6 Secret Signs of Hidden Depression

-John M. Grohol, Psy.D.

Lots of people walk through life trying to hide their depression. Some people with hidden depression can conceal their depression like pros, masking their symptoms and putting on a “happy face” for most others.

People with concealed depression or hidden depression often don’t want to acknowledge the severity of their depressive feelings. They believe that if they just continue living their life, the depression will just go away on its own. In a few cases, this may work. But for most folks, it just drags out the feelings of sadness and loneliness.

Dealing with the black dog of depression through concealing one’s true feelings is the way many of us were brought up — we don’t talk about our feelings and we don’t burden others with our troubles. But if a friend or family member is going through something like this — trying to hide or mask their depression — these signs might help you discover what they’re trying to keep concealed.

6 Signs of Concealed Depression

1. They have unusual sleep, eating or drinking habits that differ from their normal ones.

When a person seems to have changed the way they sleep or eat in significant ways, that’s often a sign that something is wrong. Sleep is the foundation of both good health and mental health. When a person can’t sleep (or sleeps for far too long) every day, that may be a sign of hidden depression.

Others turn to food or alcohol to try and quash their feelings. Overeating can help someone who is depressed feel full, which in turn helps them feel less emotionally empty inside. Drinking may be used to help cover up the feelings of sadness and loneliness that often accompany depression. Sometimes a person will go in the other direction too — losing all interest in food or drinking, because they see no point in it, or it brings them no joy.

2. They wear a forced “happy face” and are always making excuses.

We’ve all seen someone who seems like they are trying to force happiness. It’s a mask we all wear from time to time. But in most cases, the mask wears thin the longer you spend time with the person who’s wearing it. That’s why lots of people with hidden depression try not to spend any more time with others than they absolutely have to. They seem to always have a quick and ready excuse for not being able to hang out, go to dinner, or see you.

It’s hard to see behind the mask of happiness that people with hidden depression wear. Sometimes you can catch a glimpse of it in a moment of honesty, or when there’s a conversation lull.

3. They may talk more philosophically than normal.

When you do finally catch up with a person with masked depression, you may find the conversation turning to philosophical topics they don’t normally talk much about. These might include the meaning of life, or what their life has amounted to so far. They may even open up enough to acknowledge occasional thoughts of wanting to hurt themselves or even thoughts of death. They may talk about finding happiness or a better path in the journey of life.

These kinds of topics may be a sign that a person is struggling internally with darker thoughts that they dare not share.

4. They may put out a cry for help, only to take it back.

People with hidden depression struggle fiercely with keeping it hidden. Sometimes, they give up the struggle to conceal their true feelings and so they tell someone about it. They may even take the first step and make an appointment with a doctor or therapist, and a handful will even will make it to the first session.

But then they wake up the next day and realize they’ve gone too far. Seeking out help for their depression would be admitting they truly are depressed. That is an acknowledgment that many people with concealed depression struggle with and cannot make. Nobody else is allowed to see their weakness.

5. They feel things more intensely than normal.

A person with masked depression often feels emotions more intensely than others. This might come across as someone who doesn’t normally cry while watching a TV show or movie suddenly breaks out in tears during a poignant scene. Or someone who doesn’t normally get angry about anything suddenly gets very mad at a driver who cut them off in traffic. Or someone who doesn’t usually express terms of endearment suddenly is telling you that they love you.

It’s like by keeping their depressive feelings all boxed up, other feelings leak out around the edges more easily.

6. They may look at things with a less optimistic point of view than usual.

Psychologists refer to this phenomenon as depressive realism, and there’s some research evidence to suggest that it’s true. When a person suffers from depression, they may actually have a more realistic picture of the world around them and their impact on it. People who aren’t depressed, on the other hand, tend to be more optimistic and have expectations that aren’t as grounded in their actual circumstances. Non-depressed people believed they performed better on laboratory tasks than they actually did, compared to people with depression (Moore & Fresco, 2012).

It’s sometimes harder to cover-up this depressive realism, because the difference in attitude may be very small and not come across as something “depressing.” Instead of saying, “I really think I’ll get that promotion this time!” after having been passed over it four previous times, they may say, “Well, I’m up for that promotion again, but I doubt I’ll get it.”

Early Childhood Language Skills May Impact Depression Risk

-Rick Nauert, PhD

Emerging research suggests language skills children possess early in life can predict the likelihood they may experience depression.

Childhood depression can lead to social, emotional, and academic setbacks during childhood and later in life. According to the American Academy of Child and Adolescent Psychiatry, about one in 20 children and adolescents in the general population suffers from depression at some point.

Children under stress, who experience loss, or who have attentional, learning, conduct, or anxiety disorders are at a higher risk for depression. Depression also tends to run in families.

University of Missouri investigators discovered that children who experience low levels of language learning stimulation beginning at three years of age are more likely to experience language delays by first grade. The children are then three times more likely to develop depression by third grade.

“It is clear that the amount of language that children are exposed to early on is very important for their development,” said Dr. Keith Herman, a professor in University of Missouri’s College of Education.

Kids can experience language via a variety of sources.

“Whether it is through pre-school classes, interactions with parents and siblings, or through consuming media such as television and books, exposure to greater amounts of language and vocabulary will help prepare children to succeed socially and academically when they begin school.”

Researchers discovered falling behind on language can lead to social and academic deficits by the first grade. Thereafter, chances are they will continue to fall further behind in school each year, which can lead to negative self-perceptions and depressive symptoms by third grade.

The study appears in the journal Prevention Science.

Herman and a team of researchers examined data from 587 children and households in Hawaii. The data included children’s language skills and exposure to language stimulation in the home beginning at age three.

The children were tested on their language skills in the first grade and then tested for depressive symptoms in the third grade.

The children who had higher language exposure and stimulation as three-year-olds were more likely to have adequate to better-than-average language skills in first grade. They also were much less likely to experience depression by the third grade.

Children who did not receive adequate language stimulation early in life were much more likely to have poor language skills and ultimately experience depression.

“These findings are important because we have been able to identify key stages of child development that can help determine the mental health of children later in their academic careers,” Herman said.

“By understanding that the amount of language a child is exposed to early in life is important, we can create interventions and programs that can help parents and childcare providers improve language exposure during this critical development age,” he said.

“Also, we can identify first graders who may lack language skills and give them extra attention to help catch them up academically and socially before they develop depression.”

The study was coauthored by Daniel Cohen, Sarah Owens, Tracey Latimore, Wendy M. Reinke, Lori Burrell, Elizabeth McFarlane and Anne Duggan.

4 Disorders That Resemble, But Aren’t, Depression

Why it never hurts to get a blood test before diagnosis.

-Ralph Ryback, MD

“It ain’t what you don’t know that gets you into trouble. It is what you know for sure that just ain’t so.”

This quote, frequently attributed to Mark Twain, describes the dangers of believing something false with all your heart. Instead of focusing on treating the real problem, you find yourself putting all of your effort into fixing another issue that bears little relevance to your future. This quote was most famously used in the film “An Inconvenient Truth” to highlight the risks associated with denying climate change.

The quote is also — quite ironically — misattributed. At the very least, it was uttered by someone other than Mark Twain.

Nevertheless, the wisdom behind it is hard to ignore. When you believe in something that is false, you can suffer adverse effects. This is particularly true if your false belief involves your health.
Depression: A common misdiagnosis

Mental illness is always a little difficult to diagnose, particularly because there are no physiological tests to help clinicians out. Diabetes is diagnosed through blood tests, cancer is diagnosed through biopsies and medical imaging … and mental illness is diagnosed through checklists of self-reported symptoms.

For this reason, mental illnesses including depression are sometimes misdiagnosed. According to a 2012 article in Current Psychiatry, 26 to 45 percent of patients referred for “depression” did not meet diagnostic criteria for a depressive illness. A 2009 meta-analysis discovered that general practitioners can only correctly identify depression in patients in 47.3 percent of cases and that many doctors diagnose depression in people who don’t have it.

Here are four conditions that are commonly mistaken for depression, both by clinicians and the public.
1. Bipolar disorder

Bipolar disorder, like depression, involves periods of intense lows. During these lows, people with bipolar disorder experience the exact same symptoms found in depression. They may feel hopeless, worthless or even suicidal. Unlike depression, people with bipolar disorder also experience high periods, or mania, where they feel confident, productive and otherwise on top of the world. Sometimes, this manic phase is so pleasant that people with the disorder are unable to recognize it as part of their illness. Instead, they only seek help during the low periods.

According to a study published in The British Journal of Psychiatry, up to 22 percent of people with bipolar disorder are mistakenly diagnosed with depression. Another study found that people with bipolar disorder have an average gap of 10 years before they receive the proper diagnosis. Recognizing the difference between bipolar disorder and depression is vital, since the medications used to treat depression can often worsen the symptoms of bipolar.
2. Hypothyroidism

Hypothyroidism is a condition in which the thyroid gland does not release a sufficient amount of hormones. Because these hormones are necessary for the brain and body to function, people with this disorder typically experience fatigue, diminished concentration and a low mood — all characteristics of depression.

Researchers estimate that 20 million Americans have a form of thyroid disease, but that up to 60 percent of these people are unaware of their condition. Instead, they erroneously believe that they are easily fatigued, lazy or — yes — depressed.

Unlike depression, people with hypothyroidism are overly sensitive to cold temperatures and may feel cold all the time. They’re also more likely to experience dry skin, hair loss and a hoarse voice. Thankfully, hypothyroidism can be checked with a simple blood test, and treating hypothyroidism requires only one pill a day.
3. Diabetes

Diabetes is another illness that is commonly confused with depression. Often, people develop Type 2 diabetes without recognizing it. They may suddenly find themselves losing weight, feeling fatigued and growing more irritable than usual. Since all of these symptoms are also associated with depression, they may fail to recognize that their body is having problems with insulin. Insulin resistance, one of the precursors to Type 2 diabetes, has been significantly linked to depression.

People with diabetes are also at risk for “diabetes distress,” a condition that mimics depression. A study conducted in 2014 found that people who were diagnosed with both diabetes and depression experienced reduced depression symptoms after receiving interventions designed to help manage diabetes. In other words, their symptoms were not due to depression, but instead due to the stress of living with a chronic illness.

“Because depression is measured with scales that are symptom-based and not tied to cause, in many cases these symptoms may actually reflect the distress that people are having about their diabetes, and not a clinical diagnosis of depression,” said lead author of the study, Lawrence Fisher, Ph.D., ABPP.
4. Chronic fatigue syndrome

Chronic fatigue syndrome — also known as myalgic encephalomyelitis or systemic exertion intolerance disease — is an illness characterized by extreme fatigue with no apparent cause. Chronic fatigue syndrome also involves difficulties concentrating, muscle pain and problems with sleep. Since these symptoms are also associated with depression, people with chronic fatigue syndrome are frequently misdiagnosed. A study published in The Primary Care Companion to the Journal of Clinical Psychiatry found that chronic fatigue syndrome is under-diagnosed in more than 80 percent of the people who have it and that depression is the most common misdiagnosis.

Thankfully, there is at least one clear difference between depression and chronic fatigue syndrome. Whereas people with depression are both exhausted and uninterested in their hobbies, people with chronic fatigue syndrome may still want to participate in their hobbies despite lacking the energy.

Does anyone have depression?

Yes! Depression is a very real, very serious illness that affects millions of people each year. The majority of people who are diagnosed with depression are diagnosed correctly and are able to recover with proper therapy and medication.

Still, a misdiagnosis is always possible. If you are being treated for depression and aren’t experiencing any benefits, it is entirely possible that you have a disorder that is mimicking the condition. Before starting an antidepressant regimen, it never hurts to take a blood test to rule out one of the commonly confused conditions such as hypothyroidism or diabetes.

Remember: “It ain’t what you don’t know that gets you into trouble. It is what you know for sure that just ain’t so.”

How Mood and Stress Reduce Lifespan

A study, published this week in Molecular Psychiatry, finds the genetic basis of a poorly understood phenomenon. Mood and stress are known to contribute to shortened lifespans, and researchers may now have identified the genes that are involved.
[Blue genes]
An in-depth study charts the genetics involved in the shortening of life in response to mood and stress.

A team from Indiana University School of Medicine and the Scripps Research Institute, CA, conducted a multifaceted project investigating the genetic basis of premature aging in response to stress and psychiatric illness.

Using human participants and Caenorhabditis elegans, one of planet Earth’s most-studied worms, the researchers delved into this intractable question.

They managed to identify a raft of genes that seem to control the impact of mood and stress responses on the longevity of an organism.

A gene called ANK3 was of particular interest and appeared to play a key role in the process.

The role of ANK3

ANK3 codes for a protein called ankyrin-G. This protein is involved in certain types of synaptic transmission (messages being sent between neurons). Ankyrin-G has previously been associated with bipolar disorder, autism, and schizophrenia.

This gene is a prime candidate for uncovering the links between emotional responses and premature aging.

“We were looking for genes that might be at the interface between mood, stress, and longevity. We have found a series of genes involved in mood disorders and stress disorders which also seem to be involved in longevity.”

Lead author Dr. Alexander B. Niculescu III

After analyzing the genes further, Dr. Niculescu and his team found that the genes in question changed their rates of expression with age. When examining the genes of individuals who experienced significant stress or mood disorders – for instance, people who had committed suicide – they noticed shifts in the expression of these genes.

The changes are of the type that would normally be associated with shorter lifespans and premature aging.

Earlier research, carried out by one of the co-authors of the current study, Michael Petrascheck, Ph.D., found that when C. elegans was exposed to mianserin – an antidepressant – the animals lived longer. This acted as the starting point for the current project.

Stress, aging, genes, and worms

To examine the roles of genes in mood, stress, and lifespan, the team embarked on a thorough program of experiments:

  • Firstly, the team investigated the genetic changes mianserin made to C. elegans. The drug was found to affect 231 genes that were then cross-referenced to the human genome. In total, 347 corresponding, similar genes were identified in humans.
  • These 347 genes were compared with the genomes of 3,577 older adults. Of these genes, 134 overlapped with depressive symptoms in humans.
  • The researchers used a database containing genes already known to be involved in psychiatric disorders. They also used Niculescu lab’s Convergent Functional Genomics approach to prioritize the genes in order of their involvement in mood and stress disorders. The top scoring gene was ANK3, a gene that is becoming well known for its role in psychiatric disorders.
  • Focus then shifted back to C. elegans. The team used strains of the worm that had been bred with inactive ANK3 genes. These worms were tested under the effects of mianserin and oxidative stress. ANK3 is known to increase with age and mianserin keeps these levels down. However, they found that mianserin needs at least some ANK3 to provide its life-extending effects.
  • Next, 700 blood samples from psychiatric patients and people who had committed suicide were examined. ANK3 was found in higher levels in older patients and those who had committed suicide.
  • A panel of biomarkers was collected by adding some of the other high-scoring genes from the Convergent Functional Genomics investigation. When taken as a group, they gave an even stronger result than ANK3 on its own. The correlation was particularly strong for the suicide group, showing that the cluster of genes the team had identified did seem to play a role in psychiatric conditions.

The next question is how these genes might affect longevity. It was shown that the genes that overlapped most with mood- and stress-modulated longevity seemed to be involved in mitochondrial dysfunction. This relationship makes sense; a link between mitochondrial dysfunction and aging is steadily growing support from other research.

The authors of the study conclude that “these studies uncover ANK3 and other genes in our dataset as biological links between mood, stress, and lifespan, that may be biomarkers for biological age as well as targets for personalized preventive or therapeutic interventions.”

As ever, more work will be necessary to back up the findings, but the thorough nature of the investigation and its agreement with other studies gives future researchers a strong platform to build upon.

-Tim Newman