Depression is not just sadness

Empty park bench in autumn

The underestimated symptoms that hardly anyone talks about.

Many people still believe that depression primarily means sadness, crying, hopelessness, and withdrawal.

This is a simplistic view—and precisely why depression is often unrecognized, misinterpreted, or downplayed.

In my daily work, I see something different: Depression often manifests itself where no one is looking.

1. Emotional Emptiness Instead of Sadness

A key, yet poorly understood, symptom is emotional numbness.

Those affected say things like:

"I don't feel anything anymore."

"Neither joy nor sadness."

"Everything is flat."

This is called anhedonia—the loss of the ability to experience joy or interest. And it is often more debilitating than sadness because it attacks identity and relationships.

➡️ People continue to function, but inside, there's nothing left.

2. Irritability, Impatience, Aggression

Depression manifests not only internally, but often externally.

Many sufferers are:

easily irritable

thin-skinned

explosive over minor things

Especially in men, but also in high-achieving women, depression is frequently misinterpreted as:

"stress," "weak character," or "bad mood."

Irritability is often an expression of inner exhaustion of the nervous system.

3. Indecisiveness and Mental Block

Another key symptom: decision paralysis.

Not because someone is "unsure"—but because the brain cannot prioritize efficiently under depressive conditions.

Typical symptoms:

constant rumination

endless deliberations

fear of making the wrong decisions

This is often misunderstood as perfectionism or procrastination—but it can be explained neurobiologically.

4. Physical Symptoms Without a Clear Cause

Depression is not a purely psychological illness.

Common physical manifestations:

Pressure in the chest

Tightness in the throat

Gastrointestinal problems

Chronic fatigue

Tension pain

Many patients undergo years of somatic examinations before anyone asks:

"How are you really feeling emotionally?"

5. Morning Worsening

A classic, but little-known sign: 👉 It's worst in the morning.

Those affected feel:

empty inside

weak

emotionally "switched off"

It can improve slightly during the day – which leads to depression being overlooked.

6. Feelings of Guilt and Worthlessness Without Cause

Not all guilt is rational.

Depressive guilt is often:

diffuse

exaggerated

not tied to specific actions

Statements like:

"I'm a burden."

"Others would be better off without me."

These thoughts are not a realistic self-image, but rather part of the illness.

7. High-Functioning Depression: When No One Notices

A particularly insidious course: 👉 People function—professionally, socially, and outwardly.

But:

everything takes enormous energy

nothing feels meaningful

recovery no longer occurs

This form often goes undetected for years—until the body or nervous system collapses.

Why this knowledge is crucial

Depression doesn't become dangerous because people are "too weak." It becomes dangerous because it goes unrecognized.

The longer symptoms are misinterpreted as:

Stress

Personality

Life stage

the deeper the illness becomes entrenched.

My clinical perspective

Depression is not a character flaw. Not a lack of willpower. And certainly not a matter of "positive thinking."

It is a complex interplay of:

Nervous system

Biology

Life history

Current stressors

And that is precisely why it requires differentiation, not simplification.

Key takeaway

If you recognize yourself in these points—or know someone who "basically functions" but is empty inside:

👉 Take it seriously.

👉 Depression often manifests differently than we have been taught.