3 Signs of Depression That Often Go Unnoticed

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Depression is a ubiquitous term, and it seems most people have some idea, if not entirely accurate, of what it means. The symptom of sadness might come to mind for some, while others envision a suicidal gothic character. What lies between these extreme ends of the continuum—an isolated, fleeting symptom and an almost caricature representation—is vast. There are subtypes of depression, and even people suffering from the same subtype can present differently.

Further, some people are more internalized or externalized in their expression and possess greater or lesser abilities in managing. Jane, for instance, upon evaluation, might possess eight symptoms but seems OK because she works and cares for her family. Joe, on the other hand, might have five and be unable to care for himself. The severity of depression isn't necessarily weighed by several symptoms but by how impaired someone is by them. Regardless, given Joe’s symptoms are more visual, he might get help and live a higher quality of life while Jane silently suffers through life, or, worse, to a tragic ending.

With this in mind, it is important to pay attention to hidden signs of depression. There might be more to someone always sighing, frustrated, and agitated than meets the eye.

Unusual and Subtle Signs

Would it surprise you that depression can be hidden in plain sight, perhaps chameleonized as a "different issue?"

People arriving for sleep problems, anger, or infidelity may just be presenting the tip of the depression iceberg. As I wrote about in this earlier post, for instance, aggressive or thrill-seeking behaviors can be downstream effects of an internalized process. This is especially true for males/cultures where displaying emotional “weakness” is considered dishonorable.

Internalized emotional pressure, coupled with insomnia and poor diet, might escape as anger reactions. Cheating or indiscriminate sex may assuage one’s low self-image, providing a sense of desirability or thrill in the face of an otherwise flat internal landscape. Providers should always provide careful diagnostic assessments, as no symptom/behavior exists in a vacuum. Trying to address the anger or infidelity alone will only provide tenuous abatement at best, like clipping back a weed but leaving the root to grow it back.

More Complicated Dynamics

Anyone who has worked with angry people knows that “They’re just an angry person” isn’t likely. This is also the case with someone who sighs a lot, acts frustrated, and appears rattled. There’s an internal conflict being expressed, and often, a mood or personality complication behind it.

Behaviors are expressions of thoughts and feelings.

People who are depressed often present with sighing, frustration/irritability, and agitation, but if the package presents itself sans obvious depression, don’t write it off. Depression could be driving that demeanor, but the person is otherwise managing to conceal the foundational struggle. Take the case of Jessie (composite identity), who was referred by his employer to the employee assistance program for appearing increasingly discontent over recent months.

Jessie was never the life of the office, but he was dependable and pleasant enough. Insidiously, he had taken to exaggerated exhaling throughout the day, as if trying to externalize some burden so his day could go on. His work quality and productivity were not suffering, but he uncharacteristically became frustrated if there was a meeting or he was approached by colleagues, which disrupted his work. In meetings, it was hard not to notice his being fidgety or that he might roll his eyes and look about in an “I can’t believe this” gesture like his time was being wasted.

Jessie’s workload hadn’t changed, and there was no inter-collegiate problem present. However, his supervisor, Jenna, was concerned that his demeanor, despite his ongoing productivity, was placing a burden on the office milieu and referred him to the employee assistance program.

The Sigh-Depression Connection

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Sighing alone isn’t necessarily a signal of negative emotionality (Danvers et al., 2021). We sigh every few minutes, as it is normal for respiratory function to inflate alveoli in the lungs (Li et al., 2016). However, when pronounced sighs are presented regularly with other observations, as Jenna noticed, maybe it’s time to check in with the person or oneself.

This is because we sigh more when stressed or emotional. Vlemincx et al. (2022) noted that “[Sighs reset] emotional states by facilitating emotional transitions.” Perhaps more frequent sighing helps people mired in negative emotions constantly reset to a manageable emotional state.

Agitation, of course, is not only a physical expression of one’s restless mental state but can serve as stimulation/preoccupation/distraction. It can also be an expression of frustration, which is not unusual in depressed people. This, of course, lends itself to sighing, too.

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The inherent poor sleep and appetite of depression alone can cause irritation/agitation, but couple that with cognitive slowing and rumination of depression, and someone’s emotional experience could be akin to a pot with a lid on it beginning to boil; we don’t see the roil, but the shaking indicates something is up inside.

We all periodically roll our eyes, grunt, and/or hold our foreheads when frustrated, but when that fleeting state(s) becomes a trait, chronic internal turmoil likely keeps it afloat.

Clinical Implications

When encountering someone like Jessie, exploring their internal landscape is required for effective therapy:

After exchanging pleasantries, I said, “So, Jessie, we briefly spoke on the phone that you were referred because of seeming frustrated and on edge at work lately. What can you tell me about that?” Jessie went on to describe what Jenna did in the EAP referral.

“Seems like it’s become more noticeable over time," I replied. "I’m curious about what you can tell me about your experience as it was all building. Like, what changed? What has been on your mind in conjunction with all this?”

Though not directly answering the thought process question, Jessie reflected that for several months, he had been feeling “a grey mood” and could get irritable. He also slept more. It wasn’t the first time it happened. He remembered a similar event when his parents divorced when he was in his teens, 15 years earlier. Now, his mother had just divorced again and began “guilting” Jessie into doing things for her around the house. He set hard boundaries, engendering never-ending squabbling between him, his mother, and his siblings.

Jessie thought he kept any signs of bad moods hidden. Work was the most stimulating thing in his life at the moment, and he figured being occupied wouldn’t allow his bad mood to show through to colleagues. Work was an escape, but some of his inner world was escaping at work. Thankfully, it brought him to therapy, where he was able to work through his familial problems and not be left to stew in his emotions privately.

Robbins (2011) provides a good reminder of why it is important to keep vigilant for people like Jessie:

Because depression most immediately affects people’s inner mood and cognitive landscape, it is often “invisible” to outsiders. Thus, depression’s privacy can impede its early detection and thereby adequate treatment. These issues are compounded when the social stigma surrounding depression leads to patients intentionally hiding symptoms. Therefore, identifying observable, behavioral markers of depression is an important scientific endeavor with theoretical and clinical implications.

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