People often delay seeking help for depression because they are still going to work, getting things done, or do not feel “sad enough” to call it depression. But depression does not always look like sadness. It can show up as exhaustion, irritability, withdrawal, poor concentration, disrupted sleep, or a gradual loss of interest in things that used to matter. If sadness is the only symptom you are looking for, depression can be surprisingly easy to miss.
Some of the symptoms described here, including fatigue, changes in appetite or weight, disturbed sleep and difficulty concentrating, can have causes other than depression. Physical health conditions, medications and prolonged stress can all affect how we feel and function. If these changes are persistent, it can be helpful to speak with a GP as well as considering whether psychological support might be appropriate.
What it actually looks like
Two of the central features of depression are persistently low mood and a marked reduction in interest or pleasure. Either can be more noticeable than the other. Loss of pleasure does not always feel like sadness. It can feel more like a flattening. Things you used to look forward to may become things you simply do. Food may lose some of its enjoyment. Music may stop moving you in quite the same way. You may still be functioning, but much of what normally makes life feel rewarding can seem further away.
Depression can also affect sleep, concentration, decision making, energy and relationships. Not everyone experiences the same combination of symptoms, and some people remain outwardly very capable while feeling considerably different inside.1
Symptoms adults most often overlook
These experiences can occur for many reasons, including physical health conditions, medications, prolonged stress and difficult life circumstances. What matters is the overall pattern: how long the changes have been present, how widely they are affecting your life, and how much they are interfering with everyday functioning. Having one or more of these symptoms does not necessarily mean that you are depressed. It is the combination of symptoms, their persistence and their impact on your life that helps determine whether further assessment may be appropriate.
If you are experiencing thoughts of suicide or feel you may be at risk of harming yourself, please seek immediate professional or emergency support.
A difficult period, or depression?
Everyone has periods when life feels harder. A difficult week, a stressful season or a painful event does not necessarily mean that a person is depressed. Depression is assessed by looking at a broader pattern of symptoms, their persistence, their severity and their effect on everyday life. For a major depressive episode, symptoms are present for at least two weeks and include either depressed mood or loss of interest or pleasure, together with additional symptoms and clinically significant distress or impairment.1
A simple comparison can help illustrate the difference, but it cannot diagnose depression on its own.
| A difficult period | Depression |
|---|---|
| May fluctuate with circumstances, affect particular areas of life, and still leave room for moments of enjoyment and connection. | Tends to be more persistent and pervasive. Interest or pleasure may be markedly reduced, and work, relationships, self-care or other areas of functioning may become increasingly difficult. |
There is no need to wait until you can no longer function before asking for help. Someone can be struggling significantly while continuing to work, care for other people and meet their responsibilities.
When things have felt different for a while
Depression does not always announce itself dramatically. Sometimes it is a gradual change that is difficult to name. You are getting through the day, but everything seems to require more effort. You are doing the things you normally do, but they no longer give much back. You may be more irritable, more withdrawn or more tired than usual without initially connecting these changes to your mood.
If you have noticed a significant change in yourself that has persisted for several weeks, particularly if things you normally enjoy no longer seem to reach you, it may be worth having the pattern assessed. You do not need to decide for yourself whether it is “really depression” before speaking to someone.
When to seek help sooner rather than later
It is not necessary to wait for symptoms to become severe before seeking support. Consider an assessment if low mood, loss of interest, exhaustion, changes in sleep or appetite, concentration difficulties, withdrawal or persistent self-criticism have continued for several weeks or are beginning to interfere with everyday life.
Please seek immediate help if you are having thoughts of harming yourself, thoughts that you would be better off dead, or thoughts of ending your life. Go to your nearest emergency department. If you are in immediate danger, seek emergency assistance. Our emergency resources page lists crisis lines operating around the clock in South Africa.
It can also be worth speaking with a GP. Some medical conditions, medications and other factors can produce symptoms that overlap with depression, so a medical assessment can help clarify what may be contributing alongside any psychological assessment.
What treatment involves
There are several effective treatments for depression, and the most appropriate approach depends on the severity of the depression, the symptoms involved, the person’s circumstances and their preferences. Psychological therapy is an established treatment for depression. Depending on the presentation, treatment may include approaches such as cognitive behavioural therapy, behavioural activation or interpersonal therapy. Antidepressant medication can also be appropriate, particularly in more severe depression, and psychological therapy and medication may sometimes be used together. NICE recommends discussing the available options with the person and making a shared decision about the treatment that best fits their clinical needs and preferences.2
Therapy may involve understanding the patterns that are maintaining the depression and gradually rebuilding areas of life that have become smaller or harder to access. For some people, this may involve gently increasing activity and reconnecting with experiences that provide a sense of pleasure, connection or achievement. For others, there may be more emphasis on the harsh self-judgements, hopelessness or thinking patterns that can accompany depression. Often, the work involves both what is happening in a person’s life and what is happening within them.
Where depression occurs alongside grief, trauma, relationship difficulties or a longstanding pattern of distress, those circumstances matter too. They are not simply background information. Understanding the context can help shape what treatment needs to address.
Our depression page sets out more about our approach, and you are welcome to make a confidential enquiry.
If you are not sure whether you need therapy
It is not necessary to be certain that you are depressed before reaching out. You may simply know that you have not felt like yourself for a while. Perhaps you are functioning, but everything takes more effort. Perhaps you have stopped enjoying things without really noticing when it happened. Perhaps other people have noticed a change before you have.
An assessment can help make sense of what has changed, whether depression may be part of the picture, and what kind of support may be appropriate. Sometimes the most useful first step is simply understanding what is happening, with the help of a qualified professional.
This article is general information, not a substitute for individual professional advice, assessment or treatment. If you are in crisis, please see our emergency resources.
Sources
- American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.). American Psychiatric Association Publishing.
- National Institute for Health and Care Excellence. (2022). Depression in adults: treatment and management (NG222).
