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∙8 minute read
Depression is often imagined as a singular, recognisable condition—one that looks the same for everyone. The reality, however, is far more complex. Depression manifests in multiple forms, from persistent sadness to extreme irritability, and even physical symptoms like chronic pain and fatigue.1
Yet, despite being one of the leading causes of disability worldwide, depression remains widely misunderstood and underdiagnosed, particularly in people who don’t fit the stereotype of someone who is visibly sad and withdrawn.2 This is because people with mental disorders often face a lack of support, and the stigma associated with mental health issues may prevent them from accessing the right treatment. The consequences of the lack of diagnosis and treatment can be severe, with untreated depression linked to cardiovascular disease, and long-term health complications.3
There isn't a one-size-fits-all outlook on depression. The symptoms can vary from person to person depending on how their depression manifests. Below are just a few examples of different classifications of depression.
1. Based on severity
The ICD-10, which is the international classification of disease used in the UK to diagnose depression, differentiates depression into different categories based on severity, duration, and symptom presentation.4
Mild: an individual with mild depression will have at least four symptoms of depression (e.g. low mood, fatigue, loss of interest), but their daily functioning will remain mostly intact albeit with some difficulty.
Moderate: those with moderate depression will exhibit more symptoms than mild depression at increased severity. They’ll also find significant difficulty in daily activities and responsibilities.
Severe: individuals who present with most symptoms of depression, including possible psychotic symptoms like delusions, would be classified as having severe depression.
2. Recurrent depressive disorder
Recurrent depressive disorder is the most widely recognised form of depression, characterised by persistent low mood, loss of interest in activities, sleep disturbances, fatigue, and suicidal thoughts.4
Recurrent depressive disorder can also manifest as dysthymia, which is a longer-term chronic depression that lasts at least two years. It’s less severe than major depression but is more persistent.
3. Atypical depression
People with atypical depression often experience mood reactivity—meaning their mood can temporarily improve in response to positive events.4,5 Symptoms may include excessive sleeping, overeating, and extreme sensitivity to rejection. This form of depression is frequently misdiagnosed as laziness or a personality trait rather than a clinical disorder.5
4. Mixed depression
Mixed depression is a dangerous and often overlooked subtype where depressive symptoms co-exist with features of mania or hypomania, such as irritability, racing thoughts, restlessness, and impulsivity.6 These individuals may not appear sad at all—instead, they might seem agitated, reactive, and emotionally volatile, leading to frequent misdiagnosis as anxiety or personality disorders.
5. Melancholic depression
Depression can be felt as much as it is experienced emotionally. Many individuals with depression report chronic pain, headaches, digestive issues, loss of pleasure in almost all activities, and extreme fatigue, often without realising that their symptoms are linked to their mental health.4, 7 This can lead to repeated medical investigations with no clear diagnosis, causing frustration and hopelessness.
6. Seasonal affective disorder (SAD)
SAD is a recurrent form of depression that follows a seasonal pattern, usually worsening in winter when sunlight exposure is limited.8 Symptoms include low energy, increased sleep, weight gain, and difficulty concentrating. SAD is more common in regions with less sunlight and can be effectively treated with light therapy.9
Depression doesn’t just affect individuals—it has serious economic and public health consequences. In the UK, depression costs the economy over £105 billion per year in lost productivity and healthcare expenses.10
Additionally, untreated depression significantly increases the risk of suicide. The World Health Organization estimates that over 700,000 people die by suicide each year, with depression being a major contributing factor.11
Despite this, many people still don’t seek help due to stigma, misdiagnosis, or a lack of awareness about the different ways depression can present.10
Depression isn’t just attributed to feeling sad. If someone you know seems more irritable, exhausted, or withdrawn than usual, check in with them. Likewise, you can still seem fine and happy but still have depression, and hence, it often goes unnoticed. The earlier depressive symptoms are identified, the better it can be managed and treated.12
1. Reach out and offer support or ask for help
Many people struggling with depression won’t ask for help. Simply letting them know you’re there—without judgement—can make a world of difference. Offering practical support, such as running errands or cooking a meal, can also be invaluable.
However, if you’re the individual struggling, then don’t shy away from asking for help. Long-rooted stigmas have made asking for help seem like a “weak” mentality, but in reality, it’s anything but. All those around you are here to help, so don’t be afraid to ask.
2. Encourage professional help
Depression is highly treatable. A combination of therapy, lifestyle changes, and (if necessary) medication can significantly improve quality of life.13 If you or someone you know is struggling, encourage them to seek professional guidance.
3. Try mindfulness and stress-reduction techniques
Mindfulness-based interventions have been shown to reduce symptoms of depression by promoting self-awareness and emotional regulation.14 Simple strategies like deep breathing, meditation, and journaling can help manage negative thoughts and improve emotional wellbeing.
Want to integrate mindfulness into your daily routine? Join our March Mindfulness Challenge and learn how to use mindfulness techniques to support mental health.
If you’re struggling with your mental health, know that you’re not alone—help is available. Whether you’re feeling overwhelmed, anxious, or just need someone to talk to, these organisations offer free and confidential support:
Samaritans – Available 24/7 for anyone in distress. Call 116 123 for free or visit www.samaritans.org.
Mind – Provides advice and support for mental health challenges. Call 0300 123 3393 or visit www.mind.org.uk.
CALM (Campaign Against Living Miserably) – Focuses on suicide prevention and mental wellbeing, particularly for men. Call 0800 58 58 58 (5 pm–midnight) or visit www.thecalmzone.net.
If you’re in immediate danger or need urgent help, please contact 999 or visit your nearest A&E. You’re not alone, and support is always within reach.
Depression can look like sadness, irritability, exhaustion, or even physical pain. Depression can also be invisible. Because of this, far too many people go undiagnosed and untreated. Recognising the many faces of depression is the first step towards reducing stigma and ensuring that everyone gets the help they need. If you or someone you know is struggling, don’t wait—reach out, seek support, and take the first step towards recovery.
Benazzi F. Various forms of depression. Dialogues Clin Neurosci. 2006;8(2):151–161. doi: 10.31887/DCNS.2006.8.2/fbenazzi.
‘Depression: let’s talk’ says WHO, as depression tops list of causes of ill health [Internet]. Who.int. [cited 2025 Feb 3]. Available from: https://www.who.int/news/item/30-03-2017--depression-let-s-talk-says-who-as-depression-tops-list-of-causes-of-ill-health
Understanding the link between chronic disease and depression [Internet]. National Institute of Mental Health (NIMH). [cited 2025 Feb 3]. Available from: https://www.nimh.nih.gov/health/publications/chronic-illness-mental-health
World Health Organization. ThelCD-10 Classification of Mental and Behavioural Disorders. 1992.
Benazzi F. Testing DSM-IV definition of atypical depression. Ann Clin Psychiatry. 2003;15(1):9–16. doi: 10.1023/a:1023272408562.
Benazzi F. Mixed depression: a clinical marker of bipolar II disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2005;29(2):267–274. doi: 10.1016/j.pnpbp.2004.11.010.
Trivedi MH. The link between depression and physical symptoms. Prim Care Companion J Clin Psychiatry. 2004;6(Suppl 1):12–6 1998;155(10):1398–1406. doi: 10.1176/ajp.155.10.1398.
Magnusson A, Partonen T. The diagnosis, symptomatology, and epidemiology of seasonal affective disorder. CNS Spectrums. 2005;10(8):625–634. doi: 10.1017/s1092852900019593.
Campbell PD, Miller AM, Woesner ME. Bright Light Therapy: Seasonal Affective Disorder and Beyond. Einstein J Biol Med. 2017;32:E13-E25. PMID: 31528147; PMCID: PMC6746555.
Department of Health. No health without mental health: a cross-government mental health outcomes strategy for people of all ages. London: DoH; 2011.
World Health Organization. Suicide worldwide in 2021: global health estimates. WHO; 2021
Halfin A. Depression: the benefits of early and appropriate treatment. Am J Manag Care. 2007;13(4 Suppl):S92-7
National Institute for Health and Care Excellence. Depression in adults: treatment and management [Internet]. 2020. Available from: https://www.nice.org.uk/guidance/ng222
Hofmann SG, Gómez AF. Mindfulness-based interventions for anxiety and depression. Psychiatr Clin North Am. 2017;40(4):739–49.
