to stigma)
• Insufficient community resources (wellness programs, occupational assistance, case management)
• Symptoms are overlooked due to other comorbid issues

If you have depressive symptoms that are affecting your daily life (such as changes in appetite, lack of energy, or persistent sadness), or believe symptoms that have been attributed to a different condition may be due to having depression, speak to a mental health professional about your concerns. They will be able to help you identify the source of your symptoms and create an effective treatment plan tailored to you.

It’s important to know what your own depression’s red flags are so that you can take preventative steps, rather than waiting until your depression is worse when it could be more challenging to motivate yourself and take action. Checking in and gauging your emotions will also help you realize earlier on that you’re feeling depressed.

What Is Non-Dysphoric Depression?

Non-dysphoric depression is a non-clinical term that refers to a depressive state that doesn’t feature agitation or predominant feelings of discontentment. 

This type of depression is not recognized in the DSM-5. However it is understood to represent a type of depression where all the symptoms are present except agitation and discontentment.

There is mixed research that associates non-dysphoric depression with elderly adults. Non-dysphoric depression can also be seen in people with affected or limited awareness of their emotions and ability to communicate them.

Is Depression Difficult to Diagnose?

Sometimes depression can be hard to diagnose, but not usually. Depression is one of the more common mental health conditions, and most mental health professionals are very familiar with its symptoms and diagnostic criteria.

One of the few reasons why someone might struggle to get a diagnosis is because its symptoms tend to be nonspecific and are shared by other disorders like anxiety or bipolar disorder. Because of this, it’s important that enough diagnostic clarity is provided for a diagnosis. This in no way means that it’s impossible to get diagnosed with depression, or, on the other side, that it is self-diagnosable. 

Again, If your depressive symptoms are making it difficult to function normally and are interfering with daily life, talk to a doctor about getting diagnosed and starting treatment.

What Conditions Can Be Mistaken for Depression?

There are a number of conditions that can be confused for depression, since depression shares symptoms with many different conditions. If you have one of these conditions, it may be very difficult to tell if you might have depression alongside it.

Conditions that are commonly mistaken for depression include: 

• Anxiety
• Anemia
• Bipolar disorder
• Chronic fatigue syndrome (CFS)
• Diabetes
• Cyclothymic disorder
• Premenstrual dysphoric disorder (PMDD)
• Post-traumatic stress disorder (PTSD)
• Fibromyalgia
• Hypothyroidism
• Vitamin D deficiency
• Attention-deficit/hyperactivity disorder (ADHD)

Why Do We Need to Be Aware of Depression?

It is prudent to be knowledgeable about and aware of depression because it is likely to affect us or someone we love. Depression is one of the most common mental health conditions and one of the leading causes of disability. The lifetime risk of developing clinical depression is 1 in 8 for women and about 1 in 10 for men.

Around the world, approximately 280 million people have depression. According to the World Health Organization, a total of 5% of adults are diagnosed with depression worldwide.

However, there’s more to the statistics than that. Depression affects people differently by gender as well, as women are twice as likely as men to suffer from depression.

Even on a personal level, being aware of your mood and recognizing any signs of depression you might exhibit can help you be more proactive in managing and treating it. This way, you don’t have to wait until things are bad or too hard to deal with to start treatment. 

Simple ways to help manage early depressive symptoms include:

• Participating in activities you enjoy
• Staying physically active
• Getting adequate sleep
• Eating well balanced meals regularly
• Nurturing friendships
• Keeping up with routine wellness checks (doctor, dentist etc.)

If your symptoms are more serious and thoughts of death start to occur, please contact the Suicide and Crisis Lifeline at 988 or go to your nearest emergency room.

How Can People Be Aware of Depression?

There are many ways to learn more about depression, such as:

• Reading: Read about depression from a credible academic source, such as peer-review articles or studies, or perhaps a biography about someone’s experience with depression.
• Interacting with people struggling with depression: Learn about depression from a friend or another close individual that experienced depression, learned to manage their symptoms, and is comfortable sharing their experience.
• Practicing self-awareness: When you feel depressed, make a habit of noting the specific thoughts, behaviors, or feelings you experience. It can be helpful to journal about them or write them down in some way.
• Watching movies that address mental health issues directly. Watching movies that talk about things like eating disorders, depression, anxiety, or other mental disorders can help contradict stereotypes, reduce stigma, and make the information overall more digestible and accessible.

Attending seminars: Listen to speakers discuss depression in an informative and easy to understand manner. Organizations like the National Institute of Health and Cigna have put together in-person and virtual seminars on a variety of mental health topics. Searching for mental health seminars in your area is a great place to start.

Treatment Options for Depression

Treating depression starts with diagnosis, and from there, doctors suggest either psychotherapy (also known as talk therapy), medication, or a combination of the two.

Each method’s effectiveness depends on the patient. Talk therapy can be just as effective as medication, and vice versa. 

Psychotherapy

Talk therapy works to treat depression by addressing patterns, relationships, or feelings that could be causing depression symptoms and working through them. Therapy can even help just by giving you a personal connection to someone. Having someone to talk to regularly can help you feel less isolated or lonely.

Medication

Common antidepressants include:

• Selective serotonin reuptake inhibitors (SSRIs)
• Selective-norepinephrine reuptake inhibitors (SNRIs)
• Tricyclic antidepressants (TCAs)
• Atypical antidepressants

Aside from these two methods, there are ways that you personally can also contribute to your mental health. One thing that needs to happen alongside any treatment that you choose is taking care of yourself. When you’re depressed, this can seem like a gargantuan task. 

Checking in with yourself is an important method of self-care. Especially if you didn’t realize you were depressed, gauging how you feel is an integral part of measuring your progress and assessing how best to help yourself.

Other good tactics for taking care of yourself are getting the right amount of sleep, avoiding substances like alcohol or drugs, eating healthier, keeping a schedule and routine, seeing other people, and participating in activities that give a sense of purpose, such as exercise. 

If you think you might be depressed, or even if you’re unsure, talk to a medical professional about your symptoms and see what treatment options are available to you. It could change your life for the better.