Depression Doesn't Have to Look Like Sadness: A Psychologist on the Four Signs We Most Easily Miss

We picture depression as someone crying in a dark room. But many people who struggle with it go to work, answer messages and laugh over coffee. The signs are quiet, so they are easily mistaken for "a bad patch", tiredness or personality.

Spanish doctor Carlos Atef Harkous explains that depression can appear without visible sadness: as a loss of interest in and pleasure from things the person used to love, as a lack of energy, changes in sleep and appetite, difficulty concentrating, or physical complaints with no clear cause.

The four signs we most easily miss

Psychologist Virginia del Palacio singles out four signs we rarely connect with depression. The first is difficulty making ordinary, everyday decisions. The second is harsh self-blame for small mistakes. The third is abandoning projects and the motivation that used to drive them. The fourth is an increasingly hopeless view of the future - quiet, undramatic, but persistent.

Why we say "I'm fine"

An Ipsos study for Lancôme and the Anxiety and Depression Association of America, conducted among women in five countries in 2025 and 2026, found that 80 percent of respondents had at least once said "I'm fine" when it wasn't true. The reasons: not wanting to be a burden on others, feeling they had to cope on their own, and fear of looking vulnerable. Helena de Carlos of the Manantial foundation links this directly to stigma. How many times have we answered "how are you?" with "fine" just so we wouldn't have to explain?

If you want to help someone, experts advise against jumping to conclusions. Build trust, ask with genuine interest and listen without judgment. Don't shrink the other person's feelings with "come on, it's nothing", and respect their pace - the conversation doesn't have to happen in one evening.

When is it time for professional help? According to Harkous, if the changes last two weeks or longer and seriously interfere with daily life. In older people, apathy or cognitive changes should not automatically be written off as "old age", warns Miriam Piqueras of Sanitas Mayores. And thoughts of suicide, a sudden deterioration or a person's inability to take care of themselves call for an urgent response, not waiting for it to pass on its own.