For many people, depression hits hard — they suddenly find themselves enveloped in a veil of tears and debilitating hopelessness that makes it difficult to get through a normal day. For others, however, the signs may not be quite as obvious. In fact, because depression is a such a complex condition, it’s possible to be depressed without even realizing it.
“Most people think the only symptom of depression is intense or chronic sadness,” Maureen Werrbach, licensed therapist and owner of Urban Wellness Counseling in Chicago, Illinois, told me in an interview. “So many people overlook physiological symptoms.”
Here are some subtle ways your body could be warning you of an underlying mental health issue.
We all feel burnt out from time to time. But if you’ve been feeling inexplicably tired even when you’re getting to bed early, it could be a sign of chronic depression. In fact, according to a study published by the U.S. National Library of Medicine in Innovations in Clinical Neuroscience, fatigue is one of the most prevalent symptoms of major depressive disorder, also known as MDD.
“Most commonly you can notice a physical exhaustion or reduced energy,” Shemiah Derrick, a mental health therapist, told me in an interview. “These symptoms tend to manifest themselves after attempts are made to resolve a problem or work through a challenge mentally; the body kicks in to help but without continued resolution, the dissonance goes from mental to physical.”
Aches and pains
Along with fatigue, Derrick says many people with depression experience aches and pains. “Tightness creates tension in the muscles of the body,” she told me, explaining that some people experience tension in their neck, back, or joints, while others might feel a general tightness in their chest, as well as irregular breathing patterns. “Some tend to unconsciously hold their breath,” explained Derrick.
Nicolette Amarillas, women’s life-coach, holistic health practitioner, and founder of Expansive Voice, agreed, telling me that pain along the spine is common in people with depression. “Your low back holds a lot of tension from external and internal stress,” she told me. All that tension, Amarillas explained, can also take a toll on our posture. “The shoulders start to round forward, the head falls forward due to looking down, often times associated with a lack of confidence or self-esteem.”
Tension in the body can cause other pain, too. “It is not at all uncommon for depression to also manifest with headaches,” Dr. Ramani Durvasula, a licensed clinical psychologist and professor of psychology, told me. “Depression impacts neurotransmitters and neurohormones (and is a byproduct of these imbalances) that in the long term can impact stress response, inflammatory responses, and the functioning of other bodily systems.”
In an interview with Everyday Health, Dr. Richard B. Lipton, director of the Montefiore Headache Center in New York City, said there is a strong relationship between depression and migraines. “People with migraines are two to three times as likely to have depression as the general population,” he said. “Migraines and depression have common underpinnings in the brain, which can develop due to environmental factors, genetic causes, or a combination of both.”
Whether you find yourself dozing off in the middle of the day or lying awake at 3 a.m., your sleep patterns can reveal a lot about the state of your mental health. According to Kimberly Hershenson, a clinical social worker and therapist, early awakening, excess sleepiness, insomnia, or restless sleep, accompanied with sadness that doesn’t seem to go away could be a sign of clinical depression.
“If symptoms persist for more then two weeks it is time to seek help from a mental health expert such as a psychiatrist (for medication) or therapist,” she advised.
Stomach problems are common among people with depression and anxiety, especially kids and teens. “Lots of kids have tummy problems and when you look into them, you find they’re often related to school anxiety or their peer relationships,” Robin Haight, a Virginia-based psychologist told Everyday Health.
And while symptoms like nausea and diarrhea can happen as a result of depression, other chronic digestive issues like Crohn’s disease can become worse for people with anxiety and depression. “I’ve had folks who were referred to me by the ER because that’s where they went for their symptoms,” Haight said.
Being overwhelmed with school, work, or family obligations can often leave us feeling mentally drained. This can result in forgetfulness and a general inability to concentrate, otherwise known as brain fog.
While sometimes all we need is a bit of rest to reenergize and clear our heads, long term brain fog could be a sign of an underlying problem. “You could be experiencing some depression,” said Austin-based Clinical Psychologist Jo Eckler. “A therapist can help you determine possible reasons for the depression and teach you mental and behavioral techniques to help lift you out of the fog.”
Changes in your menstrual cycle
Our periods can be affected by many different factors with pregnancy being the most common (though things like birth control and even stress can also impact menstruation). Studies have also shown a link between depression and changes in the menstrual cycle including heaviness, duration, and consistency.
Other studies have found our periods can make depression symptoms worse. In a 2005 study, 64 percent of women with major depression reported having their symptoms worsen 5-10 days before menstruation.
According to the Mayo Clinic, people who are depressed are at higher risk for developing diabetes. On the flip side, people with diabetes may also have a greater risk of developing depression. Other side effects of depression, such as fatigue and unhealthy eating habits, can lead to weight gain — a major risk factor of diabetes. At the same time, diabetes can have a direct effect on the immune system, which can worsen symptoms of depression.
Houston-based Psychiatrist Jared Heathman explained to me that depression can contribute to weight gain through a variety of ways. “Depression and anxiety triggers the release of cortisol, a stress hormone, which increases the release of insulin,” he said. “Insulin drops blood sugar which causes people to crave food high in sugar. In addition to these cravings, eating can be a learned coping skill in dealing with sadness. Eating can promote the release of dopamine which stimulates the brain to perceive pleasure.”