"But I don't feel that depressed..." Is it possible to be clinically depressed and not even know it? The answer is YES. As I mentioned last week, a feeling of sadness is only one component that makes up the criteria for a diagnosis of depression. Sometimes people don't acknowledge that they are feeling down because they are unable to provide an explanation for it. First of all, it's important to understand that you don't need an excuse to feel depressed! Although it could be helpful to identify a reason for the purposes of psychotherapy, there are many things that can cause depression. Not to worry; I will be reviewing the possible causes (and treatments) for depression in next week's blog post. For now, just know that you have the right to feel depressed for no apparent reason.
"I don't feel that sad. I just don't care anymore." This statement best describes apathy, which is a loss of interest in the things that were once important to you. On the other hand, "It's just not fun anymore" is a statement that best describes anhedonia. Anhedonia is a lack of pleasure in the things that you once enjoyed. If apathy and/or anhedonia are present, clinical depression can be diagnosed even when a person does not feel particularly sad. In addition, research indicates that (for adolescents) irritability can replace the feeling of sadness. Other common symptoms of depression could include changes in sleep and appetite, appearing to be either keyed up or slowed down, constant fatigue, trouble concentrating, difficulty making decisions, feelings of guilt or worthlessness, and recurrent thoughts about death.
Even though the symptoms of depression that I listed above might sound fairly straightforward, their presentation can vary a great deal from one individual to another. Consider the following two scenarios. A high school teacher calls to inform you that your 17-year-old daughter has appeared distracted in class for the past month and that she failed a recent exam in her favorite subject. When you sit down to talk with her, you notice that she seems to have lost weight. She becomes defensive and complains of stomachaches, and she also tells you that she has difficulty sleeping at night. She then blames you for failing her exam, begins crying, and withdraws to her bedroom. You decide that it's probably just her hormones and you make a mental note to attempt another conversation next week. Now let's compare your daughter's presentation to your 72-year-old father. You've been stopping by your parents' house on a regular basis only to find him asleep in front of the television. He always says that he's watching the news but he doesn't seem to have a good understanding of current events. You encourage him to get outside more and golf with his friends. However, he states that he isn't interested in golfing anymore. Furthermore, he has become less talkative during family activities, and he can't make up his mind about which birthday present to buy for your mother. You feel slightly concerned that he might have the beginning stages of Alzheimer's disease.
I'll be the first to point out that my case examples don't take into account situational stressors, health problems, the side effects of medication, alcohol consumption, etc. While it is certainly possible that your daughter's hormones are out of control and that your father is experiencing the onset of dementia, it is equally possible (based on the limited information provided above) that they are both suffering from clinical depression. Now let's factor in cultural differences, attitudes and beliefs about mental health treatment, and atypical symptoms of depression, and we can really throw a party here! All joking aside, an accurate diagnosis is extremely important. If I were to conduct an evaluation for your father and determine that he meets diagnostic criteria for depression and not dementia, then my recommendations would necessarily follow suit. With the focus geared towards improving his mood, the other issues (e.g. trouble concentrating and making decisions, anhedonia, low energy, disrupted sleep) could not only be better managed, but his symptoms could potentially be reversed altogether.