When you imagine a depressed person, it's probably someone who acts very sad and hopeless all the time. Thing is, depression symptoms can be a lot more subtle than that, manifesting not just with emotional signs, but with physical ones as well.

"Depression doesn’t always look like debilitating sadness," says Richard Kravitz, MD, MSPH, a professor of internal medicine at University of California, Davis, and an expert in identifying depression in primary-care settings. "Patients are reluctant to consider depression as a cause of their symptoms—in part because they may equate it with weakness, but also in part because they simply don’t associate those symptoms with depression."



Accurately identifying the problem is key, he adds, because the sooner you get treatment, the easier it will be to return your happy, healthy self. Here are the surprising warning signs you don’t want to miss.

This content is imported from {embed-name}. You may be able to find the same content in another format, or you may be able to find more information, at their web site.

1. You're in pain.

Depression and pain share some of the same biological pathways and neurotransmitters. About 75% of people with depression suffer recurring or chronic pain, research shows. In a Canadian study published in the journal Pain, people with depression were four times more likely to have intense or disabling neck and low back pain than those who were not depressed. "When you're in a negative state, you're apt to tune into your body more carefully, and therefore feel any discomforts more acutely," Kravitz explains. You might also notice stomachaches and headaches, or just experience greater sensitivity to pain in general. A 2008 study in the Archives of General Psychiatry found that when people with depression anticipate pain, their brain activity indicates more emotion and less coping, so they're less able to handle the hurt.

2. You've gained weight.

Where did that extra roll come from? Maybe from all the late-night ice cream you've been inhaling? Or from the frozen dinners you've been eating because you don't feel like shopping or cooking? Although comfort food can raise levels of the mood-boosting brain chemical serotonin, over time emotional eating can lead to weight gain and feelings of guilt and shame, plus it does nothing to treat the underlying causes of depression. A new study in the journal Obesity confirms that high levels of stress and depression make it tough to drop pounds and stick to effective weight-loss strategies. On the flip side, some people may lose weight, as depression zaps appetite.

3. You have a short fuse.

If the slightest mishap sends you into a rage, or grouchy is your new normal, you may be depressed. In a 2013 study published in the journal JAMA Psychiatry, 54% of people with depression reported feeling hostile, grumpy, argumentative, foul-tempered, or angry. "Once you’re on the negative side of the house, you're more accessible to the rooms where other negative moods hang out—irritability, frustration and anger," says Simon Rego, PsyD, associate professor of clinical psychiatry and behavioral sciences at Albert Einstein College of Medicine and director of psychology training at Montefiore Medical Center. "You're not directly there, but it's a short walk."

An estimated 16.2 million American adults has experienced at least one depressive episode. (NIMH)

4. You feel nothing.

Feeling blah? Neutral? Numb? "Most of us have motivations that get us out of bed in the morning, whether it's work, exercise, socializing, or making breakfast," says Rego. "But for people who are depressed, those pulls dry up." And things that once brought tears or smiles now barely register. This kind of zombie behavior is a hallmark of depression, and it can make you seem cold, distant or aloof, pushing away the people who would otherwise give you love and support.

5. Your evening cocktail is now three.

If you're having several glasses of alcohol every night, it's probably more than a rough day at work. Nearly one-third of people with depression also have an alcohol problem, research shows. And though one drink can take the edge off, a second or third can amplify negative emotions—anger, aggressiveness, anxiety, and greater depression. It's important to note: You don't have to be a raging alcoholic to be abusing alcohol. The healthy limit, according to the U.S. Department of Health and Human Services, is one drink per day for women, and two drinks per day for men. (Are you overdoing it? Check out these 6 sneaky signs you drink too much.)

6. You're glued to Facebook

Or gambling or shopping...basically doing anything in excess, especially online. Several studies confirm that people who go online compulsively and have more virtual social interactions than real ones may be depressed. They may feel deprived of real human companionship and/or may be using the online world to escape from their thoughts and feelings. While Internet addiction and depression are separate diagnoses, they often overlap. "The quest for a short-term boost is a common coping mechanism," says Rego.

7. Your head is in the clouds.

Daydreaming a lot lately? About becoming a movie star, falling madly in love, how your friend's kid is smarter than yours, or the boss has it in for you? Psychologists from Harvard University have shown that we're happiest when our minds are firmly rooted in the present moment, and when our minds wander, it can make us wistful, anxious, and unhappy. While daydreaming can help find creative solutions to problems, more often than not it's linked to low mood. (Here's how to become more mindful—no matter how crazy your schedule is.)

8. You can't make up your mind.

We make upwards of 70 conscious decisions every day, Columbia University research shows, and most of them are no-brainers. Snooze or wake up? Get dressed or stay in pajamas? Eat oatmeal or eggs? Read or watch TV? "When we’re depressed, those cognitive processes take a big hit," says Rego. "Little things we normally don't think twice about suddenly become weighty decisions."

9. You've stopped combing your hair or brushing your teeth.

Even if your grooming routine was modest to begin with, it may disappear when you're depressed. In a 2014 survey of more than 10,000 people, 61% who had poor oral health reported suffering depression. And the more dental issues they had, the more severe the depression was. "It's a spectrum," says Rego. "Neglecting your physical wellbeing and appearance is only problematic when it crosses over into distress or dysfunction." Ultimately, not caring what you look like on the outside is a strong sign of problems happening on the inside.

10. You can't seem to stick to a sleep schedule.

Depression can mess with sleep in multiple ways. Many people struggle with insomnia, and either have trouble falling asleep or staying asleep the entire night. But depression can also have the opposite effect, with some sleeping excessively—all night, and then a good part of the day as well.

If you're worried you may be depressed, take our quick quiz for more information, and share your concerns with a health-care provider, so you can get the help you need to start feeling better.

This content is created and maintained by a third party, and imported onto this page to help users provide their email addresses. You may be able to find more information about this and similar content at piano.io