The Many Faces of Depression

What Does a Depressed Face Look Like?

A depressed face may be difficult to identify. In ads for depression medication, you can usually tell which people are depressed—they’re the ones who look sad. But in real life, you may not be able to pick someone suffering from depression out of a crowd. Depression isn’t always obvious; it looks different in different people and not everyone suffering from depression exhibits a depressed face. Depression can also feel differently-some of us experience certain symptoms of depression but not others.

What Does Depression Look Like?

Depression may manifest differently in different people. But for someone to be diagnosed with depression, they must have at least five of the following symptoms on a daily basis, for at least two weeks:

  • Feelings of hopelessness
  • Irritability or restlessness
  • Feeling guilty, unworthy or helpless
  • Fatigue or lack of energy
  • Moving or talking more slowly
  • Trouble concentrating, remembering or making decisions
  • Trouble sleeping, waking very early or sleeping too much
  • Changes in appetite; gaining or losing weight
  • Physical aches and pains, such as stomach cramps and headaches, without any apparent cause
  • Thoughts of suicide or death, or suicide attempts

At least one of two other symptoms must be present to confirm a diagnosis of depression: a low or depressed mood OR the inability to experience pleasure. We are conditioned to expect sadness. However, we may not recognize depression in a person who smiles and seems “fine” but inside, feels unable to enjoy life or get any pleasure from it.

An African American women with a depressed face, having trouble sleeping.

How Depression Looks at Different Ages

Some depressed people experience most of the symptoms above, while others have just a few. In addition, symptoms may vary with age. The National Institute for Mental Health notes these differences among age groups:

  • Children with depression may appear more anxious and irritable than depressed. They may pretend to be sick, refuse to go to school or worry excessively about losing a parent. 
  • Preteens and teens may manifest their depression in ways you might expect for their age—getting into trouble, being gloomy, lashing out with frustration or being restless. Low self-esteem may start to surface, along with eating disorders, anxiety or ADHD. They may sleep or eat too much, or substance use may become a problem. 
  • Young adults with depression often exhibit irritability and sleeping or eating too much, as well as other disorders such as anxiety, panic disorder, substance use and/or social phobias.
  • Middle-aged adults often report trouble sleeping or staying asleep, as well as gastrointestinal problems.
  • Older adults may have co-occurring medical conditions that can cause depression or contribute to it. Physical aches and pains may be present. With severe depression, older adults can have such trouble with memory that they appear to have dementia.

Depression and Anger

Depression occurs more often in women than in men, or at least it is diagnosed more often. According to the Centers for Disease Control, in 2019, 21.8% of women experienced symptoms of depression, while only 15% of men experienced symptoms.

In women, depression often appears in the form of sadness, for example, exhibiting a depressed face that doesn’t align with their typical appearance, or feelings of worthlessness and guilt. But in men, it may manifest as irritability and anger. In addition, men may act out with recklessness and be more inclined to abuse alcohol and drugs. Because they are not “sad,” men may not realize they could be depressed. Because they don’t seek help, they often go undiagnosed. 

Children and adolescents also tend to manifest depression with irritability and anger. Some depressed children may even be diagnosed with Oppositional Defiant Disorder, which is what it sounds like. “Contrary” behaviors often get depressed children labeled as troublemakers. They are then disciplined when they actually need to be evaluated and treated for depression.

Whether you are suffering from these symptoms yourself, or trying to help a friend or loved-one, it’s important to remember that there are many faces of depression, depending on the person, their age and circumstances. A depressed face is not the only thing to look for–looking a little deeper and paying closer attention to behaviors could make all the difference for early intervention.

“Depression is among the most treatable of mental disorders. Between 80% and 90% percent of people with depression eventually respond well to treatment. Almost all patients gain some relief from their symptoms.”

Different Types of Depression

In addition to different symptoms, there are different types of depression, depending on the severity or nature of the disorder. 

A young women sitting on the floor with her chin on her knee with a depressed face and downcast eyes.

Major depression involves at least five symptoms, including sadness or loss of interest or pleasure in activities. Various areas of life are impacted. For example, someone having a major depressive episode may stop going to school or work or start avoiding people or social activities.

Dysthymia, also known as persistent depressive disorder, involves a sad mood that lasts for at least two years (or for children, one year of mostly irritability). It is not as severe as major depression. The low mood lasts for most of the day and appears on most days. To be diagnosed with dysthymia, people need to have two of the typical symptoms of depression (except for suicidal thoughts or attempts). 

Premenstrual dysphoric disorder is a part of premenstrual syndrome that can cause fatigue and changes in eating and sleep habits. Moodiness, irritability, anger and sadness are all hallmarks of PMDD.

Seasonal Affective Disorder is a form of depression tied to changes in the season. It usually occurs during winter, when days are shorter and natural sunlight is in short supply.

Adjustment disorder with depressed mood is tied to a stressful event like a major life change. It usually resolves within a few months as the person starts to cope with the stressor.

Bipolar disorder is characterized by mood swings that alternate between the lows of depression and highs of mania.

How Do You Know It’s Depression?

Depression can be somewhat of a hidden disorder. People may not feel able to acknowledge their feelings of sadness or worthlessness. If depression is not on their radar, they may not realize it could be the root of their problem. And so, they may not seek the diagnosis and treatment that could help them

depression can mimic other disorders

Depression can also masquerade as other disorders or physical problems or co-occur with diseases or medical issues. Primary doctors, when confronted with fibromyalgia or persistent constipation, may look for physical causes first and not mental health issues. Some medical conditions such as thyroid problems can mimic symptoms of depression, making it difficult to tease out the true cause of issues like fatigue. 

Depression Should Be Taken Seriously 

Mental health professionals are key in diagnosing and treating depression, which affects a significant number of adults every year. In 2019, 18.5% of adults experienced symptoms of depression. At some point in their lives, one in six people will experience depression. Numbers of children experiencing anxiety or depression have been rising; the number of teens who received treatment for depression increased from 38% in 2005 to 43% in 2019. Preliminary data gathered during COVID-19 reported that 40% of adults struggled with mental health or substance use, 31% reporting symptoms of anxiety or depression. 

Because depression can lead to suicide, especially among teens and young adults, it must be taken seriously. If you suspect depression in yourself or a loved one, seek help. Best Day’s counselors are here to diagnose depression and determine the best possible course of treatment to return to a full, satisfying life.

How We Can Help You?

Best Day Psychiatry and Counseling is here to help you have a better day and find a better way. We treat a wide range of psychiatric conditions for both children and adults. Contact us today, we’re ready to help:

Charlotte: (980) 867-4440• Durham: (919) 659-8686 • Fayetteville: (910) 323-1543
Fuquay-Varina: (919) 567-0684 • Greenville: (252) 375-3322 • Raleigh: (919) 670-3939
Wilmington: (910) 500-7072 • Winston-Salem: (336) 934-5556