Thanks to sensationalized media depictions of mental illness and stigma surrounding mental health conditions, people tend to have a limited view of what depression actually looks like. When you think of a “depressed person,” perhaps you envision an image from a movie or medication commercial: Someone lying alone in a dark room, crying into a box of tissues, overcome with feelings of hopelessness.
This picture is not necessarily inaccurate; it is simply incomplete. There are many more manifestations of depression — symptoms that aren’t necessarily visible or immediately obvious.
Knowing the seldom discussed symptoms of depression is a valuable skill; being able to recognize the less obvious signs may help you or a loved one identify and seek treatment for depression, if needed. Additionally, knowing and fully understanding these symptoms allows us to be more compassionate and helpful to those who are living with mental health conditions.
Here are a few lesser-known symptoms to look out for:
Brain Fog
Studies have shown that depression can reduce cognitive functions, including working memory, long-term memory, decision making and ability to focus. Research also suggests that people with depression often have “widespread grey matter structural abnormalities” in the brain — observable structural differences that contribute to such cognitive deficits.
This often presents in what we refer to as a “brain fog,” in which people may experience an inability to focus on tasks, slower reaction times, forgetfulness and feelings of being mentally “blocked.” Naturally, this can lead to a number of professional, personal and emotional challenges; combating cognitive symptoms can be a frustrating and demoralizing experience.
If this is a symptom you have observed in yourself or someone else, remember to have patience; you and those around you are deserving of grace while navigating a health issue.
Substance Use
While substance use disorders are complex conditions, they are often linked to depression. People experiencing substance use challenges often face the consequences of misinformation and stigma; many are blamed for “poor choices” and irresponsibility.
However, this misguided discourse fails to recognize many of the facets of addiction, including the fact that many people misuse drugs and alcohol to self-medicate their depression. They may not be aware that they are depressed, may not have the resources to treat their depression or may grapple with the stigma surrounding seeking help.
We all have a role to play in dismantling stigma surrounding treatment for mental health conditions; if we can acknowledge that mental health is health, seek help ourselves and encourage others to follow suit, we may, in result, see a decline in substance use.
Weight Changes
While weight changes can be indicative of a shift in physical health, they can also be connected to mental health. Depression is known to affect appetite; some people with depression experience increased appetite and report eating more, while others experience a decrease in appetite and undereat. Accordingly, large weight fluctuations may be a symptom of unmanaged depression.
The challenge of coping with depression is often compounded by stigma surrounding weight and body size; one person may be “fat shamed” for their weight gain while another is praised for their weight loss, despite both weight changes being a result of mental illness. Overeating and undereating — and grappling with public opinion about bodies — only adds to the physical and emotional challenges of depression. A holistic approach to treating depression requires a degree of body positivity: An acceptance of all sizes with the goal of mind and body health.
Irritability
Irritability, anger and impatience often accompany depression. Perhaps you have experienced the surprise of these negative emotions that seemingly “come out of nowhere” — either when you experience them or are on the receiving end of an outburst from someone else.
Often, these outbursts are referred to as anger attacks, sudden intense spells of anger could be considered uncharacteristic and inappropriate in the moment. In turn, this can lead to feelings of shame and confusion surrounding an inability to control these intense emotions. A 2009 study found that angry reactions in depressed individuals may stem from rejection, guilt, fear and “ineffective management of the experience and expression of anger.”
While this experience can be distressing, sharing your concerns with a trusted health care professional could prevent further attacks.
Extreme Fatigue
Often, the chemical imbalances that accompany depression can strip people of their energy. Individuals with depression often have low levels of norepinephrine, serotonin and dopamine. Without appropriate levels of these chemicals, we can experience fatigue, sleep issues, low motivation, decreased interest in once-enjoyed activities and a general lack of joy.
For these reasons, many antidepressants work to increase these chemicals in the body.
From the outside, these symptoms may be judged as a personal failing. Perhaps someone appears lazy, disorganized or unclean — but in reality, they are doing their very best to cope when they are struggling to simply get out of bed. In these moments, chores may go undone, hygiene may falter and basic tasks may get overlooked.
Rather than passing judgment or demanding change, we need to remember that, often, compassion and medical intervention are the appropriate response.
Physical Pain
Other possible physical manifestations of depression are vague aches and pains. The chemicals serotonin and norepinephrine don’t simply affect mood — they also influence how we feel pain. Accordingly, the chemical imbalance linked to depression is also linked to many types of physical pain.
Additionally, research shows that there are biological factors that increase inflammation and decrease immunity during depressive episodes. Those with depression may experience headaches, body aches and stomach aches, among other ailments.
Ultimately, it’s important to remember that depression is complex. It is a mental health condition that doesn’t always look like the tired trope we see played out in the media and stigma-laden conversations.
Depression manifests in a wide variety of symptoms — both mental and physical — that most people may not be aware of. Of course, it is certainly possible to experience brain fog, misuse substances, battle fatigue and feel pain without having depression. But if you are noticing these behaviors and feelings in yourself or someone else, remain vigilant and consider seeking help. Prioritizing your health is not only wise; it is brave.
Ginger Robertson is a registered nurse and mental health blogger. She hopes her work can end the stigma surrounding mental illness and seeking mental health care.