Depression can be insidious, affecting people in different ways with warning signs that aren’t always obvious.
“Sometimes you are the last to know,” Dr. Samantha Boardman, a New York City psychiatrist, tells TODAY.com.
“The people around you, the people who you spend time with are the ones who are aware of it before you are.”
Almost 1 in 5 U.S. adults, 19%, say they currently have depression or are being treated for it, a rate hovering near the historical high, Gallup reported. Depression rates have “risen dramatically” among younger adults, it noted.
Feeling sad for two weeks or longer to the point where it interferes with everyday life is a major symptom, according to the Centers for Disease Control and Prevention.
But there can be more subtle warning signs of depression, Boardman says.
She practices positive psychology, which focuses on optimism, resilience and post-traumatic growth.
“It’s really looking at those other questions — not just what’s wrong, but what’s strong?” says Boardman, who helps people find wellness within mental illness.
“What is somebody’s strength? Tell me about a time you were at your best. How can you do more of that? Kind of getting people out of their heads rather than that self-focus and self-immersion that I think sometimes modern therapy is very focused on.”
When it comes to depression, Boardman doesn’t want people to start over-diagnosing themselves. There’s a difference between sadness and a depressive episode, she emphasizes. There are also different types of depression.
It’s important to look for a cluster of symptoms and a marked change from a person’s normal behavior, rather than making a quick diagnosis based on a little snapshot of a day, she cautions.
“One has to be very careful about quickly putting a label on something and saying, ‘This is who I am, this is what I have,’” Boardman says.
Knowing what she knows, here are the subtle symptoms of depression the psychiatrist would monitor in herself:
Change in Appetite
This could mean eating more or eating less than usual. “Am I forgetting about food?” Boardman might ask herself.
Change in Sleep Patterns
Sleeping more or sleeping less could both be signs of depression.
“Usually, I sleep eight hours a night, no problem, and for the past months, I can’t get to sleep or I’m staying in bed. I just feel like lounging in bed all day. I feel like bed rotting,” the doctor says.
Lack of Interest in Things You Used to Enjoy
The loss of pleasure in activities that once brought joy is known as anhedonia.
“Somebody (might) say, ‘Do you want to go to a concert? I’ve got tickets for Harry Styles,’ and you love Harry Styles, but you just don’t feel like it,” Boardman says.
“Because it’s the absence of something rather than the addition of something, it’s sort of a hard thing to notice. That’s sometimes where friends or loved ones will notice that in you.”
Social Withdrawal
Are you pulling away from friends and family, or canceling plans? Boardman calls this a “huge” warning sign.
Irritation
Feeling frustrated, irritated, agitated or easily on edge can be a clue.
Having a Hard Time Concentrating
“I have five emails to return at work, and it takes me usually 10 minutes to do that. It’s taking me an hour,” Boardman says.
Self-Neglect
If somebody who typically likes to present herself in a certain way to the world is suddenly not doing that, it could be a warning sign. An example is a person who has always found it important to have beautifully coiffed hair and manicured nails, but is now showing up with unwashed hair or chipped nails.
“There’s a change in their presentation in the world,” Boardman notes.
Poor Posture
The psychiatrist sometimes sees patients holding themselves differently, describing it as “folding in” on themselves. People with depressive symptoms can have a slumped posture, studies have found.
They may also slow down, like they’re “moving through molasses,” or speak more slowly or with a softer voice, Boardman says.
Rumination
This means dwelling on negative thoughts and feelings, and replaying them on a loop, according to the American Psychiatric Association. It can be an “on ramp to depression,” Boardman warns.
“You find yourself just rehashing, rehashing, rehashing something,” the doctor notes.
“You get sort of stuck. … Why did this happen? What’s going on? Why am I feeling this way?”
Best Self-Help for Depression
Depression can be treated with therapy and medication. But there are also simple but powerful antidotes to the milder form of depression known as dysthymia, the psychiatrist says.
“When this sort of does sneak up on you, the response is to shut down, to withdraw, to cancel your plans,” Boardman says.
“We often hear: Be yourself … (but) this is exactly where you need to do the very opposite of the thing that you feel like doing.”
Walk
The easiest way to improve mental health is to go for a walk, preferably outside because nature is calming and a powerful stress reducer, so it can provide a reset button, the doctor notes.
“Even when I don’t feel like it, when it’s pouring with rain, I walk,” Boardman says.
“We know that being outdoors is great. Movement outdoors is even better. Movement outdoors with somebody else even better.”
Do Something for Someone Else
Boardman sometimes prescribes volunteer work for patients.
“It’s a powerful way to not only distract but to give you that sense of agency — that you have a certain control over something and that you’re contributing to something beyond yourself,” she says.
Practice Self-Distancing
Instead of self-focus and self-immersion, give yourself some perspective.
Boardman suggests asking yourself:
- What advice would I give to a friend in this moment?
- What would I think about the situation a month or two from now?
- How would a fly on the wall describe this?
Depression is episodic — it comes and it goes, Boardman says, pointing to a quote poet Robert Lowell once wrote in a letter to a friend: “Life swims back.”
If you’re severely depressed and need immediate help, call or text 988, the Suicide and Crisis Lifeline.