Autism and Depression – How it Can Present Differently in Neurodiverse Individuals

We all experience passing feelings of sadness, grief, and hopelessness from time to time.

Typically, these are temporary mental states that come and go in fleeting moments. When these symptoms persist or accompany other signs of mental distress, it may indicate clinical depression. Millions of people in our population are diagnosed with depression every year. Most individuals are diagnosed based on common ‘by the book’ symptoms, but this can leave an entire segment of our population out.

Depression often presents itself differently in neurodiverse individuals, which makes it much more difficult to pinpoint as an autistic, and to diagnose as a clinician.

What is Depression?

The Mayo Clinic describes depression as a mood disorder that leads to persistent feelings of sadness and loss of interest. Depression is also called major depressive disorder or clinical depression. “Depression affects how you feel, think and behave and can lead to a variety of emotional problems.”

People with depression can experience a range of symptoms, and lingering symptoms can lead to feeling as if life is no longer worth living. Depression is not a condition that you can simply think yourself out of. It can require treatment and monitoring in the long term. Depression is common among autistic people. Some studies indicate that people diagnosed with autism often experience co-occurring mental health conditions, and depression rests at the top of those that are most reported.

Autistic adults and teens (compared to neurodiverse children) are more commonly diagnosed with depression, with up to 40.2% having lifetime depression. Mental health care professionals report that depression is one of the most common concerns expressed by autistic adults before a depression diagnosis is made.

Common Symptoms of Depression

The warning signs of depression are similar for both the neurodiverse and neurotypical populations:

  • Feeling deep sadness (grief) or hopelessness
  • Lacking energy
  • Loss of interest or pleasure in activities (especially in activities that were much-loved)
  • Anxiety
  • Intense, chronic, or repeated bouts of anger (or other behaviors that are out of character)
  • Confusion (difficulty concentrating or remembering)
  • Panic or panic attacks (sudden fear or intense discomfort)
  • Negative views of life or the world
  • Feeling worthless
  • Feeling guilt (without doing anything specifically wrong)
  • Social withdrawal (from family, friends, or people in general)
  • Change in appetite (increased or decreased)
  • Change in sleep patterns (sleep too much or too little)
  • Physical complaints (headaches, stomachaches, and body aches from tension)

How Depression Presents Itself Differently in Neurodiverse Individuals

While the symptoms of depression are shared in all individuals, including autistics, a common denominator may clarify why autistics are diagnosed with depression more often than neurotypical individuals. Studies indicate that people who present autistic traits, whether they are neurodiverse or not, show more symptoms of depression. The correlation is still being studied, but it is suggested that depression and autism are related and may be the result of living with autism.

Marion Lewis, an adult autistic, blogs via the University of Surrey:

“From personal experience, living in a world where everything tends to be too loud and confusing, and nothing is designed to suit the way you’re wired is really challenging. I’ve been diagnosed with generalized anxiety disorder and major depressive disorder alongside autism which is not a surprise at all to me. Many of my neurodivergent friends have the same (or similar) cocktail of mental health challenges to deal with on top of their neurodivergent experience.”

Marion finds that her anxiety or depression is more disabling than being autistic, but that both feed into each other.

How does depression present itself in neurodiverse adult and teen individuals?

The most common symptoms include:

  • Feelings of sadness or hopelessness – Repetitive thinking about negative events and emotions. Severely criticizing oneself.
  • Physical symptoms – Constantly feeling fatigued. Unexplained body aches and pains (i.e., headaches, joint pain, stomach issues, tense muscles, etc.).
  • Obsessive behaviors – Increased repetitive behaviors.
  • Difficulty concentrating – Unable to focus. Difficulty with decision-making.
  • Social withdrawal – Disengaging from everyday activities and withdrawing from family and friends.
  • Shifting focus – Giving up on a much-loved focus or shifting to an entirely new focus or activity.
  • Oppositional and aggressive behavior – Feeling irritable. Experiencing more feelings of an impending meltdown.
  • Sleep disturbances – Shifts in sleep pattern. Sleeping too much or too little. Insomnia.
  • Changes in eating patterns – Eating too much or too little. Major loss or gain in weight.
  • Self-injury – Ruminations of self-injury and suicidal thoughts.

Looking More Closely at Self-Injury and Suicidal Thoughts

Repetitive thoughts of self-injury and suicide are all too common to autistic adults. Dr. Steven Gutstein, Ph.D., explains in the podcast, Autism & Suicide, that even though completed suicides are statistically rare, the rate of suicidality in adult autistics is alarming. In a recent study, 72% of “high functioning” adults with autism scored higher than the clinical cutoff score for suicidality. Over 80% of high-functioning adults with autism report some type of psychiatric condition compared to about 20% of the control individuals.

Related: Read more about “High-Functioning” vs. “Low-Functioning” Autism, and how labels can lead to anxiety and depression.

Dr. Gutstein relays that:

“Researchers (agree), there’s something about having this diagnosis (autism) that makes you much more at risk for suicidality than just depression itself. Even though depression is a risk factor.”

Learn more about suicidal risks with autism – including the possible links to masking/camouflage, world expectations (“The world needs to adapt to me”), adapting to the world, and mitigating risks through a capacity for growth, management, and treatment – by listening to the RDIconnect podcast episodes Autism & Suicide, Part 1 and Part 2.

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