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Why Do Some Depressed People Appear Happy?

You don’t look depressed! How many times have you heard someone say that? As someone with depression and who works in the mental health field, that comment absolutely drives me nuts. How is depression supposed to look? Depression has many faces and many symptoms. Not everyone experiences depression or any mental health issue in the same way. Some people who have depression don’t even realize they are depressed. Many times, those with depression have developed coping skills that would lead others to believe they are happy. Let’s explore this topic.

Depression can show itself in weird ways. Some of the typical symptoms include sadness, irritability and loneliness. What you might not know is that depression can also present itself as fatigue, a loss of interest in things you once enjoyed, pain and insomnia. An example might be, that if you can’t stomach (nauseous) the fact that you need to get out of bed and go to work, or if you isolate and sleep most of the day, or if you cry for no obvious reason…you might be considered classically depressed. Often times though, it’s a compilation of many different symptoms.

If you have these symptoms, it does not necessarily mean you are depressed, but it could mean you that you might want to investigate your symptoms a little further. Many people are considered to be high functioning, while still being diagnosed as depressed. So, if you have a great job and you hang out with a close group of friends every week, or maybe you are at the top of your class in school and everyone is scrambling to date you, but you still don’t feel happy…you might be depressed, but high functioning.

Often high-functioning depressed people can look like they have it all together and are winning at life, but in reality, they are crumbling inside. These people put on a happy face for society; smiling, socializing, excelling in their profession, super organized and well put together, because they feel they have to “put on a happy face” so people can’t tell that they are suffering inside. Some of these traits are developed as coping mechanisms and allows them control something in their life. Many of these coping mechanisms are learned early on during childhood to help them get through difficult times.

Sometimes, this kind of depression is hard to identify and treat but is crucial to do so. If left untreated, these people may not be able to self-identify as depressed and therefore never seek help. They might also be hiding other mental health issues and develop severely unhealthy coping mechanisms that they hide from others, like excessive spending, drug abuse or sabotaging relationships. This can even lead to more severe mental health issues down the road.

High-functioning depression could be characterized as dysthymia. Dysthymia, is defined as a mental health disorder characterized by “Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least two years,” and includes the presence of two or more of the following symptoms, “Poor appetite or overeating; insomnia or hypersomnia; low energy or fatigue; low self-esteem; poor concentration or difficulty making decisions; feelings of hopelessness.” according to the “Diagnostic And Statistical Manual of Mental Disorders 5th Edition” (DSM 5). Experiencing only TWO of these symptoms could get you “classified” as having dysthymia.

These symptoms are just the tip of the iceberg with true reality of all depression symptoms. While the symptoms are very similar to Major Depression Disorder, they stand apart because people with dysthymia may not have the same critical levels of altered biological and mental capabilities that can make major depression easier identify. These people appear “happy” or at very least content with their lives. (Slowly raising my own hand)

Here are some things that might point to high-functioning depression:

• Difficultly experiencing or feeling joy
• Highly critical of both self and others
• Lack of energy
• Anger issues or high agitation and irritability
• Chronic self-doubt
• A sense of being overwhelmed all the time
• Relying on coping mechanisms more and more despite not having a reason why (that you know of)
• Feeling guilty or worried over things beyond your control, especially past events and future endeavors
• Feeling unable to fully rest or “take it easy”
• Overall sadness
• Perfectionism
• Unexplained pain
• Physical symptoms like headaches or heaviness in your chest
• You are “letting yourself go”
• You feel indifferent
• You are listening to sad, angry or “dark” music

High-functioning depression is a biological and psychological disorder that mandates clinical treatment. While there may be a genetic component, your genetics only predispose you to certain elements that could lead to certain outcomes, most times they don’t guarantee that you will have any trait. So even though you might have a family history of depression, is does not indicate that you will too. Oftentimes, families with similar mental health issues, have not address the underlying core issues that are passed down through the generations. This breaking the cycle is critical to preventing future generations from suffering the same issues.

Depression is typically caused by neurotransmitters and neuropathways that are essentially “misbehaving.” New research shows that our brains can “re-route” neuropathways and our brains have system have neuroplasticity. We once thought that we could not regenerate new brain cells and that has now been proven wrong. The movie Changing Your Mind explains exactly how neuroplasticity works. Furthermore, Transcranial Magnetic Stimulation (TMS) treatment has worked for me to re-route neural network with no adverse side effects, I write about it in this post. TMS literally changed my life. TMS has been approved to treat not only depression, but obsessive-compulsive disorder, headaches, anxiety and PTSD as well. The potential for this technology to help with other mental health issues are still being studied and the possibilities appear to be endless. (For more details and research start here)

Many people think that the more they push themselves, they can “will themselves out of it,” they can make themselves better on their own (and some can), but in reality, instead of seeking proper support, the symptoms may get worse, and the cycle continues on. The good news is that with help and support dysthymia or depression can be managed.

Here are some small things to start helping yourself today:

• Seek out a therapist or some kind of treatment today
• Talk to someone you trust, preferably someone who doesn’t judge you
• Create or find a support group for yourself
• Don’t be afraid to explore ALL your options when it comes to treatment. It’s not always one size fits all.
• Consider alternative and complementary treatments like acupuncture and vitamin supplementation (Magnesium and Vitamin D have been shown to greatly improve symptoms of depression)
• Get some sun, again vitamin D (the sunshine vitamin)
• Get some exercise – if you are feeling angry, consider a boxing class or something more on the physical side to get your frustration and anger out in a healthier way
• Consider ingesting turmeric, don’t forget to add pepper to “activate” it
• Listen to uplifting music
• Watch something funny
• Play a game (watch the number of hours you play, too much gameplay can make things worse)

There are new controversial treatments and “out of the box” treatments available now as well, that warrant further research. If you don’t feel right even though everything seems to be going right, speak up! If you wake up feeling anxious and fearful to face the day, despite having everything you could ever want and need, speak up! Stop internally struggling and seek support. Stop playing the part you think you have to play. You can “have it all” and feel better too.

https://www.psychiatry.org/psychiatrists/practice/dsm