Most people associate depression with excessive sadness — but it can manifest without sadness, too.
While sadness or low mood is a common symptom of depression, it isn’t the only sign. You might notice that you’re having trouble sleeping, you’ve lost interest in your favorite hobbies, or you’ve started having angry outbursts.
You might be feeling empty, numb, or “blank,” but not exactly sad. Even if those around you don’t suspect anything is wrong, you might wonder if there’s something serious going on.
It’s a common misconception that you need to be sad to have depression. In fact, depression without sadness is more common than you may think.
According to the American Psychiatric Association, around 16% of people (1 in 6) will experience depression in their lifetime. Depression is relatively common, and various treatment options can help.
“Depression can show up in a variety of ways for different people, and those experiencing depression may not always describe what they’re feeling as ‘sadness’,” says Jeannette Bergfeld, PsyD, a clinical psychologist in Washington, DC.
Depression without sadness even has a name: nondysphoric depression.
According to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), at least one of the following symptoms must be present for at least 2 weeks for a diagnosis of major depressive disorder (MDD):
- a depressed mood
- a loss of interest in things you usually enjoy, called anhedonia
You don’t necessarily have to experience both sadness and anhedonia for a diagnosis of depression.
The DSM-5 also lists the following symptoms of MDD that may signal depression:
- significant weight gain or weight loss
- changes in your appetite
- sleep disruptions, such as insomnia or hypersomnia
- feelings of worthlessness, shame, or guilt
- fatigue or a loss of energy
- difficulty concentrating
- suicidal thoughts
Of course, you can experience some of these symptoms and not have depression. The difference is that depression causes “significant levels of distress or impairment in functioning,” and is not caused by another condition, explains Kimberly Holton, PsyD, a clinical psychologist at Ascellus.
Sadness can indicate depression, but the absence of all emotion — including sadness — could also signal depression.
“The absence of key feelings often marks depression, and many people with depression describe their emotional experience as empty, numb, or disconnected,” says Holton.
“While those with depression often do experience sadness, it’s neither a requirement for diagnosis nor uncommon to be diagnosed with depression in the absence of sadness.”
But with the absence of sadness also comes the risk of silent depression, another name for the kind of depression where you seem fine, even happy, on the outside.
Without sadness, you may rationalize your symptoms or have high-functioning depression. You might hide your depression from others or put off looking for help.
But with or without sadness, whatever you’re experiencing is valid.
Depression is often equated with sadness, but, in actuality, sadness is one of many possible symptoms.
One way to differentiate between sadness and depression is that sadness is “an emotion often related the experience of loss, disappointment to life changes, or any negative or unexpected situation,” says Holton, while depression is “a clinical disturbance in mood and behavior.”
Holton also explained how sadness might be “fleeting or sporadic,” whereas depression can last for 2 or more weeks uninterrupted — and may repeat over months or years.
Why is there a difference?
According to Bergfeld, the reason there’s so much variety in how people experience and express depression can be due to differences in brain chemistry or differences in how we respond to our emotional states.
“The ways our families and cultures help us understand our emotional states can impact how we name and express those emotions,” she explains.
“For example, if you come from a family that didn’t have much tolerance for the expression of negative emotions (or were raised in a culture where the expression of sadness is looked down upon), you may name and express your emotions in what feels like more acceptable or less vulnerable ways.”
Man, woman, or nonbinary, “you may not be read as sad or depressed on the outside, and you may have difficulty even recognizing it in yourself.” If this sounds familiar, know that you have options.
You can get diagnosed with depression without experiencing sadness.
“For diagnostic purposes, there must only be the presence of depressed/low mood or the loss of interest or pleasure in previously enjoyed activities, in addition to four or more other symptoms, per the DSM-5” explains Holton.
These symptoms must also be present for 2 or more weeks to diagnose depression. From there, your psychiatrist or general practitioner will likely offer a treatment plan.
Given that everyone’s depression looks different, your treatment plan might look different than someone else’s.
No matter how different your depression looks or feels, there are various treatment options for you to explore.
“If you’re experiencing depression without sadness, it’s important for you to target symptoms that are marked by contributing to emotional numbing,” explains Holton. The most common treatment options include therapy, medication, and self-care.
“Cognitive behavioral therapy aimed at challenging and changing negative thoughts while simultaneously engaging in targeted and goal-directed activities and social engagement can be both efficient and effective to breaking the cycle of depressive symptoms,” explains Holton.
Another option is group therapy, which tends to be more affordable.
You can see below for our list of tools and tips for finding a therapist in your area.
Doctors often recommend antidepressants to treat depression and can elevate or balance your mood. This treatment often takes time to work and is commonly paired with therapy.
There are various types of antidepressants, such as SSRIs or SNRIs, giving you ample opportunities to find what works best for you.
“Focusing on basic forms of taking care of your body can be incredibly helpful for depression, though it’s important to be patient and gentle with yourself in the process and take gradual steps to improve your daily habits,” offers Bergfeld.
Self-care for depression could look different for you than others, and finding what works for you could become part of your healing process. You could consider:
Not experiencing sadness doesn’t mean you don’t have options to treat depression:
- If you’re looking for a therapist, you could consider using Psych Central’s How to Find Mental Health Support resource.
- You could also look into organizations such as Depression and Bipolar Support Alliance and the National Alliance on Mental Illness, who offer free local peer-led support groups.
Recognizing that you’re not okay is one of the most challenging parts — especially if it looks or feels atypical. If you’ve already acknowledged this, then you’re already well on your way to progress. You don’t have to endure this in silence, and you CAN get through this.