When Depression Doesn't Show on the Outside

Medically Reviewed By William C. Lloyd III, MD, FACS
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If you break your leg or catch a cold, it’s pretty obvious to everyone around you. They can see your cast or hear you sneeze and cough. The symptoms of depression are far less obvious. Feelings such as sadness, hopelessness, and difficulty concentrating may not be apparent to anyone but you.

On the outside, you might seem like your old self, but on the inside, you may be exhausted, working hard to overcompensate for the heavy weight of your depression. This might work for a while, but most people eventually find it too much to take. This added pressure to seem “normal” can make depression an even harder burden to bear; plus, waiting longer before seeking help can sink you down even lower. When you keep your emotions locked up inside, you miss an important opportunity to get the treatment you need. Your doctor can miss the diagnosis if you don’t bring up how you’re feeling.

It’s important to get help for hidden depression before it can affect your relationships, your career, and other aspects of your life.

Why Invisible Depression Is a Problem

The stigma surrounding depression keeps some people from being open about their condition and getting the help they need. You may not want to be labeled as “that person with depression.” You might worry friends, family members, and co-workers won’t understand how you’re feeling or will distance themselves from you if they know the truth. You may even be nervous about discussing depression with your doctor.

Remember that depression isn’t a moral failing. You didn’t do anything wrong to feel this way. Depression also isn’t something you can wish away. Although sometimes it can fade over time, it usually comes back if not treated appropriately to begin with, which is why you need to address it head-on to start feeling better.

Invisible depression can have consequences. People who don’t get the treatment they need are at higher risk for:

  • Alcohol or drug use
  • Relationship issues
  • Problems at school or work
  • Suicidal thoughts or attempts

Depression Tools and Treatments

Depression is treatable. Usually, treatment involves a combination of talk therapy and medications.

Antidepressants are the type of medicine doctors prescribe for treating depression. These medications boost your mood by altering levels of chemicals called neurotransmitters in your brain.

Antidepressants come in a few different classes:

  • Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft)
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs) such as duloxetine (Cymbalta) and venlafaxine (Effexor XR)
  • Atypical antidepressants such as bupropion (Wellbutrin SR), vortioxetine (Trintellix), and brexpiprazole (Rexulti)
  • Tricyclic antidepressants such as desipramine (Norpramin) and nortriptyline (Pamelor)
  • Monoamine oxidase inhibitors (MAOIs) such as isocarboxazid (Marplan) and phenelzine (Nardil)

It can take 2 to 4 weeks for depression symptoms to improve after you start taking antidepressants. And it could take some trial and error to find the medication that works best for you.

Antidepressants are usually paired up with talk therapy such as cognitive behavioral therapy (CBT). This treatment aims to reframe and change the negative thoughts that are causing your depression.

If depression doesn’t improve with these treatments, your doctor might recommend other therapies that work by stimulating your brain.

Coping With Depression

While you’re getting treatment for depression, there are a few things you can do to help yourself feel better. One is to take good care of yourself. Make these positive health strategies part of your daily routine:

  • Eat well-balanced meals with lots of fruits and vegetables, whole grains, and low-fat dairy foods. Try not to skip meals or overeat as a way to deal with depression.
  • Take a walk, go on a bike ride, or do whatever exercise you prefer for at least 30 minutes a day. Exercise is a natural remedy for depression.
  • Set aside time each day to do something you love. You might read a book, watch a funny movie, or plant flowers in your garden.
  • Reach out to the people you care about, so you don’t feel so alone. Call or meet up with a good friend or family member who supports you and boosts your self-esteem.

Stigma and fear can lead to hidden depression. Take that first step toward getting the help you need. Ask your doctor or a mental health professional for help. If you don’t have a doctor you trust, reach out to an organization like the Substance Abuse and Mental Health Services Administration (SAMHSA) at 1-800-662-HELP (4357).

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 May 21
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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