The Many Faces of Depression

The many faces of depression: sad, hopeless, anxious, numb, irritable

Depression – it’s one word to describe so many different things. The many faces of depression means that no one person’s experience can ever capture what depression is. It’s a simple word for a complex illness, so let’s chat a bit about what that complexity can look like.

Major depressive episode symptoms

The possible symptoms of a major depressive episode are the same whether it occurs in major depressive disorder, bipolar disorder, schizoaffective disorder, or any other depressive. These include:

  • depressed mood, including feeling sad, hopeless, or irritable
  • lack of interest/pleasure (anhedonia)
  • decreased or increased appetite, with weight loss or gain
  • insomnia or hypersomnia (sleeping excessively)
  • psychomotor retardation or agitation
  • fatigue
  • feeling worthless/guilty
  • decreased concentration
  • suicidal ideation

Melancholic features

There are a few different subtype specifiers for depression that may apply if the depressive symptoms follow a particular pattern. One of these is melancholic features, which tends to involve these symptoms, although not necessarily all of them:

  • anhedonia
  • lack of mood reactivity to positive events
  • depressed mood feels subjectively different from grief/loss
  • decreased appetite
  • psychomotor agitation or retardation
  • early morning awakening
  • excessive guilt
  • mood worse in the morning

Atypical features

Depression with atypical features involves these symptoms:

  • mood reactivity, i.e. mood brightens in response to positive events
  • increased appetite
  • hypersomnia
  • leaden paralysis (feeling heavily weighed down by fatigue)
  • longstanding pattern of interpersonal rejection sensitivity

Atypical depression doesn’t get that name because it’s uncommon; it’s because the mood reactivity, appetite, and sleep are opposite from what’s typically seen in melancholic depression.

Different people, different patterns

There are also assorted other depressive diagnoses and features, like persistent depressive disorder (previously known as dysthymia), premenstrual dysphoric disorder (PMDD), seasonal features (seasonal affective disorder), peripartum onset, etc. It’s quite the diverse set of options, with room for a lot of different faces of depression for different people.

How much overlap is there biologically? That’s still not clear. There’s been some debate about whether melancholic and atypical depression are different illnesses from one another, but given that the DSM is categorical in nature rather than being aligned with specific biological processes, it probably doesn’t really matter one way or the other.

While different people can have very different patterns of symptoms that they experience, I think there’s still a lot of commonality in having a mind that doesn’t behave the way we’d like it to.

Same person, different patterns

For the same person, the pattern of symptoms may vary over time, and certain symptoms may respond differently to different medications. Same person, different faces of depression.

I’ve generally tended towards melancholic features. The anhedonia and psychomotor retardation have become quite treatment-resistant over the last few years, and the psychomotor symptoms have had a huge impact on my level of functioning, but meds mostly keep my other symptoms reasonably reined in.

Not always, though. Late August through September tends to be a bad time for me, and this year, my sleep and appetite were bad, and I was irritable, crying a lot, and having guilt try to poke its way into my head. Fuck off, guilt, I don’t want you in my head!

Irritability flares up periodically when I’m depressed. It doesn’t happen that often, but when it does, I don’t have much control over it. Anhedonia is the most consistent mood feature. I suppose I have the melancholic depressed mood that’s subjectively different from grief. Sadness doesn’t tend to play a big role in my depression; I would describe it more as a sense of the mental version of physical pain. Being without hope has become pretty much a constant, but more active feelings of hopelessness don’t intrude too much as long as I’m well-medicated.

I’m naturally a morning person, so the worsening of mood in the morning that’s often a part of melancholic depression only tends to happen when I’m unmedicated or really under-medicated.

I’ve never had atypical features; when my sleep and appetite are affected, they’re decreased.

Making room for diverse faces of depression

Sometimes I see bloggers write that they’re not sure if they should share their experiences because there are already so many people writing about mental health. I think the diversity of mental illness experiences makes it extra important that as many people share their stories as possible. The more people that are talking, the more likely it easy that everyone will be able to find someone who’s going through something similar.

If you’ve experienced depression, have you noticed changes in your pattern of symptoms over time? What faces does your depression wear?

book cover: Managing the Depression Puzzle, 2nd Edition, by Ashley L. Peterson

Managing the Depression Puzzle takes a holistic look at the different potential pieces that might fit into your unique depression puzzle.

It’s available on Amazon and Google Play.

So you've just been diagnosed with... [ mental illness]

The So You’ve Just Been Diagnosed with… [a Mental Disorder] page brings together information, advice, and resources from people who’ve been there. New input is always welcome!

36 thoughts on “The Many Faces of Depression”

  1. I’m sorry that you’re going through it. Yes, I absolutely agree that as many people as possible should be sharing their stories, so that we all know how common mental health problems are. I don’t like the world where only positive emotions and success have it’s place.

    Well done for making all this effort to create this blog and write books. I’ll keep my fingers crossed for you.

  2. Do they have a term for when you are depressed one hour and maybe less depressed another hour… all in the same day? There are those times when I feel I can get better overtime throughout a given day, but it’s a day by day thing.

    1. The term labile would be used if there were significant swings in mood, or reactive if mood was shifting in response to things that were happening, but I can’t think of a specific clinical term for mild ups and downs throughout the day.

        1. That’s part of my diagnosis 😌. I like to toss out the word “labile” because many don’t know it and also because it feels vaguely naughty. i have no idea why.

  3. I think I experience all those things on the top chart from time to time (sad, anxious, hopeless, numb & irritable.) But when I do, they’re fairly easily transcended, although sometimes I have to work at it. I don’t think I would qualify as having major depressive disorder or any similar diagnosis; that is to say, physiologically. It’s not the way I’m wired. My mental health challenges are in another area.

  4. Thank you for the informative post as always….. Still digesting the difference between clinical depression and anxiety. And how anxiety affects me versus how depression does.

    While my diagnosis is bipolar, I find that what presents most often for me is feelings of anxiety. Clinical depression for me has really only existed a handful of times in the last 35 years. At those times it was as if my whole world were turned upside down and everything was really really slow moving and I was prone to isolate and to find little pleasure in everyday things.

    With the anxiety my world doesn’t get turned upside down as much but my anxiety is so bad I project six or 12 months out into the future and keep mental track of items I think will be creating anxiety for the next year. Who does that? It is the epitome of needing to be in the present versus not being that. My anxiety is always pushing me 6 months ahead or 12 months ahead. The words living in the moment are soo telling for me since my anxiety propels me 6 to 12 months forward. So much can change in that time. Crazy to be obsessing over things that won’t occur for a year…!

  5. Whenever someone mentions the face of depression, I always think of the pictures taken shortly before people commited suicide, where the victims appear completely happy. Chester Bennington, the singer for Linkin Park, was performing and taking pictures smiling with his family just before hanging himself. It’s a shame, but depression can be totally invisible.

  6. I don’t think it’s helpful for me to rehash my own history of depression, but I was very fortunate to find a good therapist a couple years ago who challenged me hard on my negative thought patterns. Right before Covid shut everything down last year, we started doing EMDR therapy. Between the talking and the EMDR things turned around for me dramatically. I’m not cured–I don’t think you’re ever cured–but my mood and outlook improved greatly. I don’t want to be the way I was ever again.

  7. I have some features of both, always have. My dwpressed mood is also pretty labile but there’s definitely distinct subjective differences between when I’m depressed versus grieving.

  8. The labeling struggle I have is actually whether to use the label of “depressed” or “depression” in the first place. It feels dishonest as I’ve not been formally diagnosed (I had started therapy and I liked my therapist, but I really never managed to broach this particular challenge, which is telling in itself. In any case, I’m not seeing a therapist at present). It also feels dishonest because I have a job and a marriage and a family, so I’m managing, right? But I read these lists of symptoms that seem spot-on and persistent, and I’ve not managed to be truly honest (in blog or in therapy) about the many ways in which I’m not managing at all.

    TL;DR – there’s a lot that resonates when I read about depression, but my situation doesn’t seem bad enough so idk if it makes sense to label myself

  9. I like the point you make about depression being diverse enough. I also write about depression, self-help, writing tips, because as a writer depression goes hand-in-hand with me. Thanks for breaking down all of the various types.

  10. In the last 4 years I have experienced all of those, I realized I was deeply depressed a year back and the worst thing is that where I live and especially in my family no one really believes in depression and mental health so I have to deal and try to heal and survive on my own. This really helped me. thank you

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