Life gets tough sometimes, and you may start to feel stressed or down. Over the last few weeks, or months, you’ve noticed you’re having more bad days than good – you’re less productive at work, spending more time alone, and haven’t been able to sleep.
Something feels different from the normal ups and downs you’ve experienced before. So you go to the doctor and tell them how you’ve been feeling, and how long you’ve been feeling that way. The doctor says it sounds like you are depressed, and that you might have major depressive disorder.
Major depressive disorder is one of the most common mental disorders in the United States, with an estimated 17.3 million adults age 18 or older have at least one major depressive episode in 2017. About 1 in 6 adults will have depression at some point in their life, but anyone at any age can get depressed.
What is major depressive disorder?
Also known as clinical depression, major depressive disorder (MDD) is a mood disorder that affects the way people feel, think, and handle daily activities like eating, sleeping, or working.
Depression is a serious mental health condition that needs professional care. Of those who seek treatment, more than 80% of people will feel better in four to six weeks.
Who is at risk for MDD?
While the exact cause of depression isn’t known, it’s likely to be a combination of biological, environmental, genetic, and psychological factors. Some risk factors for depression include:
- Abuse or trauma
- Stressful life events, such as job loss or divorce
- Other health conditions, especially serious ones like cancer
- Personality traits, such as low self-esteem
- Family history of depression
Women are at a greater risk for depression, although men may be less likely to recognize that they are depressed and seek treatment.
Depression is often portrayed as someone sitting alone in a room or constantly crying, the truth is that depression is not always obvious, even to those who are struggling. Some people with depression are still able to go about their day and appear as if “nothing is wrong,” despite feeling depressed. Others choose not to share how they are feeling because they don’t want to worry the people around them.
What are the symptoms of MDD?
The Diagnostic and Statistical Manual (DSM-5) characterizes major depression by having at least five of the following nine symptoms, and symptoms persist daily for at least two weeks:
- Feeling sad or having a depressed mood
- Loss of interest or pleasure in activities that were once enjoyable
- Appetite and weight changes
- Trouble sleeping or sleeping too much
- Loss of energy or increased fatigue
- Psychomotor changes, like slowed speech and movement
- Feeling guilty or worthless
- Trouble thinking, concentrating, or making decisions
- Thoughts of death or suicide
While these symptoms are clear signs of depression, some symptoms are far more subtle. These symptoms can often be dismissed as everyday problems or mimic other conditions so they may mask depression. Here are a few hidden signs of depression to look out for.
One of the most common, but not very well-known, signs of depression is physical pain. Back, joint, and limb pain are frequently reported in people with depression.
Studies have shown that physical pain and depression have a biological connection; the neurotransmitters (chemical messengers) that influence both pain and mood are serotonin and norepinephrine. Serotonin’s primary role is to stabilize mood, feelings of well-being, and happiness, and also helps with sleep and digestion. Not enough serotonin or too much of it may lead to depression. Norepinephrine helps mobilize the brain for action and can improve energy, focus, and attentiveness. Low levels of norepinephrine result in decreased energy levels, inability to focus, and depression.
The link between pain and depression explains why 85% of patients with chronic pain are affected by severe depression.
In addition to physical pain, depression can also cause decreased pain tolerance. This means if someone is depressed, things may hurt more than they would if the person was not depressed.
Although doctors consider patients to be “in remission” from depression when their emotional symptoms have subsided, physical symptoms may linger and cause depression to resurface.
People who have chronic migraines are five times more likely to develop depression than someone without migraines. The more frequent the headaches, the more likely a person is to have depression.
Migraines are a neurological disorder that can cause moderate to severe throbbing or pulsing on one side of the head. The debilitating pain caused by migraines can disrupt your entire life, leaving you in bed for days. Chronic migraines can be so intense, they can cause increased feelings of sadness, hopelessness, and loneliness.
Although most people associate depression with sadness, irritability can also be a symptom. Irritability means it is more likely for someone to get frustrated or upset easily, even by things that seem minor.
Since irritability is a symptom of MDD in children and adolescents, but not in adults, it can be easy to overlook, even for doctors, who typically look for feelings of hopelessness or lack of motivation to diagnose depression.
Someone who is depressed might believe there are other reasons for their irritability—maybe they didn’t sleep well the night before (which could also be a sign of depression), or perhaps they were stressed. But if someone is constantly irritable and there appears to be no rational reason for it, it could be because they are depressed.
It can be difficult to recognize anger as a sign of depression because it’s normal to experience anger. Anger is an emotion that is usually experienced when you feel someone has wronged, harmed, or mistreated you. While it’s normal to feel anger, feeling anger too frequently or too intense can be a sign of depression.
Research shows that one-third of people with depression also have “anger attacks”, where they lose their tempers and engage in behaviors like screaming, slamming doors, and throwing things.
The ability to regulate emotions is a key role in developing depression. People who have difficulty managing their emotions and have difficulty processing negative information, tend to be more depressed. This results in behaviors like rumination, impaired cognitive reappraisal, and increased suppression of emotions. Studies have shown the same is true for people with anger. The harder it is for someone to regulate emotions, the angrier they become.
Anger is seen more in men than in women, but men are less likely to talk about it and hide their emotions. Masking emotions only intensifies them and as a result, may lead to depression.
Increased alcohol use
Almost one-third of people with depression also struggle with alcohol use, and each increases the risk of (and can worsen) the other. Some people may use alcohol to deal with depression as a form of self-medication, and over time this can turn into an alcohol use disorder. It is a vicious cycle that is exacerbated by the fact that alcohol is a depressant. So if someone is using alcohol to try to “drown their sorrows,” they might be making it worse without realizing it.
It’s important to recognize alcohol use can lead to impaired thinking, which may cause someone to act on impulse and do something they wouldn’t normally do. Depending on the seriousness of the action, this can also contribute to depression or feelings of guilt and regret.
Change in vision or vision loss is another overlooked symptom of depression. Like alcohol use, vision changes are bidirectional; people who experience vision loss are more likely to suffer from depression, but people who are suffering from depression may also notice changes in their eyesight. Someone who is depressed might notice that their vision seems blurry or that their vision seems poorer.
While vision loss might be associated with getting older, research has shown that poor vision is not an inevitable part of aging. The study showed that younger people can also experience vision changes if they are depressed and it’s a symptom that shouldn’t be ignored.
Although changes in appetite are a well-known sign of depression, changes in digestion can also be a symptom. Abdominal cramping, bloating, constipation or diarrhea are often written off as something that didn’t agree with your system, gas, or even menstrual pain. But if these symptoms increase in frequency and intensity, it may be a sign of depression.
Research has suggested that there is a link between anxiety, depression, and gastrointestinal pain. It shouldn’t be too surprising – many people notice that when they are feeling depressed or anxious, they also feel it in their stomach as “butterflies” or nausea. Because the brain and the gut interact so closely if someone is depressed, they might experience inflammation of the digestive organs. The gut is often referred to as the “second brain” because of the mind-gut connection.
The gut and brain are also bidirectional, sending signals from one to the other. An imbalance in the gut microbiome negatively affects how it sends messages to the brain. When the gut can’t send messages to the brain to help control things like stress, it can lead to depression.
Depression impacts daily living, including personal hygiene. Things like brushing your teeth, combing your hair, taking a shower, and putting on clean clothes, are often second nature. But for someone struggling with depression, these daily tasks can be some of the most difficult to do.
Poor hygiene that persists for a week or longer at a time, can be a sign of self-neglect and low self-worth. As the behavior persists, it’s common for people to feel depressed and shameful about their inability or lack of self-care.
Find your community
If you or someone you love has experienced any of these symptoms, it might be worth talking to a doctor to determine if depression is the cause and find a treatment plan. You are not alone in your illness. Join the conversation at PatientsLikeMe where over 60,000 patients are sharing their experience with major depressive disorder.