10 Signs of a Depression Relapse I Mistook for Anxiety

1. Fatigue

I’ve always had difficulty getting to sleep because of anxiety, and I’ve taken something for it most of my life. But when my depression is under control, I naturally wake up at a decent hour. When I started sleeping until noon or later every day, I should have realized that was a huge “red flag.” Fatigue is one of the hallmark signs of depression for me, and even though I knew something was wrong, I kept telling myself it was just my anxiety making me tired, that it was a “phase,” and it would get better.

2. Hunger

Fluctuating appetite from ravenous hunger to nausea, was probably one of the first signs something wasn’t right. Usually, my appetite is fairly predictable. I’m not a morning eater, but I snack late at night. Not the healthiest thing I’m sure, but it’s just me. When I started waking up at 5 a.m. and eating, then going back to sleep, it should have been a sign something was off. It’s unusual behavior for me, and there was no cause or explanation.

3. Difficulty concentrating

Despite my attention-deficit/hyperactivity disorder (ADHD), my ability to concentrate is also closely tied to my depression. ADHD can make it hard to stay focused. But depression can make it impossible to even try. The thought of reading (which I love to do) becomes overwhelming before I finish one page, so I give up. Often I end up re-reading the same few pages several times over the course of a week and making no progress. At that point, it is clearly a product of depression, but oftentimes it’s easier to simply blame my ADHD and just ignore it.

4. Losing track of time

It’s easy to get lost in a project and lose track of time. It is different when you are sitting in front of a clock doing nothing and suddenly it has gone from daylight to darkness. I couldn’t even remember what I had been doing (if anything), but hours would pass seemingly in an instant. The flip side is also true. Minutes became agonizingly long. Seconds ticked by and it seemed like time was frozen. Time in general starts to take on a different meaning when I’m depressed. It never seems to move at the right speed.

5. Not keeping up with my medicine regimen.

Medication compliance (taking what I’m supposed to, how and when I’m supposed to) becomes exponentially more difficult when the medication isn’t working. Being on medication for depression, I am usually quite dutiful about taking it at exactly the same time every day. But if it stops working as well, I am likely to be less diligent about taking it as prescribed. Sometimes it’s just because I am tired or forget, and sometimes it is intentional. Either way, compliance (or lack of) is a good indicator of how well my depression is being controlled.

6. Intrusive thoughts

Anxiety drives a lot of my intrusive thoughts, but there is a subset which occurs almost exclusively with depression. Anxiety tends to be future-oriented thoughts, and sometimes rumination about the past. Depression, for me, tends to be intrusive thoughts bordering on “flashbacks” about things in the past that may seem completely inconsequential. A night out drinking ten years ago. A sociology class my freshmen year of college. A walk in the park. Anything. But they have a sense of despair, as if anything good that may have happened in the past will never happen again. They drain me of any positivity in the present, and they come out of nowhere.

7. Alternating apathy and perfectionism

Anxiety makes me a perfectionist, and being a perfectionist makes me anxious. The two feed off each other. But when suddenly I became alternately apathetic about things, it was an indicator depression was starting to take hold. Going from a perfectly clean closet to clothes everywhere is a dramatic shift. Eventually, I got it cleaned up again, but it took weeks. That kind of strong shift is almost always a sign my depression is trying to take over again.

8. Canceling appointments

Maybe the most obvious sign to other people, namely my healthcare providers, is when I cancel appointments. Some of them know from experience that anxiety can lead me to cancel. But when depression takes over, I stop caring about myself and I definitely don’t want to see anyone – including doctors who might be able to help. If I manage to get the strength to actually cancel the appointment, that alone is a huge sign of a problem. But often I simply don’t show up because my anxiety stops me from actually canceling, and my depression stops me from going. At which point it is often too late for anyone to notice or say anything.

9. Becoming disturbingly reclusive

At the best of times, I am charmingly introverted. At the worst of times, I am painfully agoraphobic. The mistake I usually make is blaming an increase in my reclusive tendencies on anxiety, not depression. The underlying cause is usually anxiety, but when things get worse or I am less motivated to leave the house, it is often driven by an increase in depression. Anxiety makes going out a fearful process. Depression makes going out a fatiguing process.

10. Being overwhelmed by simple tasks

Doing the laundry, the dishes, the groceries, all of it – it’s usually overwhelming. But when just thinking about doing it is too overwhelming, I’m in trouble. It was probably tied with fatigue for the number one complaint I first saw a psychiatrist about: being overwhelmed by everything. I couldn’t do anything because it all overwhelmed me. It was always hard to differentiate between the anxiety and the depression – but being overwhelmed with anxiety is stress, impatience and chaos. Being overwhelmed with depression is fear, fatigue, and hopelessness.

It’s important for everyone to know their own personal signs when they might be slipping into a depressive episode, so they can get help before that depression becomes dangerous. Not sure if it’s depression? Play it safe and call your healthcare provider sooner rather than later. The quicker you get help, the better.

If you or someone you know needs help, visit our suicide prevention resources page.

If you need support right now, call the National Suicide Prevention Lifeline at 1-800-273-8255, the Trevor Project at 1-866-488-7386 or text “START” to 741-741. Head here for a list of crisis centers around the world.

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Thinkstock photo via fizkes