The Many Faces of Depression
Irritability and oppositional behaviors may be more than attitude.
Posted Oct 04, 2020
October is chock-full of good stuff. We get pretty foliage, balmy late summer days, and Halloween. It’s also saturated with mental health awareness. There are days dedicated to OCD, ADHD, and anti-bullying. However, given the kind of year it has been, it’s particularly important in 2020 to recognize it being National Depression and Mental Health Screening Month.
Blood pressure is ironically called the silent killer, but we hear about it everywhere. There are commercials for medications, menu alterations, and people speak freely about managing it. Depression, which we rarely hear about in comparison, is highly correlated with suicide and is the leading cause of disability for ages 15-44 in the United States, according to the American Depression & Anxiety Association (ADAA).
The National Institute of Mental Health (NIMH) tells us that it is the second leading cause of death in the U.S. for ages 10-34, and the fourth leading cause for ages 35-54. Untreated depression is also highly correlated with the development of hypertension and diabetes, both associated with premature death. Despite these startling facts, when was the last time you heard depression mentioned in any public forum? Probably a commercial for medication.
Let’s face it—mental health is still a taboo topic; like sex, it’s everywhere, but simultaneously considered an off-color topic. Many treatment centers don’t even use the words “mental health” or “psychology” in their titles; perhaps this is well-intended, making it less stigmatizing and, therefore, more welcoming for clientele, but at the same time, it is as if they are saying, “Don’t mention that word!” Nonetheless, judging from the length of therapy and psychiatry waitlists, and the rate at which psychotropic medications are prescribed, more people acknowledge their mental health than meets the eye.
Naturally, if depression (and other conditions) was more talked about, it could be more recognizable. More people would be treated; there’d be less suffering and global impact. British psychiatrist Edward Bullmore (2018) noted that depression is so widespread, its economic effects so vast, that if it was cured in England alone at the time of his writing, the economy’s annual growth rate would triple.
Many Faces of Depression
It may surprise readers that depression has many faces. Don’t be fooled by characters like Eeyore from Winnie the Pooh or Schleprock from the Flintstones. A lot of people are depressed and look nothing like these icons. Depression can also present as anger, irritability, opposition, and defiance, especially for children and adolescents, and especially males.
Believe it or not, a noticeable sad or irritable mood is not even necessary for the diagnosis of Major Depressive Disorder (MDD). Diagnostic criterion A in the Diagnostic and Statistical Manual of Mental Disorders (DSM) notes that a depressed mood, or an inability to experience pleasure, the fancy word for which is anhedonia, must be present. Unfortunately, outside of professionals in the field, the majority of people get ideas about what constitutes mental illnesses from pop culture. Clearly, the mold pop culture made for depression is not accurate, leaving many to not recognize they could be depressed.
Kids With Attitude
That oppositional and defiant youngster in your office, home, or classroom? There’s a good chance they’re not simply an Oppositional Defiant Disorder “behavioral bad seed” as they’re so often written off. Consider this: An irritable child is likely to be argumentative. This is easily viewed as opposition and defiance by others and spurs power struggles, the pattern is set. Looking beneath the surface when I evaluate such children, what is discovered is a months-to-years-long pattern of co-occurring feelings of inadequacy, hopelessness, appetite and sleep disturbances, and stewing over the past.
It is noted in the DSM that ODD is not to be diagnosed if better accounted for by depression. Unfortunately, the “ODD” speaks loudest, so it takes center stage, and there is a failure to recognize that the opposition and defiance often evolved along with any depressive symptoms the child has. Treatment providers then focus on limit setting and finger-wagging, failing to see the depressed kid at hand and addressing the depression. Two years into unsuccessful treatment, they are viewed as incorrigible, when a change in the lens they’re viewed through could make a world of difference. They never had a chance, all because the stereotypes of depression don’t account for irritability and oppositional/defiant behaviors.
For adults, it is still not unusual for depression to manifest as an angry or irritable mood, especially in males. Perhaps this is a cultural matter that it is better to be aggressive than crying, or the fact there’s more testosterone, an aggressive hormone, at play in males. This does not mean that depressed females are always the stereotypical, sobbing, damsel in distress, either.
Keep in mind, too, that “crankiness” in senior citizens may not simply be “old people with attitude” so frequently portrayed in TV shows and movies. This stereotype, coupled with assumptions they’re naturally more tired and less hungry because of age, can render depression in seniors unrecognized.
It's a Package Deal
The bottom line: Any alteration in the mood to a baseline pattern of weeks or months of “bad mood” can be telling of depression. Coupled with other symptoms, such as appetite and sleep disturbances, thoughts of death/suicide, agitation, lack of motivation, inability to concentrate, and disinterest in previously pleasurable activities ranging from hobbies to work to sex, it is likely depression knocking.
The Good News
While this all sounds miserable, the good news is, depression is extremely treatable once identified. It has been well-established that therapy or medication, independently, can have a significant effect on dissolving the condition. However, psychotherapy, in combination with antidepressant medication, is the standard approach and does not have to be a years-long process.
Even self-help, for the motivated sufferer, has its merits. Take, for example, Dr. David Burns’s book Feeling Good: The New Mood Therapy. With millions of copies sold since 1980, it could be considered the top most-recommended self-help book for depression.
It’s been a less-than-pleasant seven months. There have not only been health worries due to a worldwide pandemic, but political upheaval, natural disasters, and it’s creepy even going to the gym for a stress-busting workout if you still go. Perhaps in October, being National Depression and Mental Health Screening Month, it’s time to take a scan of yourself and others in your life.
If you or a friend/loved one has had intensifying irritation and sleeplessness and not been yourself/themselves, don’t let it become a runaway train. But remember, like the year 2020, depression knows no age discrimination. Therefore, don’t forget to reconsider what's up with those kids with attitude, and check in on the elderly, who have been hit particularly hard by COVID-19. Like any malady, the sooner it’s identified and addressed, the better. 2021 can be different!
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Anxiety and Depression Association of America. (2020, October 4). Understanding the facts: Types of depression. https://adaa.org/understanding-anxiety/depression
Bullmore, E. (2018). The inflamed mind: A radical new approach to depression. Piscador.
Burns, D. (1980). Feeling good: the new mood therapy. Avon Books.
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Association, 2013
National Institute of Mental Health. (2020, October 4). Suicide is a leading cause of death in the United States. https://www.nimh.nih.gov/health/statistics/suicide.shtml#:~:text=Suicide%20was%20the%20second%20leading,ages%20of%2035%20and%2054.