From the moment Nita Sweeney, 57, of Columbus, Ohio, wakes up, her struggle is on.
Her first thoughts are often dark: Her husband, sister and dog have died. Loved ones are stranded in a foreign country. She has a general feeling of dread and anxiety, as though something terrible has happened — only nothing has. “There’s also usually a completely illogical component that it’s somehow all my fault,” Sweeney says.
Many people would be surprised this is what it looks like. Ads for pharmaceutical companies depict depression as sadness, lack of enjoyment at activities you once took pleasure in, tears or suicidal thoughts. And those are the classic symptoms of a depressive disorder. But not everyone gets hit with the characteristic symptoms. Sometimes depression shows up with lesser-known symptoms that aren’t often discussed, like Sweeney’s sense of foreboding.
How Depression Works
“Depression does present itself differently due to many things, including cultural factors,” says Dr. Shirley Pakdaman, adjunct clinical professor at Pepperdine University and a psychotherapist in Beverly Hills, Calif.
For example, depression often looks different in men than it does in women. For men, “it doesn’t come out like tearfulness, crying and sadness; it’s more like irritability and anger,” says Pakdaman.
She says that depression has a “biopsychosocial” process, which means biological, chemical and psychological factors are at work. When this trifecta goes awry, the mind can ruminate or obsess on bad things like fears or unfortunate circumstances — which explains Sweeney’s morning dread.
This often leads to self-abuse (critical inner self-talk), which causes stress. The brain then releases cortisol, a stress hormone that makes the person feel depleted. That makes it hard to get out of bed or complete a task, so the person becomes self-critical again, and the cycle continues. “You can see how it all interacts,” Pakdaman says. “It’s a spiral downward.”
Lesser-Known Symptoms of Depression
People experiencing symptoms of depression should seek help immediately by talking to a primary care physician or mental health professional. Depression left untreated can lead to much worse outcomes, including disease and suicide. Talk therapy and anti-depressants are common and effective forms of treatment.
Here are five more symptoms of depression that are often not recognized, along with suggestions for lessening their effects:
Symptom: Feeling Numb/Absence of Emotion
You feel blank or blah.
What’s Happening? Sweeney notices this when she’s watching TV with another person who feels sad or wells up in response to something sad happening in the show. “I’ll think ‘Oh, that was really sad, I should feel sad, too, and I don’t. I feel blank.’” It’s similar with anger, fear or happiness. Sweeney says it’s as if her body conserves every bit of energy it needs when depressed, and feeling emotion is just too much to handle.
“Ultimately many of the signs of depression have more to do with our energy or the lack thereof,” says Dr. Sherrie Campbell, a psychotherapist in Orange County, Calif., and author of Loving Yourself: The Mastery of Being Your Own Person. There is almost always an exhaustion component to depression that may result in the absence of emotion, she says.
What Helps? “It is very important to adopt the belief that all of your feelings are acceptable and temporary. There is no right or wrong when it comes to emotions,” says Dr. Fran Walfish, a Beverly Hills family psychotherapist.
Symptom: Physical Pain
You have aches and pains all over.
What’s Happening? “Physical pain often leads to experiencing depression and depression can often lead to experiencing physical pain,” Pakdaman says. Sweeney likens it to a mild discomfort, like when you’re coming down with the flu and you feel achy. “It’s like something is coming on,” she says.
Since the body-mind connection is powerful, pain is more pronounced, you have a lower tolerance and it’s more likely to bother you when you’re depressed. “The relationship is so strong, that a lot of times, people with chronic pain are prescribed antidepressants — and it actually helps,” Pakdaman says.
What Helps? Research on how over-the-counter pain relievers change the brain’s response have found that the pain medicine acetaminophen (Tylenol) may blunt depression pain.
Symptom: Changes in Sleep
Some people with depression sleep way too much; others experience insomnia.
What’s Happening? Dopamine and serotonin, two neurotransmitter chemicals in the brain that bring a happiness boost and work to stabilize mood, are low when you’re depressed. This can make it hard to get out of bed and make you feel sleepy all the time. Other times, depression feels like anxious distress. So, feeling edgy, irritable or ruminating can keep your mind too busy to sleep.
What Helps? Being more active can help with fatigue (yes, it’s hard to do an activity when you’re sluggish, but knowing it helps may motivate you). Writing about your thoughts and feelings also can help with sleep issues. Sweeney downloads all her thoughts on paper, and if she feels blank, she just describes what she sees in front of her. “My dresser, a blue lamp, a water glass.” The act of unburdening your mind may reduce anxiety and allow a person to sleep.
Symptom: Changes in Appetite
Some people with depression eat more than usual; others have no appetite.
What’s Happening? Since serotonin regulates appetite and runs low when you’re depressed, it’s not uncommon to feel uninterested in food. Some people react the opposite way and overeat, especially comfort foods, in a subconscious attempt to lift their mood.
What Helps? Depression researchers emphasize the importance of a healthy diet to accompany whatever treatment a person is getting (sometimes easier said than done). A plant-based Mediterranean diet, high in nuts, fruits, legumes and olive oil has been found to decrease depression.
Symptom: Forgetfulness/’Depression Brain’
People report they feel forgetful or like they’re in a fog.
What’s Happening? “This could have to do with the chemicals that are released in the brain when someone is depressed. It could also have to do with the brain ruminating,” Pakdaman says. A person with depression can be focused inward so much that he or she doesn’t pay adequate attention to things or “encode” (lock down and retain) information. That can make the person feel absentminded. In fact, studies show the depressed brain does have poorer memory, and people experience short-term memory loss.
What Helps? Exercise, although to a person with depression, it often feels counterintuitive due to lack of energy. Sweeney says when she forces herself to get out for a walk or break a sweat, she feels much better. In fact, it’s worked so well for her that she wrote the book Depression Hates a Moving Target: How Running with My Dog Brought Me Back from the Brink. Aids like setting alarm reminders, using time-tracker apps or writing sticky notes are helpful for people who are experiencing forgetfulness during depression.
If you have any of the symptoms above or others, like the inability to accomplish a task, keep up with grooming or tackle your to-dos, you may not have previously associated them with depression. But talking with your doctor can help determine if you do have unrecognized symptoms of depression.