Over the past couple of posts, I’ve shared my personal experience with depression – that persistent mental fog, the fatigue, the gradual dimming of joy while satisfaction remained. But today I want to talk about something really important: your experience of depression might look completely different from mine, and that’s both normal and important to understand.
Depression isn’t a single, uniform condition. It’s more like a constellation of patterns that can cluster in different ways. Some people experience depression primarily as exhaustion and physical heaviness, while others might maintain their energy but feel emotionally numb. Some lose their appetite and can’t sleep, while others find themselves sleeping constantly and craving carbohydrates. I might have maintained the ability to feel satisfaction while losing joy, but someone else might lose both while maintaining their ability to think clearly.
Let me share some examples of how dramatically different depression can look. I’ve had clients who mainly experienced depression as intense irritability – everything and everyone got on their nerves, but they never felt particularly sad. Others described feeling like they were “wrapped in bubble wrap” – emotionally disconnected from everything but not necessarily unhappy. Some maintained high functioning at work while their home lives fell apart, while others could sustain close relationships but couldn’t manage basic daily tasks.
Even physical symptoms can vary wildly. While I experienced that constant “hangover” feeling with cognitive fog and fatigue, others might feel physically restless and unable to sit still. Some people’s depression shows up primarily in their bodies – with headaches, back pain, or digestive issues being their main symptoms. They might not even recognize it as depression until other parts of the pattern emerge more clearly.
Sleep and appetite changes can be weird. The typical pattern we often hear about is insomnia and loss of appetite. But in atypical depression (which, despite its name, is quite common), people tend to sleep more and eat more, particularly craving carbohydrates (I became a cookie monster). Some people’s sleep patterns fragment – sleeping in short bursts throughout the day and night – while others maintain normal sleep patterns but never wake feeling rested.
Understanding these patterns matters because it helps explain why different approaches work for different people. When someone tells me that exercise cured their depression, they’re not wrong – but they’re also not necessarily right for everyone. Their pattern of depression might have responded beautifully to increased movement and the accompanying norepinephrine and endorphins. Meanwhile, someone else might find that pushing themselves to exercise just depletes their already taxed resources.
This variation isn’t random. These different patterns offer important clues about what’s happening beneath the surface. For instance, depression that comes with anxiety, agitation, and early morning waking often signals a different underlying mechanism than depression with lethargy, oversleeping, and increased appetite. These patterns have been recognized across cultures and throughout history, though they’ve been understood and described in different ways.
Traditional healing systems often had multiple categories for what we now lump together as depression. For instance, Greek Medicine distinguished between “natural” melancholia that arose from an excess of black bile, and what they called “adust” – melancholia that came from the burning or overheating of various humors. When yellow bile became “burned,” it could lead to an agitated, anxious form of melancholia with restlessness and fearfulness. Burned black bile was associated with a more severe form that could include delusions and profound despair. Burned blood was thought to create a form of melancholia characterized by excessive joy and laughter – what we might now recognize as aspects of bipolar disorder. Each of these patterns required different therapeutic approaches. Cool, moist remedies were prescribed for the “burned” forms, while warming, stimulating remedies were used for cases of excess black bile. They also recognized the importance of diet, exercise, and daily routine in treating these different manifestations – creating treatment plans that addressed both the immediate symptoms and the underlying imbalances they believed caused them. Traditional systems, while working from different theoretical frameworks than modern medicine, recognized something important: depression isn’t one thing.
Modern medicine continues this tradition of recognizing distinct patterns within depression, though they now use different frameworks to categorize them. Modern psychiatry has specifiers like “with anxious distress,” “with melancholic features,” or “with atypical features” that help identify particular symptom clusters. For instance, melancholic depression is characterized by profound lack of pleasure, early morning waking, and significant changes in appetite and movement – a pattern remarkably similar to some classical descriptions of melancholia. Atypical depression presents with almost opposite features – oversleeping, increased appetite and a unique ability to feel temporary pleasure in response to positive events. These modern specifiers often point to different underlying mechanisms and can help guide treatment approaches. Someone with anxious depression might need different support than someone with primarily melancholic features, just as Greek physicians prescribed different remedies for different types of melancholia. Modern research is beginning to recognize that depression might be better understood as several related but distinct conditions that we currently group together because they share some common features. Someone whose depression is primarily driven by inflammation might need a very different approach than someone whose depression is linked to circadian rhythm disruption or chronic stress.
This brings us to an important point about recovery. Just as depression can look different in different people, recovery paths can vary significantly. Some people experience a complete resolution of symptoms, while others, like myself, find their way to a new normal that might include some lingering changes. Understanding these variations helps us set realistic expectations and develop appropriate support strategies.
Over the next few weeks, we’ll explore several different frameworks for understanding these patterns – from modern neuroscience to traditional healing systems to evolutionary biology. Each perspective offers valuable insights that can help us understand why depression manifests differently in different people, and more importantly, how to work effectively with these different patterns.
For now, I invite you to reflect on your own experience or what you’ve observed in others. What patterns do you notice? How might recognizing these different faces of depression change how we think about supporting those who struggle with it?
With care,
-Thomas