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Can A Person Be Seriously Depressed Without Feeling Depressed?

Can A Person Be Seriously Depressed Without Feeling Depressed?

Major Depressive Disorder is a psychiatric diagnosis that
is used to classify and define severe depression. Naturally enough, we may
expect that painful emotions such as sadness, depressed mood, hopelessness,
guilt, worthlessness and emptiness will accompany this problem.

While the symptoms above often do accompany major
depression, they do not have to be evident at all in order for the diagnosis to
be met. In fact, a person suffering major depression might correctly say that
he or she does not feel depressed. How can this be?

In order to meet the diagnosis, at least one of the
following two requirements must be met: 1) depressed mood; or 2) inability to experience pleasure (anhedonia).

The inability to feel or experience pleasure
from enjoyable activities is one of the so-called “vegetative” signs of
depression, meaning that its presence indicates that “organic” or
neurobiological factors are contributing to the problem.

In addition to anhedonia, other symptoms compiled by the American Psychiatric Association must be present in a two-week period:

  • Significant weight loss when not dieting; or weight gain (e.g. a change of more than 5 percent of body
    weight in a month), or decrease/increase in appetite nearly every day
  • Insomnia or extreme oversleeping nearly every day
  • Behavioral agitation or becoming markedly slow nearly every day
  • Loss of energy nearly every day
  • Feelings of worthlessness or excessive or inappropriate guilt nearly every day
  • Diminished ability to think or concentrate, or indecisiveness nearly every day
  • Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan,
    or a suicide attempt or a specific plan for committing suicide

If anhedonia is combined with insomnia, agitation, fatigue and indecisiveness nearly every day in a two-week period, the diagnosis of major depression is met despite a lack of negative emotions accompanying the picture,
a fact which any therapist evaluating someone for depression must bear in mind.

If the diagnosis is missed because the patient isn’t complaining of feeling low, appropriate treatment interventions may also be missed, and in the case of major depression, due to the serious and
potentially lethal consequences of this disease, it is extremely important to
begin correct treatment (antidepressant medication, cognitive-behavior therapy,
regular exercise, etc.) as soon as possible.

Westside Behavioral Care is a network of 25 therapists serving the Denver Metro area. Many Westside therapists specialize in the treatment of depression.