Unmasking Depression

by Charles H. Booras, MD

7/19/98

When you think of depression you may think of "feeling blue" or "being down in the dumps." These feelings certainly are a part of depression for most people. But for others, depression may be hidden beneath other symptoms that seem to have nothing to do with "the blues."

Perhaps you suspect that you have depression, but just aren't sure. Perhaps a family member, friend, or even your doctor has suggested that you might be depressed.

This was written to help you recognize and understand some of the less obvious symptoms of depression so that you feel more comfortable discussing the way you feel with your doctor.

Sometimes it's difficult to take the first step and talk to someone about depression. But there's no reason to feel embarrassed or ashamed. Depression is not a sign of weakness: it is a disorder that responds well to various treatment programs. You might be surprised at how soon you could be feeling better.

Towards the end you'll find a questionnaire that might help bring some of your "hidden" symptoms out into the open. Filling it out could make it easier to explain what's been bothering you to your doctor.

A quick look at the facts

More people are affected by depression than you might think. In fact, in the United States alone, 5% of the population may have depression at any given time. Researchers believe that between 10% and 25% of all people in the United States will experience a major depression at some time in their lives.

Depression strikes backgrounds, ages, possible causes people of all nationalities, and lifestyles. Some of the potential causes that researchers have suggested are genetic (inherited) factors, various life events and stresses, and "chemical imbalances" in the body.

But depression is almost always caused by a combination of factors in a person's life. Sometimes it may be possible to pinpoint a certain life event that may have set off a depression. But for other people, depression seems to strike for no reason at all, even when life is going well.

Fortunately, early recognition and treatment programs seem to decrease the length and severity of depressive episodes for most people.

Some of the ways depression can be "masked"

Feelings of sadness or unhappiness are of course common symptoms of depression. But as we've mentioned, some of the other aspects of depression may be difficult to recognize for what they really are since some physical symptoms may be more noticeable than emotional or mood symptoms.

Someone might, for example, have chronic aches and pains or digestive problems that just can't be explained and don't ever seem to get better. Another person may feel tired all the time, yet be unable to sleep. Some people oversleep but yet never quite feel rested when they awaken. Some people overeat and yet others may find that they have no appetite at all for their favorite foods and begin to lose weight. Various combinations of these physical effects are also common.

Symptoms of depression that show up as changes in bodily function are known as somatic or physical effects. Let's take a closer look at some of them.

  • Fatigue.

Do you feel tired most of the time?

People who are depressed often do, no matter how many hours of sleep they get. Sleeping seldom relieves the fatigue and loss of energy that come with depression.

To make matters worse, many depressed people are troubled by insomnia. They may have difficulty falling asleep or staying asleep or they may wake too early in the morning and be unable to get back to sleep.

On the other hand, some depressed people find they want to sleep all the time. But no matter how much sleep they get, they still feel exhausted.

You may have heard of the disabling conditions known as "chronic fatigue syndrome" or "Fibromyalgia." Researchers are still debating the possible causes and treatments, but some believe that in certain cases, these disorders may be related to the same chemical imbalance that causes many cases of depression. For these people, treatment with antidepressant medication can be helpful.

Fatigue and lack of energy can complicate other problems depressed people have, such as loss of interest in formerly pleasurable activities, including sex.

  • Appetite changes.

Most commonly, people who are depressed lose appetite and weight. Some people, however, experience an increase in appetite and a consequent weight gain; this is less common but does occur.

  • Chronic pain and other unexplained health changes.

Depression can make itself known through persistent, recurrent headaches, backaches, or stomachaches that seem to have no cause. Unexplained pains may appear, migrate from one side of the body to the other and disappear when depression lifts. Depressed people also commonly complain of a range of problems with the digestive system, including dry mouth, constipation, and less commonly, diarrhea.

  • Worrying and Irritability.

Being constantly worried, anxious, or concerned over everyday matters doesn't mean you're "just a worry wart" - it could mean you're depressed. Depressed people frequently have persistent negative thoughts about their lives and future. Anxiety, which is defined as a sense of dread that something terrible yet unknown will happen, is common with depression and can be extremely troubling. Exaggerated fears about specific situations (phobias) can occur as well.

Increased irritability with family members, coworkers or others is another often missed sign of depression. Problems with memory and concentration are also common.

Test yourself to see if you have symptoms of depression

A test for depression, known as "The Wakefield Questionnaire," has been included here to help you become more familiar with some signs and symptoms of depression that you may have overlooked.

You don't have to learn to live with it.

The single most important step you can take is to tell your doctor if you suspect you are depressed. Many treatment options are available for depression. But first, there's a simple but important step to take: talking to your doctor. Your primary care doctor is a good person to talk to first, because he or she already knows a good deal about your history and your health. Once your doctor has taken depression into consideration, it is usually easy to confirm or rule out the disorder. Relief from what's bothering you could be right around the corner.

Fortunately, depression is a treatable illness that responds extremely well to a wide variety of treatment programs that are not habit-forming. The best therapy is one that includes counseling in addition to appropriate use of medication.

An herbal supplement, St. John's Wort, has proven helpful in treating mild to moderate depression but should not be used unless first cleared by your personal physician. Standard antidepressant treatments should be substituted if the depression does not lift or worsens after one or two months of taking St. John's Wort. This product should not be used for more severe depression.

Bring along this questionnaire… it will make it easier to explain how you are feeling. Together you and your doctor can determine whether or not you have depression. Then the two of you can decide on an appropriate treatment program.

Modified from information provided by
Pfizer Pharmaceuticals
and Principal Health Care, Inc.


For more information on depression

Depression / Awareness, Recognition and Treatment (D/ART)

National Institute of Mental Health
5600 Fishers Lane
Rockville, MD 20857
(800) 421-4211

National Depressive and Manic Depressive Association (NDMDA)

730 North Franklin Street
Chicago, IL 60610
(800) 82-NDMDA

John H. Greist, MD and James W. Jefferson, MD, "Depression and Antidepressants: A Guide" and "Depression and Its Treatment"

Dean Foundation for Health, Research and Education
2711 Allen Blvd.
Middleton, WI 53562
(608) 836-7000

National Mental Health Association (NMHA)

1021 Prince Street
Alexandria, VA 22314
(900) 969-NM HA

TGila Web Productions
(904) 739-2292