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:
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
- 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.
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.
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?