Am I tired or depressed?

A fellow caregiver asked...

How can I tell the difference between being tired or depressed?

Expert Answer

Dr. Leslie Kernisan is the author of a popular blog and podcast at She is also a clinical instructor in the University of California, San Francisco, Division of Geriatrics.

To screen for depression, doctors often ask the following two key questions:

  • During the past month, have you often been bothered by feeling down, depressed, or hopeless?
  • During the past month, have you been bothered by finding little interest or pleasure in doing things, especially activities you used to find pleasurable?

Answering "yes" to either is a red flag. Persistent sadness and the inability to enjoy anything (anhedonia) are strong signs of depression.

Changes in sleep habits, including sleeping more or less than normal, can be a sign of depression, too. But sleep is often disrupted simply as a result of the demands of eldercare, or as a feature of certain diseases and recovery processes. So fatigue alone is not a reliable indicator of depression. However, if you find yourself usually feeling sad or hopeless, or you're no longer able to look forward to things that used to make you smile, it's possible that you might be suffering from clinical depression.

Don't be shy about mentioning your concerns to your healthcare provider. Discuss whether it seems reasonable to do a trial of depression therapy (usually a combination of antidepressants and talk therapy). If you pursue this course, be sure to check back with your provider after two to three months to assess whether there has been a change in symptoms.