According to the National Institute of Mental Health, 17.3 million Americans, or approximately seven percent of the adult population, suffer from a major depressive disorder. However, only one in five depressed adults receives appropriate treatment. In order to get the help we need, we need to recognize the many ways that depression can manifest.
Most people know that persistent sadness, feelings of hopelessness, and apathy are symptoms of depression, but the biology of depression is more complex. Depression can impact every system in the body and every daily activity. Suicide is a serious risk with any mental illness, but it is far from the only cause of death. For example, people with a history of depression are four times more likely to have a heart attack, so it’s crucial to get medical attention as soon as possible.
Here are five often-overlooked depression symptoms.
The first and most persistent symptom of depression is often physical pain. The pain may be located in one particular area or present as diffuse muscle or nerve pain. Patients commonly report unexplained neck tension, back spasms, headaches, and digestive disorders. Depressed patients experience more severe and longer lasting pain than their non-depressed peers.
The same neurotransmitters that affect brain chemistry also regulate our circulation, digestion, and inflammatory response. People with untreated depression, therefore, are at an increased risk of heart disease, stroke, and diabetes. They experience higher rates of arthritis, fibromyalgia, and irritable bowel syndrome.
Just as depression can cause chronic pain, chronic pain that limits our daily activities can be depressing. Many patients are told the pain is “all in their heads” while others may receive treatment for the pain but not for the underlying depression. A comprehensive care plan is required to break this vicious cycle.
Fatigue is one of the most prevalent presenting symptoms of major depressive disorder, and a third of patients whose other depressive symptoms are in remission still experience fatigue. Depressed people suffer from low energy, tiredness, weakness, and decreased physical endurance. They often feel a general sense of heaviness, slowness, or sluggishness. Physical tasks require more effort, so activity levels drop, and lack of physical exercise further reduces energy levels.
Some depressed people experience chronic insomnia, while others sleep excessively. Sleep is frequently non-restorative, so patients wake up feeling just as exhausted as when they went to bed. They face criticism and judgment when they are late for work, nod off during meetings, or back out of planned activities. When they treat daytime drowsiness with caffeine or use alcohol to induce sleep, their circadian rhythms become even more disrupted.
Prescription drugs used to treat depression sometimes cause daytime drowsiness or nighttime palpitations, but don’t give up on the medication before consulting a specialist. A psychiatrist may adjust your dose, suggest an alternative medication, or add a medication to treat sleep-related side effects. Some patients benefit from taking melatonin at bedtime, but always check with your doctor before taking over-the-counter sleep medications or supplements. Some herbal remedies like St. John’s Wort can interact dangerously with prescription drugs.
Depression-related fatigue can affect cognitive function, too. Depressed people have trouble focusing on work or school. They become forgetful, easily distracted, and slow to react to stimuli. Tasks they could previously do easily, such as memorizing phone numbers or doing simple math, become far more difficult.
Because depression impairs problem-solving and higher thinking, patients feel helpless to improve their situation. They become incapable of making decisions and lose interest in daily activities. Others mistake their cognitive fog for insensitivity or carelessness, so both their relationships and their self-image suffer.
Although antidepressants can improve mood substantially, they are less effective for treating cognitive deficits. Patients usually require a combination of medication and therapy to achieve lasting results. Cognitive behavioral therapy helps patients learn to challenge distorted thinking patterns. Cognitive remediation therapy uses specially-designed drills to improve memory and executive function.
Not every case of depression presents as sadness or hopelessness. Many depressed people feel angry or react aggressively. Harvard professor Dr. Maurizio Fava points out that irritability and uncontrolled outbursts are recognized symptoms of major depression in children and adolescents but are often ignored in adults.
“I would say 1 in 3 patients would report to me that they would lose their temper,” says Fava. “They would get angry, they would throw things or yell and scream or slam the door.” He describes these incidents as “anger attacks,” which can be just as debilitating as panic attacks.
Men are more likely to exhibit aggression, while women are more likely to direct their anger inward.
Distorted thoughts lead patients to view their co-workers and loved ones as threatening. When they fly off the handle, they feel guilty and isolate themselves to avoid further incidents. Depressed people in this state are a danger to themselves and others and need immediate attention. However, antidepressants, therapy, and anger management techniques prove effective in most cases.
Have you or your loved ones suffered from any of these depression symptoms? Share your story in the comments.