3 Subtle Ways Depression May Manifest

Recently a client, I’ll call him John, reported that he was feeling more irritable, short-tempered and reactive. He also mentioned that he was feeling forgetful lately, which wasn’t something he usually struggled with. I started to wonder if he was experiencing some symptoms of depression, so I asked a few follow-up questions. Turns out, he wasn’t sleeping as well as he usually does, and he just felt tired a lot.

Depression is a complex mental illness that affects millions of people worldwide, and it can look different from person to person.

While some individuals may exhibit obvious symptoms, like persistent sadness, feelings of hopelessness, or loss of interest in activities, others may experience more subtle symptoms that often go unnoticed, or aren’t obviously associated with depression. Recognizing these subtle signs is crucial for early intervention and support, and can help someone with depression feel less shame.

Let’s explore three subtle ways that depression may manifest.

1. Irritability

While depression is commonly associated with feelings of sadness and emptiness, it can also manifest as irritability and unexplained anger. This aspect of depression is often misunderstood or overlooked, especially when individuals exhibit irritability rather than classic depressive symptoms. Research suggests that irritability is a prevalent and distinct symptom of depression, particularly among adolescents and adults.

The science behind this lies in the disrupted neurobiology of depression. Studies have shown that individuals with depression may have altered neurotransmitter levels, specifically involving serotonin and norepinephrine, which can contribute to changes in mood regulation. When depression manifests as irritability, individuals may become easily frustrated, short-tempered, and prone to outbursts.

Recognizing irritability as a potential sign of depression is essential for accurate diagnosis and treatment. Addressing this symptom can lead to more effective management of the underlying depressive disorder, which will in turn improve an individual’s quality of life and their relationships.

In therapy, we can help a client with this symptom of depression develop patience and compassion toward their irritable and angry parts. We can also support a client in developing compassion for their angry and irritable feelings and build healthy ways to address this challenging symptom of depression. With help and self-awareness, this irritability can lead to new opportunities for healing and growth.

2. Physical Pain

Depression is not solely confined to emotional symptoms; it can also manifest through various physical ailments. These can include unexplained headaches, chronic pain, and fatigue. Chronic stress associated with depression can also lead to increased muscle tension and heightened sensitivity to pain signals.

Another common physical ailment linked to depression is gastrointestinal distress. Symptoms such as nausea, diarrhea, constipation, and abdominal pain frequently co-occur with depressive disorders. The gut-brain axis, a bidirectional communication system between the gut and the central nervous system, plays a key role in this relationship.

Dysregulation of this axis due to depression can disrupt normal gut function, leading to inflammation, altered gut motility, and changes in gut microbiota composition. These disturbances not only contribute to gastrointestinal symptoms but also impact overall immune function and increase inflammation.

Paying attention to what is going on in our gut is very important to our overall well-being. You know that term, “gut instincts”? Our gut is very wise in a lot of ways. In fact, our gut is sometimes called our “second brain”! Honoring the information we are getting, even if it is literally uncomfortable, can lead to some important insights and pathways for healing.

In addition to gastro-intestinal symptoms, depression often disrupts sleep patterns, resulting in insomnia or excessive sleeping. Sleep disturbances, in turn, can exacerbate physical symptoms and contribute to a vicious cycle of poor mental and physical health. Talk with your therapist about your sleep patterns and how you can improve your sleep hygiene. There are excellent guided meditation and “yoga nidra” recordings on YouTube, InsightTimer or other apps that can help relax the body and mind in preparation for a good night’s sleep. Exercise is also a big help in improving sleep and alleviating symptoms of depression.

Recognizing physical symptoms as potential indicators of depression is crucial. Treating both the mental and physical aspects of depression will significantly improve a person’s life.

3. Cognitive Changes

Depression can subtly affect cognitive functioning, leading to difficulties in concentration, memory problems, and indecisiveness. These cognitive changes can significantly impact productivity. People experiencing depression often have “brain fog” and feel unfocused, which in turn contributes to self-criticism and low mood. And the cycle continues until there is intervention. But there is help available! With tailored help, many of the cognitive symptoms of depression are greatly alleviated or disappear completely once the depression is resolved.

Neurobiological studies have revealed that depression is associated with structural and functional changes in certain brain regions, particularly those involved in cognitive processing. Reduced volumes of the hippocampus and prefrontal cortex, areas critical for memory and executive functions, have been observed in individuals with depression.

Neurotransmitter imbalances, such as decreased dopamine levels, can contribute to cognitive impairments commonly seen in depression. These changes may manifest as forgetfulness, mental fog, and an overall sense of cognitive sluggishness.

Recognizing cognitive symptoms is vital for receiving tailored treatment. Therapy modalities such as Internal Family Systems (IFS), Cognitive-behavioral therapy (CBT) and other interventions aimed at addressing cognitive distortions can be particularly effective in managing these aspects of depression.

Next Steps

My client John didn’t like the fact that he was having symptoms of depression, but he did tell me that he was relieved to know what was going on. Together, we put together an action plan for him that started with getting “back to basics” including drinking enough water each day, paying attention to his eating including getting sufficient protein and fiber each day, and prioritizing a regular bedtime. He also talked in therapy about the life stressors that have been contributing to his feelings of depression, including conflict with his spouse over parenting their teenage daughter, and feeling stuck at work.

Within a few weeks, John was starting to feel some relief. He said it felt good to be focusing on himself for a change, instead of just “pushing through” and being strong for everyone around him. He mentioned that his mother had struggled with depression but had never gotten help, and he began to have new insights about how her untreated depression impacted him and his siblings growing up. This awareness made him even more motivated to address his mood and to model healthy choices for his own daughter.

Depression can manifest in various subtle ways beyond traditional emotional symptoms, and understanding these more subtle symptoms is crucial for early detection and appropriate intervention.

Addressing these subtle signs can help you better manage and overcome your depression. Think you might be struggling with these subtler signs of depression? We can help—reach out today to schedule an appointment.