Chances are the first thing that comes to most people’s minds when they think about depression is depressed mood, right? But while depressed mood is often a major part of depressive illnesses, sometimes it plays a minor role and other times it’s not present at all.
Major depressive episode symptoms
Major depressive episodes can occur in the context of major depressive disorder, bipolar disorder, or schizoaffective disorder. For a diagnosis to be made, symptoms must be present nearly all day, nearly every day for at least two weeks.
The symptoms of depression are:
- Depressed mood
- Significant loss of interest/pleasure in almost all activities (anhedonia)
- Significant change in appetite and/or unintentional weight loss/gain.
- Disruption in sleep, which can be either insomnia or sleeping excessively
- Objectively observable changes in the speed of movements, either slowing (psychomotor retardation) or agitation
- Decreased energy
- Feelings of worthlessness or guilt that are out of proportion to the situation
- Problems with concentration and decision-making
- Suicidal ideation
Diagnosis of a major depressive episode requires at least 5 symptoms, with at least one of the first two. That means that a depression diagnosis can be made if there is anhedonia but not depressed mood.
Depression and mood
Depressed mood doesn’t necessarily involve sadness. In the melancholic subtype of depression, the quality of mood tends to be different from the sadness that one might experience with grief. I tend toward melancholic features, and sadness generally doesn’t play a very big role in my depressive big picture.
Increased negative affect
In his book Stahl’s Essential Psychopharmacology (affiliate link), Dr. Stephen Stahl identified two categories of mood symptoms: increased negative affect and decreased negative affect. Increased negative affect involves the presence of negative emotions, including:
- sadness
- guilt
- anxiety
- irritability
- loneliness
- hopelessness
Symptoms of decreased negative affect are difficult emotions that are experienced to a greater extent than they would be at baseline. Serotonin and norepinephrine appear to play a key role in these symptoms.
I occasionally experience depression-related irritability, and it is definitely not pretty.
Decreased positive affect
Decreased positive affect involves impaired ability to experience positive emotions, including:
- anhedonia (inability to experience pleasure)
- loss of interest
- amotivation
- loss of self-confidence
These symptoms represent a lack of positive things that would normally be present. Dopamine and norepinephrine appear to be the main neurotransmitters involved in these symptoms.
My guinea pigs are pretty much the only thing that can crack through the anhedonia, although not always. Blogging is cognitively stimulating and meaningful, but emotionally, it’s pretty neutral. I’ve always been pretty cerebral, so I’m fine with cognitively stimulating. Most of the things I used to enjoy (like travelling) now just feel meh.
While decreased positive affect may be easier to deal with in the moment than increased negative affect, it really can suck all the light out of life. It also seems like it’s harder to find something to sink one’s teeth into in terms of being able to create positive change.
Cognitive symptoms
I’m very organized and that allows me to compensate to some extent for the cognitive slowing, but it’s an ever-present challenge.& Decision-making is problematic. I have a very hard time processing multiple pieces of new information at once, which is something that I used to be quite good at. Spontaneous thought is difficult, whether that’s answering an unexpected question someone asks of me or formulating a thought-out response to someone’s blog posts.
I also have problems with sensory overwhelm, mostly with visual stimuli. I notice that a lot when I’m at the grocery store. Even when the store is quiet, visually it’s just a lot for my brain to process.
Effects on movement
I’ve had psychomotor retardation for the last several months, and it worsens when my mood drops. It’s like walking through molasses. It’s been a lot more consistently present this year than it has been in the past.
Depression can affect movement in other ways as well, but for me, it’s all about the psychomotor.
Overall picture
It doesn’t take much in terms of external triggers to make my mood drop, but when things are chugging along at status quo my mood isn’t all that much of an issue. It never ventures at all into good mood territory, but it’s not smacking me in the face with negativity, either. It’s more a feeling of being detached and emotionally turned off.
So yeah, I’m depressed without an especially depressed mood a fair bit of the time. Illness can present itself in many ways. Those of us with mental illness know that, but I suspect a lot of non-mentally-ill people don’t realize just how much variability there can be within a given diagnosis.
Are there ways that your illness doesn’t fit with stereotyped expectations? Do you ever experience depression without the depressed part?
Managing the Depression Puzzle takes a holistic look at the different potential pieces that might fit into your unique depression puzzle.
Off course, I have all surprising symptoms on my blog š The grocery store: 100% I avoid it as much as I can. But the struggle now for me is in all the small things – insignificant they seem to me – like brushing my teeth, doing laundry and just holding my head together. I zone out, time goes by and than I’m hyper in my mind, so weird!
I wish there was some sort of magical holding-head-together glue…
I hope there is and that holds me together sometimes.
I haven’t had any interest in doing anything in a long time. Maybe I’m depressed and I don’t know it?
Maybe
My depression sounds similar to yours, although some of the things can also be due to autism, which explains why they persist when the mood part of depression shifts (although that also explains why I’ve had trouble convincing psychiatrists that I’m on the spectrum and they try to push me into the depression box). I think I’ve had anhedonia for a lot longer than any other symptom, and my sleep disruption is impossible to shift even at times when I otherwise feel OK.
That timing really is key. Just because it could be depression in theory doesnāt make it the best explanation for what youāre actually experiencing.
Yes. The problem is that I’ve been depressed for most of my adult life, so it’s hard to find evidence of autism without depression, particularly as my parents didn’t notice anything particularly unusual, nor were there any troubles at school aside from lack of friends and being bullied. There are a few things which I need to emphasise for the autism diagnosis.
Yeah I can see how that would be hard.
Are there ways that your illness doesnāt fit with stereotyped expectations? Sure. I’m an enigma I suppose. Because while the mental health professionals agree that my ‘primary’ diagnosis is chronic depression or dysthemia; I have a lot of elements that don’t really fit that. I’m always being presented with someone’s new diagnosis for what I got. Bipolar II. Mild (?) BPD. Social Anxiety. I mean it gets tiring not knowing precisely what I have, and more importantly how to treat what I have. It’s naive, but dang I’d like to have someone definitively tell me “this is YOU” and this is why you’ve suffered. It’s not going to happen is my own opinion.
Thatās got to be super frustrating.
This is sort of like me except the slow moving part. My emotions arenāt present most of the time but I eventually break down after a while and it all comes out.
Yeah it’s weird how even during those periods of numbness things still start building up under the surface.
I get really numb and indecisive at times to the point where I literally have to tell myself what to do, out loud. āGo to the bathroom, then get dressed.ā Otherwise I might sit on the sofa all day clicking my phone.
Sometimes keeping it super-simple is the only way to get anything at all done.
Thank you.
Wearing dark glasses and a brimmed hat in the supermarket might help.
Xxx
Those are good ideas! xo
Whoaš¶ needed to read this
Indecision is a big one, as well as the significant mental energy I expend anytime I need to leave the house. :-/
Yes it’s exhausting!
Yes, it totally can be! I’m definitely one of those who cherishes and needs time to rejuvenate after social interaction, even if it’s with people I love and adore.
Yes, me too. ā¤ļø
I love guinea pigs. Iām hoping you can one day feel happy
Thanks! š
A wonderful post. I relate so closely. The expansiveness of depression really hit home. Thanks for writing this.
Suicidal ideation is constant to me. The only thing holding me back is my hemophobia.
That’s got to be really hard.
It is. And with the type of support I have (which is zero) it makes it even harder.
I can imagine.