Why Am I Sad?

Is it really possible to be depressed and not know it? After all, depression is a serious clinical diagnosis. In reality, it can be difficult to recognize signs of depression over common experiences like sadness or grief.

Depression can appear suddenly or gradually. It can be related to a situation (as with adjustment disorders) or there may be no "reason" at all. You may be aware that you feel bad or not like your usual self, but you may not be aware that what you are feeling is clinically significant depression.

Why You May Not Know You're Depressed

There are several possible explanations for being depressed and not knowing it. Depression might not be on your radar, either due to denial or stigma, or you may dismiss your symptoms because you've been experiencing them for so long. You may even be mistaking the symptoms of depression for something else.

The following are some reasons why you may not realize that you are depressed:

• You've been depressed for a while. If you have been depressed for a long time, it simply feels normal to you. This may be especially true for those who have been depressed since early childhood.
• You don't feel sad. Because you may not be feeling particularly sad, you may think it can't possibly be depression. In reality, depression can take more forms than just a feeling of profound sadness. You may feel tired, low in energy, or lack in any real sense of joy without necessarily feeling sadness or being weepy.
• Your symptoms have developed slowly. Depression can develop gradually over an extended period of time. When the changes in mood are subtle and come on slowly, you may not recognize that things aren't the same as they used to be.
• You feel down about yourself. If you are feeling like you are somehow bad or defective, it's easy to dismiss what you are feeling as somehow being an innate part of yourself that can't be fixed. You may feel that rather than struggling with a treatable illness, you are irreparably broken and unworthy of feeling better.
• You have internalized attitudes about mental health. Cultural differences can also make it more difficult to recognize and acknowledge depression. If those around you treat depression as something that must be borne without complaint, then you may feel as if asking for help is a sign of weakness.

Depression Symptoms

So how do you know if you are depressed? If you've been experiencing several of the following symptoms for at least two weeks then it is possible that you could be experiencing depression:

• Anger and irritability
• Anxiety and agitation
• Changes in appetite or weight (can be either a lack of appetite accompanied by weight loss or increased appetite with weight gain)
• Fatigue or lack of energy
• Feelings of sadness or emptiness
• Feelings of worthlessness, hopelessness, or excessive guilt
• Loss of interest in activities usually enjoyed
• Mysterious aches and pains with no discernible cause
• Problems with thinking, memory, concentration, and decision making
• Sleep problems such as insomnia or sleeping too much
• Slowed thought, speech, or physical movements
• Thoughts of death and suicide

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Diagnosis

If you suspect that you may have depression—or things simply don't feel quite right—it is wise to speak with your doctor about what you are feeling. Your doctor can screen you for possible causes for your symptoms and get you the proper medical care that you need.

Depression Discussion Guide

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As part of your doctor's visit, you may have certain blood tests done to rule out other causes of your depression symptoms. Certain conditions such as hypothyroidism can create symptoms that mimic depression.

Depression Treatments

There are a number of different treatment options available for depression. Your specific treatment plan will depend on your diagnosis and the severity of your symptoms.

Medications

Once other conditions have been ruled out and a depression diagnosis has been confirmed, your doctor may prescribe an antidepressant medication. There are several different types of antidepressants that can be effective for treating depression, including the following (in order of how commonly they are prescribed):

• Selective-serotonin reuptake inhibitors (SSRIs)
• Serotonin and norepinephrine reuptake inhibitors (SNRIs)
• Atypical antidepressants
• Tricyclic antidepressants (TCAs)
• Monoamine oxidase inhibitors (MAOIs)

SSRIs are by far the most commonly prescribed, although SNRIs and atypical antidepressants are also often used. MOAIs and TCAs are less commonly used due to their side effects, but may still be used in some instances.

Psychotherapy

Your doctor may also refer you to a psychiatrist, psychotherapist, or another qualified mental health professional who specializes in treating mental health conditions. Talk therapy or a technique known as cognitive behavioral therapy can be helpful in the treatment of depression.

• Individual therapy, such as cognitive-behavioral therapy (CBT), can provide a safe and supportive environment for you to explore what's behind your depression and how to work through your sadness.
• Group therapy can help you see that others are going through the same thing and help you feel less alone since it's normal to feel isolated or different when you're depressed.

Another option is to try online help for depression, which might include online depression therapy, self-guided programs, or support groups.

Whichever direction you take, remember that there is no stigma in getting help for depression. It is a serious and treatable condition—and one you don't have to manage alone.