Public awareness about the symptoms of depression is quite high, and as psychotherapists and counsellors, we spend a lot of time working with people with depression, so we know quite a bit about what depression looks like. Yet, when I experienced a bout of depression a few years ago, it took me a long time to realise that that’s what it was. This realisation made me see that one of the common uniting themes in people with depression is not actually realising that they are depressed.
One thing that makes depression so hard to spot, especially in oneself, is that it often comes with a negative internal dialogue telling you that ‘you are useless’ or ‘you are a loser’. This negative view of yourself becomes so pervasive that you actually believe you have mucked things up, or that it’s your fault that you don’t feel good about yourself.
In hindsight, it is blindingly obvious that you are thinking like a depressed person and that, rather than being a person who has failed, you are someone with a treatable illness. However, at the time, especially if you see yourself as good at coping with things and expect yourself to ‘soldier on,’ you will be aware that you do not feel good or at your best, but will put it down to being a mess or a disaster or to other factors.
Why is depression so difficult to identify?
There are several factors at play here:
1. Depression can look really different in each person it affects
Your depression might look completely different to the next person’s. You might not even have one symptom in common. For example, one person with depression might feel very low, have some suicidal thoughts, really bad insomnia, miss meals and not be able to eat more than a few morsels, and be very distracted and unable to concentrate. Whereas, another person with depression can actually feel not that down, or not all of the time, but feel they have lost interest in everything, and feel unmotivated to do even the activities they used to really enjoy. They might sleep and eat very well but just feel terribly tired and slowed down all the time, and feel completely worthless.
Those two examples are very different and yet both presentations fit with a depressive disorder.
2. There might be a good reason you feel down.
If you have just gone through a bereavement, or a divorce or are having health problems, you might think, ‘oh well of course I am affected by that.’ You expect to feel bad, and you expect yourself to ‘get over it’. But if you carry on expecting yourself to get back to okay without processing the emotions this can become depression rather than just a reaction to a difficult phase in your life.
3. There is no obvious ‘reason’ to be depressed.
Depression is not always associated with a life event or difficult phase, it could relate to something from earlier in your life that is triggered by something such as seasonal shifts that you don’t even notice. Or there might be things under the surface, such as relationship difficulties or never feeling supported by others, that have caused the low mood, but we haven’t made the connection. If there is no obvious trigger depression can be very difficult to spot.
4. Depression comes in different levels of severity and develops very gradually.
The symptoms of depression can arise and move very slowly from one level to another meaning that from day to day and week to week you might not notice any changes or become aware of these increases or new symptoms. It is hard to spot such slow movements of mood, self-image, motivation and energy. But then one day someone will say something about you or you might somehow otherwise get a glimpse of yourself and realise how all the changes and symptoms fit together.
5. Each symptom of depression will develop at different times.
People often describe depression as a fog and it does rather creep in slowly coming at you in different directions and changing the way you feel and the way you think about things. 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 more irritable than usual. And it is not always obvious that both those things are part of the same underlying depression.
6. Depressed doesn’t always mean ‘sad’ or ‘low’.
Many people with depression don’t really feel sad, it is more that they feel numb or apathetic and disinterested in things.
7. We don’t want to see ourselves as ‘depressed’.
Despite all the brilliant mental health awareness campaigns, there is still a lot of stigma around depression. People often take that stigma in and apply it to themselves, which means they see any lack of energy or vigour or feeling sad or low as a ‘weakness’ or ‘failure.’ All of which makes it hard to recognise our own depression.
8. We like to see ourselves as ‘tough’, ‘resilient’ or ‘strong’.
Many of us pride ourselves on our ability to shoulder up and ‘keep on keeping on’ so the idea of depression just does not fit with our identity. And so we attribute any symptoms such as loss of appetite or disturbed sleep patterns to something else, such as stress.
The Most Common Signs of Depression
- Lacking energy or feeling tired
- Feeling restless and agitated
- Feeling tearful
- Not wanting to talk to or be with people
- Not wanting to do the things you usually enjoy
- Reaching for alcohol or drugs or food to help you cope with your feelings
- Finding it hard to deal with everyday things
- Not sleeping
- Not eating
Why is it important to recognise Depression?
Coming to see our depression for what it is can be hugely helpful, even life changing.
As above, depression can affect every area of your life, making you feel as though everything is falling apart: you are not sleeping well, you are snappy with everyone, you cannot feel bothered about doing anything, nothing seems any fun any more, etc. If you can put all these daily struggles under a single label it makes them much more manageable. Instead of five or six difficulties, you have one. Depression is not always easy to tackle, but it is way easier than trying to sort six or seven problems without knowing what’s going on!
Another thing is that, once you have named depression, you can work out how best to treat it. This might include going to the GP to discuss its management, although if it is a low-level depression it is highly possible to manage it through a combination of self-awareness, self-help and some support from a counsellor or the people around you. There is strong research evidence that talking therapies alleviate depression, medication can also help. Just know that, once identified, you can begin to work through this and start to feel better.
If you feel you would like a safe space in which to open up about your depression, therapy could be a very helpful. Just call 020 8673 4545 or email firstname.lastname@example.org