The picture most of us carry of depression is someone who cannot get out of bed and cries a lot. That version exists. But plenty of people who meet every criterion for a depressive episode are still going to work, still answering emails, still turning up to things, and would describe themselves as fine if you asked in a car park.

Flat, not sad

The word people use most often is flat. Not miserable. Flat. Things that used to be enjoyable are now just events that happen. You go to the thing, you do the thing, and afterwards you notice you felt nothing much either way.

Clinically this is called anhedonia, the loss of pleasure or interest, and it is one of the two core features of depression. Low mood is the other. You do not need both. A lot of people have the second without much of the first, which is exactly why they do not recognise what is happening.

Irritability

This one causes a lot of damage before it gets named, because it does not look like a mental health problem. It looks like being difficult.

A short fuse over small things. Snapping at people you love and feeling wretched about it afterwards. A sense that everyone is being slightly too much. In men in particular, and in teenagers almost as a rule, irritability is often the most visible sign, and it is regularly read by everyone around them as attitude rather than distress.

The thinking changes

Depression makes cognitive work harder in a way people rarely connect to mood. Reading a page three times without absorbing it. Sitting in a meeting and losing the thread. Decisions that would once have taken a second now take twenty minutes, and small ones are somehow worse than big ones.

People often come in worried about early dementia or a brain injury. Far more often it is a depressive episode compressing working memory and concentration.

The body keeps score of it too

Waking at three or four in the morning and not getting back to sleep. Or sleeping ten hours and waking unrefreshed. Appetite gone, or appetite constant. Aches with no clear cause. A heaviness in the limbs that makes ordinary tasks feel physically effortful.

The tiredness is the one people most often take to a GP, and quite reasonably it gets investigated for iron, thyroid and everything else first.

High-functioning is not a diagnosis, but it is a real problem

Some people hold everything together at work and fall apart the moment they get home. The job gets the last of the fuel and the family gets the fumes. Because the visible parts of life are still working, nobody around them is alarmed, including them.

Two things follow. They wait far too long to get help, sometimes years. And when they finally do, they feel like a fraud for taking up a spot, because surely other people have it worse.

They usually do not have it worse. They are just less good at hiding it.

When to do something about it

Two weeks is the rough clinical marker. Most of the criteria hinge on symptoms being present most of the day, nearly every day, for at least a fortnight. That is a guide rather than a gate.

The more useful question is whether it is costing you something. Whether you have stopped doing things you used to do. Whether people close to you have said something. Whether you have started organising your week around having enough energy to get through it.

Depression responds well to treatment, and it responds better the earlier you start. You can read about how I work with depression and anxiety, and about what sessions cost with a Medicare rebate.

If you are reading this and quietly recognising yourself, that recognition is worth acting on. Send an enquiry, or talk to your GP about a Mental Health Treatment Plan.

If things are worse than that right now, please contact Lifeline on 13 11 14 or, in an emergency, 000. This practice is not a crisis service.