Is your wife (or child or mother or boyfriend) depressed?  This can be a harder question to answer than you might think.  Depression can be elusive to recognize and assess.  Often it is obvious.  The person cries easily, talks of wishing they were dead, doesn’t want to go anywhere or do anything.  They say, “I feel too depressed.”  When depression is severe, people often stop functioning entirely-staying in bed hours on end, not getting dressed or showering, missing work or school.

But sometimes depression is a sneaky diagnosis.  Even the Diagnostic and Statistical Manual, DSM IV TR, the bible of diagnosis for psychologists, defines diagnosis as a primarily sad, empty or irritable mood.  So sad is usually fairly easy to see and understand.  Empty and irritable can be more confusing.

With teenagers and men the most prominent mood displayed is often anger, hostility, or irritability.  Irritability is what we are talking about when we say we have to “walk on eggshells”.  When someone blows up about issues which shouldn’t be a big deal, when we get chewed out over something that seems like it shouldn’t matter that much and this is happening regularly, it’s time to consider that the person is suffering from depression.  Getting angry over nothing, overreacting, being too touchy and making a big deal about minor problems are all part of the picture of irritability.  Chronic anger or irritability is often the most prominent sign of depression.

Emptiness can also be challenging to recognize.  The overt symptoms are a loss of interest and enthusiasm.  The person withdraws from their hobbies and pastimes and often from friends.  They no longer want to go and do things for fun, turning down invitations, avoiding get togethers.  The person may stop suggesting activities, preferring to stay home. They don’t smile as much or laugh as much.  They just don’t enjoy things anymore.  Depression at its core strips us of our ability to experience pleasure.  The pleasure centers in our brain stop responding or registering.  This is what makes the risk of substance abuse so high when depression is the diagnosis

Recreational drugs-alcohol, marijuana, amphetamines, cocaine, narcotics all seem to have very powerful effects on pleasure receptors in the brain so even a person who is quite depressed temporarily has the sensation of feeling something when they are high.  Momentarily they really do feel better.  The problem with drug abuse as a solution to depression is that most of these drugs are fundamentally depressants and actually make the underlying condition worse.  Stimulants such as cocaine and methamphetamine don’t directly cause depression but depression is aggravated coming down from these highs and rebound symptoms are severe.

Another confusing type of depression to recognize is what I call the laughing depressives.  Many people remain cheerful on the outside and continue to keep us laughing with their wit.  When they tell us they are depressed we don’t take them seriously.  I see this often with teenagers.  When I inform the parents that their son or daughter is depressed they don’t believe me and tell me, “he’s just fine when he’s with his friends, I see him laughing and joking around.”  People with big,outgoing personalities and natural wit often maintain those personalities even when they feel terrible on the inside.  There is a difference between personality and mood.  There are famous comedians who have spoken openly about their depression such as Jim Carrey and, Robin Williams.  Owen Wilson attempted suicide.  Dave Chappelle and Roseanne Barr have talked of their struggles with depression. People who are naturally funny retain their ability to amuse us and view life with irony as their mood deteriorates.  So it is confusing when we have a loved one who seems sparkling and funny when they are in some situations and who then tells us they don’t want to go out with our friends or they don’t want to have sex because they are too depressed.  We often react with anger or suspicious crying, “well you were just fine when you were with your brother the other day” and we think the problem is us and our relationship. We might feel angry at the person instead of supportive.  With adults as with young children, home is where we feel safe and let our guard down and show how we really feel, where we don’t have to put on the act that we are feeling fine.  Just because someone seems fine at times or can behave as if they feel good is not necessarily proof that they are not suffering from true and serious depression.

A helpful way to view depression is to see it as an inability to experience pleasure.  When someone is sad, empty or irritable much of the time it means their ability to experience joy and satisfaction in day to day life is greatly diminished.  Yes, something very special might break through occasionally but this does not mean the depression is not real or serious.  When a large portion of day to day life is stripped of its ability to provide us with pleasure and fulfillment, life becomes a struggle and a chore.  Recognizing and supporting ourselves and our loved ones when we suffer from depression is essential to recovery.