Depression is a health threat you don't want to ignore. Growing populations at risk include caregivers looking after frail elders, people with dementia, and people living alone. Yet not all sadness, apathy, low energy, and low mood should be considered depression at work. Sometimes, depressive-type symptoms can flag a different condition.
It's good to know the warning signs of clinical depression -- but if you're worried about someone, also consider whether any of the following situations might apply.
Depression or a Thyroid Condition?
The tiny thyroid gland has a huge role. It regulates metabolism, which means virtually all the chemical reactions in the body, including those involving hormones. If metabolism is out of whack, a person doesn't function right -- or feel right -- usually without realizing why. Resulting symptoms like changes in mood, weight, and energy levels can be mistaken for many other conditions. As many as half of all thyroid disorders are therefore misdiagnosed or undiagnosed.
In a 2004 Spanish study, 34 percent of older adults with hypothyroidism (underactive thyroid) and half of those with hyperthyroidism (overactive thyroid) reported feeling depressive symptoms. Women are at higher risk for thyroid disorders, possibly because they experience more hormonal changes.
What to watch: Other common symptoms of thyroid disorders include weight changes, dry skin, sensitivity to cold, tingling or numbness in the hands and feet, new constipation or loose stools, puffy skin, and bulging eyes. Hypothyroidism sometimes follows childbirth (a period when postpartum depression may also strike).
What to do: Don't ignore depressive symptoms, whether you think you know the cause or not. A thyroid test can measure thyroid function. Hormone treatments are used to restore proper thyroid functioning.
Depression or Drug Side Effects?
When personality and behavioral changes strike in teens or young adults, we're quick to think of drugs. In adults, though, it's often overlooked that prescription drugs can have similar effects. Beta-blockers used to treat hypertension, angina, and other conditions, for example, can cause symptoms that appear to be depression-like, including lack of energy, changes in sleep, lack of sexual interest, and mood changes. Research shows that beta-blockers don't cause depression; rather, they can bring effects that look and feel like it.
Other medications that can sometimes cause depressive symptoms include corticosteroids (for autoimmune diseases), which can alter serotonin levels, and drugs for Parkinson's disease that affect dopamine levels, such as levodopa. Serotonin and dopamine are both linked to mood. Also beware common antianxiety drugs, such as Xanax, Ativan, and Valium.
What to watch: Ask whether the person has recently begun a new prescription or had a dosage change. Abuse of illicit drugs or alcohol can also cause depressive-like effects; be alert to these warning signs of addiction.
What to do: When seeing a doctor about worrisome symptoms, be sure to bring a list of all medications or, better yet, all the medication bottles themselves. A different drug or an adjustment to the dosage may ease the unwanted side effects.
Depression or Sleep Problem?
Say there's no obvious stressor or health symptom -- at least by day -- and yet you feel tired, lethargic, and "off." The problem may be something that's happening at night. Any kind of sleep problem can cause mood and energy problems by day. For example, those who suffer insomnia due to stress, a bladder problem, or caregiving for someone with dementia who doesn't sleep well are at higher risk for depression.
Sleep apnea, a dangerous condition that causes a person to briefly stop breathing during sleep, is often a surprising cause. In sleep apnea, the soft tissues of the throat temporarily close the airway. As many as 80 percent of sufferers go undiagnosed or are treated for the wrong problem.
A 2012 study by the Centers for Disease Control and Prevention of 10,000 adults found that people with sleep apnea have a higher risk of depression. Men, diabetics, and those who are obese are at greater risk of sleep apnea. Other risk factors include a large neck size or being over 40.
What to watch: Someone with sleep apnea usually snores loudly or sounds like he or she is struggling to breathe. A companion may notice actual gaps in breathing. Other symptoms of sleep apnea include restless sleep, plus tiredness and napping during the day.
What to do: Don't ignore sleep problems, whether you notice them during the day or night. For sleep apnea, treatments include special sleep masks. A 2012 Cleveland Clinic Sleep Disorders Center study found that patients who used them to treat sleep apnea experienced fewer symptoms of depression, even if they didn't follow the treatment exactly as prescribed.
Depression or Dementia?
When a loved one becomes withdrawn and uninterested in activities that once brought pleasure, loved ones are apt to think, "He's depressed" more often than, "He has cognitive impairment." But seeming apathy is a common early sign of dementia, as the person struggling with cognitive changes focuses more thought and energy on everyday behaviors, sometimes to the exclusion of anything else.
Depression and dementia can occur separately, but they're also often found together. The risk of depression is higher in people diagnosed with dementia (of which Alzheimer's disease is the most common cause), though there are other causes.
What to watch: There's a great deal of overlap in dementia and depression symptoms. With both, for example, someone may have trouble concentrating, seem apathetic, show personality changes, or withdraw socially. Other common early warning signs of Alzheimer's include making mistakes with money, having trouble finding the right words, having difficulty with abstract thinking, and being disoriented about time or place. Not everyone with early dementia will have all these signs, but some of them may appear along with the changes in focus and personality that look like depression.
What to do: No single test will distinguish between dementia and depression. A clinical assessment is the best way to diagnose Alzheimer's.
Depression or Burnout?
You can feel emotions like sadness, or feel overwhelmed because you're dealing with chronic stress, without having actual depression, which is a physical disorder. But it's a slippery slope from stress to burnout, and burnout often leads to depression.
What to watch: Ongoing stress (such as the demands of caregiving) is often compared to the proverbial frog in a pot of water on a stove -- the temperature rises so gradually that the frog gets used to it, and by the time he's being boiled away, it's too late. Check in with your stress level to get a sense of how advanced your stress is. One rule of thumb: The longer a stressful situation goes on, the more at risk for burnout you may be.
What to do: Whatever the source of your stress, you've got to look out for Number One even as you struggle with the burden at hand. Among the keys of beating caregiver stress syndrome, for example, are tapping into more practical and emotional support, finding physical outlets for stress, and focusing on self-care as much as possible.
Depression or Traumatic Brain Injury (TBI)?
Traumatic brain injuries (whether caused by falls, sports, accidents, or acts of violence) are commonly known as concussions, and they affect individuals differently. Often they create changes to mood, memory, attentiveness, and energy levels. A sufferer's personality may seem to change, and dramatic mood swings can be mistaken for depression. Making things more complicated, half of those who suffer head trauma will experience clinical depression, according to a 2010 study reported in the Journal of the American Medical Association. So the two conditions can overlap, or one may be mistaken for the other.
What to watch: Usually the cause of a traumatic brain injury is obvious -- but people don't always understand that the associated cognitive and mood effects can persist for several months after the incident. They can include listlessness, anxiety, paranoia, fear, irritability, difficulty beginning or completing tasks, and changes in concentration and attention.
What to do: Encourage someone who hit his or her head in a fall or other accident to get checked out afterward. (See what to tell the doctor when someone with dementia falls).Tell the doctor about ongoing depressive symptoms and encourage the person with the concussion not to be embarrassed or ashamed about sharing these symptoms.
Depression or Grief?
As with stress and burnout, the intense emotional and physical experience of grieving can be profoundly depressing. These very natural emotions aren't usually the same thing as the physical condition doctors call clinical depression, however. Grief and depression can overlap -- or be mistaken for one another.
There is an acute subset of grief, affecting 10 to 20 percent of mourners, known as prolonged grief disorder or complicated grief. (The term prolonged grief disorder was proposed for the 2013 diagnostic manual of mental disorders, DSM-5.) Psychological distress is so intense in these cases as to interfere with everyday functioning. People with this kind of grief are at dramatically increased risk for clinical depression.
What to watch: Everyone grieves differently. But a sign that someone may benefit from additional support is when there's difficulty managing everyday life. Among the other worrisome symptoms of acute grief are emotional numbness, a sense of meaninglessness, difficulty accepting the loss, and suicidal thoughts. Suicidal thoughts, in particular, should be taken seriously and brought to the attention of a clinician. Symptoms may persist a year or more after the loss, or they may not go into full swing until six months after the death.
What to do: A doctor or mental health professional can help advise on treatment for grief-related depressive symptoms. Realize, too, that grief isn't limited to mourning those who have died. Alzheimer's caregivers, in particular, often experience what's called anticipatory grief -- feelings of loss for someone who is still alive. (They don't call Alzheimer's the "long good-bye" for nothing.)