Much of my work as a clinical psychologist has focused on treating individuals with depression, so I've learned a lot about what it looks like. And yet when I gradually slipped into my own state of depression some years ago, I didn't recognize it.
Over time, I had developed the telltale symptoms, including a pervasively negative view of myself as a "loser." In hindsight, it's obvious that I was thinking like a depressed person, but at the time I believed the self-loathing thoughts. Finally, I recognized that they were being driven by my mood.
My experience could be chalked up to "another psychologist without self-awareness," and yet I don't believe that tells the full story. Many people I've treated have described a similar blindness to their own depression, until it became unmistakable.
Even the people we're closest to might not realize we're depressed, especially if we're good at "soldiering on." They may sense we're not at our best, but might attribute it to other factors.
Given the greater public awareness of depression — and professional experience in my case — how is it possible to not know when it's present? There are several factors that can play a role:
1. Depression can look really different from person to person.
Two people who are both depressed might have zero symptoms in common. Robin, for example, might feel really low, have insomnia, be unable to eat more than a few bites at a time, struggle with concentration, and be so miserable she's considering ending her own life. Terry, on the other hand, doesn't feel noticeably down, but has no interest in anything, even activities he used to enjoy. He's sleeping 12 hours a day, but is still fatigued and physically slowed, and feels completely worthless. As different as these two examples are, they both are consistent with major depressive disorder. The severity of depression can vary a lot, too, from being completely unable to function to still being able to take care of one's responsibilities and even find occasional enjoyment. We're less likely to see milder forms of depression for what they are.
2. Depression tends to develop gradually.
The development of each symptom of depression can be like hair growing, with no noticeable change day to day or even week to week. Since we're never not with ourselves, we may not have a good sense of small changes over time as our mood, energy, and view of ourselves dip. And then one day, we might finally look at ourselves and barely recognize the person we see, as the cumulative changes become obvious.
3. In a related way, the various symptoms of depression often develop at different times.
Depression often has an insidious onset — we develop a symptom here, a symptom there. We might not have as much energy as before, and a few weeks later we notice that we're crankier than usual. We might not suspect that both experiences are connected to the same underlying condition. If several depression symptoms landed in your life all at once, it would be much more obvious that they were part of a syndrome.
4. There may be an obvious reason for feeling down.
When we're facing major challenges like health problems, a painful divorce, or job loss, we expect to feel poorly. It would be strange, in fact, if our moods weren't affected to some extent. Thus we might not call our reaction "depression," because it seems so understandable. However, these kinds of losses are among the most consistent predictors of depression, as we lose reliable sources of reward, engagement, and support.
5. There may be no obvious “reason” to be depressed. On the other hand, our moods can tank without any cause that we can identify. It could be that we have a genetic predisposition to depression, or that we're sensitive to seasonal shifts. There could also be identifiable changes in our lives that could account for our low mood, but we don't make the connection. For example, we may have gotten a better job, which we expect would improve our mood; however, we also left behind a solid group of friends at our old job, and now have a stressful commute in the car whereas before we could take the train. Without an obvious trigger for our depression, we’re less likely to see it when it comes.
6. Some symptoms might not seem like depression.
We often assume that a person who's depressed is really sad, and yet depression doesn't have to include sadness. Many individuals with depression feel more numb than sad, or may have lost interest in things they used to enjoy without having an obvious shift in their emotional state. It can also be easy to attribute depression symptoms to other factors, since depression is one of several possible explanations. For example, we might blame stress for our increased appetite and sleep problems, and think our trouble concentrating is driven by poor sleep.
7. We don’t want to see ourselves as "depressed."
Despite progress over the past few decades, there is still a lot of stigma around depression. We may have internalized that stigma, seeing depression as a "weakness" or "personal failure." As a result, we might not want to recognize our own depression. Maybe we prided ourselves on our strength and resilience, and depression just doesn’t square with our identity. We may therefore look for any alternative explanation for the way we're feeling.
Coming to see our depression for what it is can be tremendously helpful, even life-changing, in at least two ways.
First, depression can affect all areas of our life, making us feel like everything is falling apart: We're not sleeping well, we're irritable, our motivation is gone, nothing is fun anymore, and so forth. Putting these many struggles under a single umbrella makes them much more manageable. Rather than having 15 problems, we have one, and obviously it's easier to tackle a single problem than 15.
Second, once we've named it, we know how to treat it. Several "talk therapies" have strong research evidence for alleviating depression. For example, a few weeks of cognitive behavioral therapy (CBT) generally has a major effect on depression symptoms. There are also medications that are used to treat depression, some of which can be as effective as the best psychotherapies.
For many people, depression can be managed without professional assistance, especially if the depression falls in the mild to moderate range, and if there's a low risk for self-harm. I was able to manage my own depression through a combination of self-help, strong support from the people closest to me, and getting involved in a triathlon.
There are also self-directed books that can be very helpful. (See Therapy Without a Therapist?) The Association for Behavioral and Cognitive Therapies maintains a list of books that have their "seal of merit." Or you can try my workbook for self-guided CBT, Retrain Your Brain: Cognitive Behavioral Therapy in 7 Weeks.
If you or a loved one has been struggling and some of your symptoms could reflect depression, it may be a good idea to schedule an appointment with your primary care doctor or a mental health professional. Psychology Today offers a database where you can search for a therapist who would be a good match for you.
However we combat depression, we don’t have to suffer — help is available. And like anything else, knowing what we’re dealing with is half the battle.