The Different Faces of Depression

With over 300 million experiencing depression worldwide, it is one of the most common mental health conditions that exists. Depression affects people of all ages, ethnicity, race, gender and income levels. Yet depression can look very different depending on age and other factors.

Knowing how to recognize depression symptoms is an important first step toward finding help when you or someone you care about is struggling.

Common Symptoms of Depression

You may be depressed if you have at least five of these symptoms occurring nearly every day for at least two weeks:

• Feeling sad or empty
• Having little interest or pleasure in doing things
• Experiencing a change in appetite with weight loss or weight gain
• Trouble falling or staying asleep, or sleeping too much
• Being tired, fatigued and having no energy
• Feeling worthless or guilty that you have let yourself or your family down
• Moving slowly or the opposite – being overly fidgety and restless
• Having difficulty thinking or concentrating on things such as reading the newspaper or watching TV
• Letting personal hygiene go – not bathing or dressing well
• Recurring thoughts of hurting yourself or thinking that you’d be better off dead

Depression Looks Different at Every Age.

Anyone at any age can experience an episode of depression. However, the signs, diagnosis of and chance that treatment will be sought can differ by age, race and gender.

Depression in Children? Yes, It Can Happen.

Although depression can occur in young children, it is much more common in adolescents and, after puberty, occurs much more frequently in girls. For a diagnosis of depression in children, as in adults, at least five symptoms must be present for a period of at least two weeks.

The signs of depression more frequently seen in children are:

• Irritability or sadness
• Boredom, lack of interest in friends and previously enjoyed activities
• Changes in appetite resulting in failure to gain weight or, especially in teens, weight gain
• Irregular sleep patterns – either having difficulty sleeping or refusing to wake up for school
• Persistent lack of energy or feeling tired
• Self-critical – feeling that “no one likes me”
• Not performing well at school
• Lack of motivation
• Inability to concentrate
• Preoccupation with death, writing or talking

Young people may also engage in high-risk sexual activities and other behaviors including shoplifting, physical fights and abuse of alcohol or drugs.

Untreated, depression can lead to devastating consequences in young people, including ongoing problems in school, at home and with friends, losing critical developmental years and increasing the risk for substance abuse.

If you are concerned your child may be depressed, it is important to talk to him or her about your observations and how he or she is feeling and to listen for key warning signs. You should try to create an open, honest communication where mental health issues, like depression, are treated like any other health risks affecting adolescents.

Psychotherapies, including cognitive behavioral therapy and interpersonal therapy, and medications have been effective in treating children diagnosed with depression. Together you, your child and your clinician, can choose a treatment that seems best. If at the end of an adequate trial, usually eight to 12 weeks, you have seen no improvement, the treatment should be changed.

Women and Postpartum Depression

Hormonal fluctuations, physical changes, sleep deprivation and the responsibility of caring for a newborn can be overwhelming. Up to 80 percent of new mothers experience the “baby blues,” an emotional rollercoaster of moodiness, tearfulness, anxiety, inability to concentrate and sadness starting around one week postpartum and lasting about three weeks. While it doesn’t feel good, the baby blues are completely normal and not a disorder.

Postpartum depression and other perinatal mood and anxiety disorders (PMADs) are the most common complication of childbirth. If untreated, there can be serious complications for moms, babies and families. Consequences include disruption in mother-baby bonding, interruption in the infant’s development, family and relationship conflicts, and in rare cases can lead to suicide or infanticide.

The highest time of risk is at six months after delivery, however, onset can occur any time from pregnancy until two years after the baby is born. Symptoms include excessive worry, sadness, guilt, hopelessness, sleep problems, fatigue, loss of interest in normally pleasurable activities, change in appetite, irritability and difficulty making decisions. In comparison to the baby blues, postpartum depression symptoms continue three weeks or longer.

Risk Factors:

• Depression or anxiety during pregnancy
• Personal or family history of depression
• Complications with pregnancy, birth or breastfeeding
• Giving birth to multiples
• History of PMS or other significant mood reactions to hormonal changes
• Negative mood changes while taking birth control medication
• Recent loss or move
• Difficulty in asking for support
• Low self-esteem or perfectionism
• Poor social, familial or financial support
• Unresolved miscarriage, abortion, adoption or loss
• Thyroid dysfunction

Surprising Signs of Depression in Men

Women experience depression at twice the rate of men, which may explain why men are so reluctant to admit they are depressed and to seek help. While men and women share the same symptoms of depression, men often express those symptoms differently. For some reason, not completely understood, men are less likely to exhibit the typical signs of depression such as crying or sadness. By suppressing these feelings, men may actually become more aggressive and irritable.

Men often feel embarrassed or ashamed about their depression and simply try to “tough it out.” They sometimes “take control” by self-medicating with alcohol or drugs. This may be why health care providers often fail to recognize depression in men.

Untreated depression in men can have serious and tragic consequences. The Centers for Disease Control (CDC) report that men in the United States are four times more likely to die by suicide than women.

Additional Signs of Depression in Men:

• Controlling, aggressive, violent or abusive behavior
• Escapist behavior, like working too much
• Increased alcohol or drug consumption
• Irritability or inappropriate anger
• Risky behavior, like reckless driving

Depression in Older Adults

Over six million Americans 65 and older are affected by late life depression but only 10% ever receive treatment. Why? Because many people think that depression is a normal part of aging. Due to the many health challenges older adults face, neither they nor their families recognize the symptoms of depression or mistake them as signs of other conditions that plague the elderly: Alzheimer’s and other forms of dementia; arthritis, cancer, heart disease, stroke, etc.

Signs of Depression in Older Adults:

• Memory loss
• Confusion
• Social withdrawal
• Irritability
• Loss of appetite
• Inability to sleep
• Delusions
• Hallucinations

If depression goes untreated, older adults face increased risks of additional illnesses and cognitive decline. The elderly are much more likely to seek treatment for other physical ailments than they are for depression and the symptoms for depression for them can be different than for those who are younger.

The best way to determine if someone is depressed is with a physical exam which includes a review of all medications, plus a clinical and psychiatric interview. Blood tests and imaging studies, such as a CT scan, can eliminate other medical conditions that require different treatments.

Fortunately, treating older adults for depression does help. In fact, 80% of those who are clinically depressed can be successfully treated with medication, psychotherapy, electroconvulsive therapy or a combination of the three.