Can you be depressed without knowing?

In this guide we will discuss whether you can be depressed without knowing about it yourself. We will also take a look at the importance of insight when it comes to mental health. 

Can you be depressed without knowing?

The direct answer to the question whether one can be depressed without knowing, is yes. You might not recognise a sign of depression for what it is – and even when you do start to suspect you’re depressed, you might feel tempted to deny it.

A few reasons why you might not be aware of your own mental health condition such as depression include:

  • Different manifestation of depression
  • You might be in denial and exploagi it away
  • You might not have a “legit” reason
  • You might be on the milder scale of severity
  • Depressed doesn’t always mean ‘sad’ or ‘low’
  • We mistake depression for weakness
  • Maladaptive beliefs about being strong and tough

Rin Hamburg for The Guardian writes of his own experience with depression and his inability to recognise it in spite of seeing it first hand in his close family members. He writes,

“It always amazes me how long it took me to figure out I was depressed. My dad had bipolar and my sister was diagnosed with depression over a decade ago, so you’d think I’d know the signs…”

For this writer, it took persistent encouragement from their friend to seek help.

Depression or Major Depressive Disorder has been deemed as one of the major disability causing conditions with an estimate of 3.8% of the population affected. 

It is extremely debilitating and can impact your social life, your occupation and career, and it can also impact your health, even leading to death. 

Depression sets in gradually and in other cases it is often caused by sudden changes such as loss and grief. However the symptoms of depression are such that you might mistake it for physical exhaustion or laziness or even “normal” sadness or stress.

Since the symptoms often start off so subtly, you might not notice what is happening to them in spite of mental health awareness being on the rise. 

While you might not have insight about your own condition, the people around you might notice and try to bring it to your attention. However, because of the stigma around mental health disorders, you and many others often choose to explain it away until it progresses in severity. 

Insight or awareness of our own mental health condition is quite tricky, especially when you have lived your entire life struggling when a certain psychological issue- it becomes the norm which makes it even difficult to see that it is maladaptive or that there is an issue at hand. 

Let us take a closer look at what insight is and why it is so important.

Mental disorder and insight

Insight, to put it simply, is having the personal awareness and understanding of one’s mental health condition. M.S Reddy notes that it involves the ability to understand the nature, severity, and significance of your disorder- like depression- in your life.

Amador and David, in their book “Insight and Psychosis”, expanded the concept of insight as:

  • Awareness of having a mental illness.
  • Awareness of the consequences of mental illness
  • Awareness of symptoms of mental disorder.
  • Attribution of symptoms to a mental disorder.
  • Awareness of the effects of medication and treatment

A study examined 247 patients with depressive disorders to determine their levels of insight with respect to their awareness of the disorder, the effect of symptoms, and their understanding of the necessity of treatment. 

The study results revealed that a high number of the participants had no awareness about the effect of their symptoms while a similar number of participants had impaired insight of their disorder.

The study also found that participants who were younger and who had more severe depression symptoms had significantly more insight into awareness of the illness. 

It is also interesting to note that people who have been diagnosed with Major depressive disorder and have insight into their illness have more insight into their need for treatment as opposed to people who have unspecified depression.

The study highlights why insight is necessary as they, like M.S Reddy, stresses that insight greatly advances treatment outcomes and recovery.

Factors that can hinder awareness of depression

If depression is so common, you might be thinking why it is so hard to recognise it. There are various factors that can hinder insight. 

Depression can manifest differently

Your depression might look completely different to someone else’s. For example, for someone one, their symptoms might include sleeping too much and weight loss while for someone else it could be gaining a lot of weight and insomnia. 

Your symptom of depression might not be what is observed stereotypically. You might not even have low moods and lethargy. You might be going to work, walking your dog, meeting your friends all with very low motivation and excitement to do them.

These examples are very different and yet they fit with a depressive disorder. Left untreated, these symptoms can aggravate and cause dysfunction in various parts of your life.

You might be explaining it away

If you have just gone through a bereavement, job loss or a divorce or are having health problems, you might think that the way you are feeling is an obvious response. 

You expect this response to those life events and think to yourself that you will eventually “get over it. 

However, you have to understand that if these symptoms persist for more than two weeks and it affects your ability to socialize, maintain relationships, meet the demands of your work then it could possibly be the onset of depression.

No reason for you to be depressed 

Your lack of insight and awareness can also be because you think that you have no reason to be depressed- or at least no obvious reason.  

Depression is not always associated with a life event or difficult phase. It could be related to something that happened earlier in your life- trauma that your brain has blocked out or even seasonal shifts. 

There might be other reasons such as feeling unsupported by your loved ones, not being satisfied with your job in spite of the heavy paycheck and benefits, it could also be your brain and it’s neurochemical imbalances that are not overtly observable. 

Different levels of severity and gradual development

Because the onset of depression can also be gradual, an accumulation of stress, time, and unresolved issues within the self, depression can go unnoticed.

In fact, people often live with depression for months before someone else notices or they themselves develop an awareness of something being “off” with them.

Depression symptoms can also start of very mildly, from being tired or sad and eventually grow into being “tired all the time” without exertion and being so sad that they contemplate suicide. 

The severity and the pace of onset can differ from person to person and from situation to situation which can make it all the more confusing for someone to understand what is happening to them.

Depressed doesn’t always mean ‘sad’ or ‘low’

Many people with depression don’t really feel sad, it is more of a numbness and disinterest in things and their lives. 

Your depression might even manifest in other ways, with other emotions – for example, you might be angry or resentful. You might be withdrawn socially and may not be able to focus on work. 

Because symptoms of depression other than being sad and low are not well known, you might not be noticing various changes in yourself in light of having possible depression. 

We mistake depression for weakness

Despite all the mental health awareness campaigns, there is still a lot of stigma around mental health disorders. 

People often internalize the stigma and apply it to themselves. They see any lack of energy or vigour or feeling sad or low as a ‘weakness’ or ‘failure’ rather than a more complicated issue relating to brain chemicals, life events, and extreme stress. 

All of which makes it hard to recognise our own depression, acknowledge it, and harder still to seek treatment.

Maladaptive beliefs about being strong and tough

Oftentimes, people tend to value the attributes of resilience, strength, and toughness. When we are grieving, people tell us to be strong and when we are caring for a sick partner or parent, people tell us how much they admire our strength. 

While they might be coming from a good place, the stress and pressure to keep your head up can become oppressive. You might begin to shun every sign of exhaustion and slowly down and push forward.

These patterns of thinking and beliefs are often maladaptive when they are done without acknowledging our own emotions and how they affect us. 

Because of these beliefs, someone who is dealing with burnout and depression after being a carer giver to an ill family member- they might push aside the possibility of themselves struggling with a mental illness, this can cause impaired insight of the disorder and the need for treatment. 

How to Know if You’re Depressed

Let’s look at the most common signs of depression. Remember, depression looks different for everyone, so it’s possible for you to experience only some of these signs. If you have depression you might be experiencing these changes in your life.

  • You seem to have a persistent low mood, you might even be feeling numb or “nothing at all”
  • You seem to notice that you no longer get excited or have interest in the things you once loved- it could be your relationship, your job, your hobbies, etc,
  • Your friends and family have begun to notice that something is “off” about you and tend to ask you if you are okay, a lot. 
  • You are eating a lot or not eating enough which is causing rapid weight loss and gain.
  • You seem to be extremely critical about yourself, have a lot of self-doubt, and think of yourself as a loser, insignificant, a burden, or even a waste of space.
  • You tend to be sleeping a lot or sleeping too little.
  • Your body seems struggling with aches and pains without obvious causes or clear medical diagnosis. 
  • You might be thinking about death a lot, or thinking about “disappearing”. You might also not want to live but at the same time not want to die.  You might be contemplatng suicide, even if it is a passing thought or actively planning it out. 
  • You might also be noticing that you seem to be struggling at work- unable to meet objectives, deadlines, and not able to focus or having the motivation to work.
  • You might also be noticing that you are withdrawing from relationships, and there is building tension between you and your loved ones. You might even be feeling like you do not love them, feel dissatisfied or someone might accuse you of not being present in the relationship. 

Next steps

Now, if you think that you are experiencing a bulk of what was discussed earlier, here are the next steps you can take:

Reach out to your loved ones- some you can trust. Tell them what you are going through. They may not be able to help you effectively but their support can be invaluable as you reach out to a professional who can help you get the treatment you need. 

You can see a physician to discuss your symptoms, a psychiatrist can help identify your disorder and get you started on treatments after various testing, they can also refer you to a therapist to help you cope with the symptoms and living life with depression. 

Get yourself committed to therapy. A combination treatment of drugs and therapy is found to be best for depression and anxiety as opposed to either stand alone treatments. 

A therapist that you can click well with, it might take time for you to find someone you can trust and be open with, can help you build strategies to cope and manage symptoms. 

However, for treatment to be successful it is crucial that you are persistent and committed to both drug treatments and therapy.

Conclusion

In this guide we discussed the importance of insight when it comes to the treatment of mental illness such as depression. We also looked into why depression can go unnoticed and what are some of the signs that are telling of the condition.

Reference

Navarro-medical.com

Theawarenesscentre.com

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4649806/
https://pubmed.ncbi.nlm.nih.gov/16122540/

Frequently asked questions related to “Can you be depressed without knowing?”

How do you know if you have undiagnosed mental illness?

The most obvious criteria of you having a possible undiagnosed mental illness is when various changes in the way you feel, think, and behave is causing dysfunction in your ability to work, maintain relationships, and causing general disruption of your quality of life. For Example, someone with undiagnosed social anxiety might find it extremely hard to go out for job interviews and engage in school related activities to the point that there avoidance cause them to lose their jobs and fail classes. 

What happens if you have undiagnosed mental illness?

Undiagnosed and untreated mental illness can lead to poor management of physical health, Substance use, relationship problems, loss of job and academic failure, psychosis, and even death. 

What are the 5 signs of mental illness?

The five main signs of mental illness are as follows:

  • Excessive paranoia, worry, or anxiety.
  • Extreme changes in moods.
  • Social withdrawal and inability to meet the demands of their lives
  • Dramatic changes in behaviour related to sleep, diet, hygiene
  • Observable changes such as delayed speech, response, and thought process. 

Can you be aware of your own psychosis?

Psychosis itself is a symptom of severe mental disorders such as schizophrenia. You may experience vague warning signs before the symptoms of psychosis begin. People who have psychosis start out extremely frightened and embarrassed and because of stigma they might not seek help. 

In the early stages of psychosis, people often are able to tell reality and hallucinations or delusions apart, meaning that they are aware of what is happening but as it aggravates, they often lose this ability and awareness, 

Can a mental illness be cured?

Mental illness cannot be cured, but the objective of treatment is remission. Mental illness can be managed and treated with both medications and psychotherapy, depending on the disease and its severity. 

In present advances in psychiatry sciences, most mental illnesses cannot be cured, but they can usually be treated to minimize the symptoms and allow the individual to function in work, school, or social environments.

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