Some of the symptoms of depression include sleep disturbances, suicidal ideation, and low mood. If some of these symptoms persist for two weeks are more, that is usually sufficient to arrive at the diagnosis of major depression (major depressive disorder). However, outside of these common key features of depression, the illness can also manifest itself in other ways. These other expressions of a depressive episode are just as real and cause significant distress to the individual. It can also be confusing to the person living through this experience. Let’s take a look at some of the lesser known signs and symptoms of depression.
Rumination
For some, a particularly harmful and taxing feature of depression is rumination. The original meaning of this word describes the action of animals known as ruminants, such as cows, who regurgitate their food and chew on it and repeat this cycle over and over again. The mental equivalent of this is reliving and rehashing some unpleasant experience. An example of this would be if during your last zoom meeting, your co-worker asked you a question that you weren’t prepared to answer. You momentarily stutter before responding that you would have to get back to them with the information. That evening and the next few days to come, you have vivid, intrusive thoughts wherein you mentally re-enact the incident over and over again. The images of the event play in your mind repeatedly like a horror movie that you would rather not see. You incessantly think about what you could have done differently. You wince and cringe thinking about that excruciating moment when the question was asked. You may wish you could stop reliving that moment but it seems almost involuntary. You feel haunted by the scenes. This may go on for weeks for some people. This is what the unpleasant experience of rumination can feel like.
Lack of Motivation
Motivation drives our efforts and keeps us moving forward in life. While in a depressive episode, a person may find that the motivation to get through the day remains just beyond their fingertips. Lack of motivation doesn’t just mean not being able to do big things like starting that new business. It can also mean not being able to complete simple daily tasks. It can make brushing your teeth feel like a huge feat. When depression has zapped your motivation, you can have the intention of getting some groceries. You know you need to get out the door, after all, there’s practically nothing in your fridge but a few soy sauce packets and a questionable burrito. You put one shoe on, then sit on the couch, and just stare. Then you manage to get the other shoe on, but you can’t immediately find your keys. You get demoralized and never make it to the store. This is a particularly detrimental symptom of depression because there are lifestyle changes such as exercise, a balanced diet, and a meditation practice that can be helpful with alleviating depression. However, without the motivation that turns good intentions into good behaviors, frustration with oneself instead of meaningful change is the inevitable result. Many patients amaze themselves when they are in recovery from depression because they are able to do the laundry, fold it, and put it away all in the same day.
Anger and Irritability
There are certainly times in life when anger is justified and makes sense. However, with depression, anger can linger for longer than makes sense for the situation and also be out of proportion. Expressed anger correlates with higher intensity of depressive symptoms. If you find yourself boiling with fury because your partner ate the last banana or the barista spelled your name incorrectly on your coffee cup, that could be evidence of an underlying depression.
Nightmares
Although each individual may experience a different constellation of depressive symptoms, sleep disturbances are one of the more common experiences within the disorder. This may include insomnia or the need for excessive sleep, also known as hypersomnia. A lesser discussed subcategory of sleep disturbances that results from depression is nightmares. In one study of armed forces members and veterans, up to 88% of treatment seeking depressed participants reported trauma-related nightmares. This is particularly concerning given that the experience of recurrent nightmares within a depressive episode is associated with an increase in suicidality.
Difficulty Making Decisions
The process of making a choice involves the weighing of potential risks and rewards of a particular course of action. In depression, a person’s tendency to focus more on the possible negative outcomes of any decision made, may render one incapable of choosing anything. They may be unable to connect to the value or benefits of a given option. Furthermore, decision making involves confidence in your ability to appropriately weigh pros and cons. It also means acceptance of the fact that the outcome of your choice cannot be fully known. Depression can rob someone of the self-reliance and confidence that is part of making even the simplest choice.
Depression Without Sadness
Depression can present without the emotional experience of sadness. One contribution to this may be that in some cultures, sadness is considered weakness so someone may subconsciously suppress it. A good example of this is children who grew up in a home where you were told ‘finish your food’ even if you were full. Those individuals are more likely to struggle with overeating because there may be confusion about whether or not they are full. The adults in your life are always right when you are a child and they told you that you weren’t full. This confusion can translate to emotions not being acknowledged or accepted. If you were told ‘stop crying’ when you were a child, you may identify with this. It is also true that sadness doesn’t always get people’s attention. Some are willing to be sad and continue on with their life. People often seek treatment for depression, not because of sadness, but when the other symptoms of depression start interfering with their ability to function. These symptoms include crippling insomnia or mental fogginess that keeps them from performing at work or studying. Those symptoms will grab someone’s attention and get them onto a psychiatrist’s couch.
Physical Pain
The mind and body relationship is not fully understood. We do know that if you are extremely anxious, that could lead to an increase in your heart rate. Or if you see your crush, you can have the experience of butterflies in your stomach and your face can turn red. So, your mental experience can have physical manifestations. In psychiatry, the general term for this is ‘somatic,’ which is when psychological symptoms show up as some sort of biological sensation. In depression, many people report aches and pains in their body. Some may go to doctor after doctor and see a variety of specialists who never find an adequate explanation for what they are feeling. This, of course, can be extremely frustrating and confusing to the patient and their healthcare providers.
A Word From Verywell
Depression can negatively impact a person’s function, subtract from the quality of life, and steal the joy out of life. Exactly how it expresses itself, can vary depending on the individual. Whether or not a depressive episode fits neatly within the DSM-5 criteria or not, it can still have devastating consequences including suicide. If you find yourself or someone you care about with any of the symptoms above, it may be time to be evaluated by a mental health professional or your primary care doctor. You may benefit from being formally diagnosed and hearing some treatment options. For more mental health resources, see our National Helpline Database.
