Not all depressions look alike. Some people experience anger, motivation problems, and feeling numb. Dr. Ellen Hendriksen explains the 11 less common “blue flags” for this serious condition.
Arielle is usually a pillar of her church and community, but she’s recently weathered some major stress.
Depression is a complex condition with both classic and less frequent symptoms. It also manifests differently from one person to another.
Arielle’s husband passed away a couple of years ago and the anniversary of his death last month was particularly hard. In addition, she found a lump in her breast that turned out to be nothing, but the biopsy was frightening and made her wonder if she was next. To top it off, her grandson was hit by a car and spent a touchy few weeks in the hospital.
Now, Arielle worries with every ache or pain, wondering what it signifies. She frets about her grandkids’ safety, ruminating about how irresponsible and stupid people can be. She’s stopped going to church and her volunteer events, rationalizing that she’s too exhausted to face other people. When she does go, getting ready is excruciating. On those mornings when Arielle remembers to eat, even making breakfast can be an effort, but usually she’s not even hungry. As she gets ready for bed, she occasionally thinks that if she were never to wake up again, that might be OK.
Arielle’s symptoms present very differently from Norman’s, but they both have depression. What are Arielle’s little-known symptoms?
Depression Sign #7: Trouble Getting Going
Trying to get motivated for a task that takes focus and organization may seem overwhelming in the context of depression. Work projects, home improvements, or paying bills can seem bone-crushingly difficult. When depression becomes severe, as Arielle’s may be, making a sandwich, taking a shower, or getting out of bed may seem like insurmountable tasks.
Depression Sign #8: Changes in Eating
As with changes in sleep, depression-driven changes in eating may lead up or down. Some individuals, in order to soothe themselves with food, may find themselves eating everything that isn’t nailed down. Others eat much less than usual. Those who eat less often report they experience neither hunger, as signified by a rumbling stomach or a feeling of low blood sugar, nor appetite, such as looking forward to eating or thinking the donuts in the bakery case look good. Depressed patients who have lost their appetite often tell me food tastes like cardboard, while those who are barely eating at all report sleeping through meals.
See also: Can You Be Addicted to Food?
Depression Sign #9: Not Showing Up
Arielle is turning into a hermit, withdrawing from her usual activities. Social isolation is a mark of depression and the polar opposite of what Arielle, or any individual with depression, needs. In another chicken and egg situation, isolation breeds depression, and depression deepens isolation. In either case, disappearance from friends and family signals a problem.
Depression Sign #10: Anxiety
Depression and anxiety go together like storm clouds and rain. Worry about a stressful situation like a divorce, job loss, or serious illness can descend into the hopelessness and helplessness of depression, or anxiety may be free-floating and non-specific, coloring every thought and action. Arielle may have inadvertently worried herself into a depression; she spins her anxieties around and around, ruminating about specifics, like each ache or pain, and generalities, like perceived human incompetence.
Depression Sign #11: Passive Thoughts of Dying
Mental health professionals divide suicidal thoughts into two categories: active and passive. Most commonly recognized are active suicidal thoughts, which are thoughts about killing oneself that may or may not include a plan. This is the most worrisome type of suicidal thought. Desire to die plus a plan is a crisis requiring a trip to the emergency room or dialing 911.
However, Arielle is experiencing the lesser-known variation, passive suicidal thoughts. Arielle doesn’t want to kill herself, but her thoughts are a flag for depression. Examples of passive suicidal thoughts include wishing one were dead, wanting to go to sleep and not wake up, or hoping to be killed accidentally. To illustrate, hoping to be hit by a bus is passive; considering jumping in front of a bus is active. Wishing to go to sleep and not wake up is passive; planning to make it happen by collecting sleeping pills is active.
What Are the Most Common Signs of Depression?
The signs of depression vary across individuals, but there are two hallmark symptoms, at least one of which must be experienced for at least two weeks for an official depression diagnosis. The first is depressed mood, which may be expressed as sadness, emptiness, irritability, or feeling low. The second is anhedonia, which means “without pleasure” and can mean not enjoying things one usually enjoys, from cooking to reading to grandkids, or not being interested in things one is usually interested in, from hobbies to sex to socializing.
See a physician or mental health practitioner if you think you or someone you care about may be suffering from depression. No one can will themselves out of a depression, just like no one can will themselves to be two inches taller. Depression, whether the symptoms are common or rare, is treatable. In all cases, seeking help is a sign of strength.
Dr. Ellen Hendriksen is a clinical psychologist at the Stanford University School of Medicine. Ellen graduated from Brown University, earned her Ph.D. at UCLA, and completed her training at Harvard Medical School. In her clinic, she treats everything from depression to trauma to panic, but has a special place in her heart for anxiety disorders. Ellen is also an active research scientist and develops therapy programs for individuals and families living with chronic illness. She lives in the San Francisco Bay Area with her husband and two sons, ages 5 and 2..