Dr MAX PEMBERTON: Why a creeping depression can be so hard to spot

One of the strange things about depression is that sometimes the sufferer is the last person to know they have it.

For some people it hits like a truckload: bam, they can’t get out of bed, don’t feel life is worth living, feel hopeless and helpless. For others, it creeps up so slowly that they are starkly unaware of it.

This second type of depression can be the most debilitating — and dangerous — because those who have it often struggle for years and never seek help. They get so used to living under a cloud that it becomes normalized.

I was reminded of this last week when I read about TV presenter Paddy McGuinness, who said he didn’t realize he was depressed until his ex-wife, Christine, pointed it out to him.

The 49-year-old admitted symptoms such as losing his temper more quickly, but didn’t realize these were signs of a mood disorder. He began to resent his job, made crowds laugh, then went home miserable himself – and yet “was unaware” of how low he had fallen.

This is why partners, friends and family can be so helpful in recognizing the signs.

Not that recognizing depression in others is easy. While some familiar symptoms such as sadness or hopelessness are obvious clues, it is sometimes difficult to pinpoint exactly what is wrong.

When people lose motivation or seem disinterested or even withdraw from life, it is often assumed that they are simply grumpy or bad-tempered. Those close to them may notice more subtle changes — that they’re “not quite themselves” — but aren’t sure what it means.

If you’re worried that someone you know is going through a rough time, here’s my list of signs that the person may be depressed…

Sleep changes

There is a strong link between sleep and mood. Someone with depression may be very tired all the time and have trouble staying awake during the day. Or they experience insomnia and find it harder than usual to fall asleep at night or wake up very early.

Lack of energy

People with depression can describe feeling like they have no energy at all. Even the smallest task, like making the bed or answering an email, feels overwhelming. The term for this is “anergy,” and again, it’s an important sign. They may also have trouble getting motivated to do anything – a symptom called “avolition.”

Changes in appetite

stopping eating can be a sign of depression. Have you noticed that their clothes look looser? Alternatively, people with depression can sometimes find comfort in food and eat more than usual.

Losing concentration

We call this “cognitive dysfunction,” and it’s a common, but often overlooked, symptom of depression.

People have trouble following discussions or dropping out in the middle of a conversation. They seem to withdraw and appear aloof or aloof. They also have trouble following storylines on TV or in books.

This is common in older people and is often mistaken for an early sign of dementia, when in fact it is a symptom of depression.

Low sex drive

Of course, there can be many reasons for a dip in libido, but it is also a well-known symptom of depression. It affects both men and women equally and can affect sexual function, desire or satisfaction.

Lack of interest

People giving up hobbies or no longer enjoying things they used to do is another telltale sign. This lack of joy in life is called “anhedonia” and can be one of the first symptoms of depression.

Negative talk

People with depression often begin to exhibit “negative talk.”

They can become very self-critical, have low self-esteem and feel that the world is bleak.

They come across as pessimistic and defeated.

Pain and ill health

Of course there is a crossover between physical and mental health. People with depression may complain more about physical aches and pains.

They may talk about vague, unremarkable issues such as headaches, digestive problems, or back pain. Or very preoccupied or worried about their physical health.

Personality changes

depression affects people in different ways. Loved ones often find themselves “changed” in some way. Instead of appearing sad, they may be irritable, quick to anger, or frustrated. Or they seem withdrawn or quieter than usual.

Increased alcohol consumption

Some people with depression begin trying to self-medicate with alcohol. This may give them temporary relief, but alcohol is a depressant, so it makes their condition worse. If you notice that someone is drinking more than usual, it could be a sign that they are not feeling well.

If you’re concerned that a loved one has depression, encourage them to see their doctor. It may take a few conversations before they agree to go, but persevere. Be careful with them and offer to go with them for support.

Drew’s brave TV hot flash

Women of a certain age across the country will sympathize with Drew Barrymore who first experienced hot flashes last week during an interview with Jennifer Aniston and Adam Sandler to promote their new movie, Murder Mystery 2.

Drew, 48, was halfway through the conversation when she was suddenly overcome with heat. Instead of trying to hide it, she took the opposite approach, exclaiming, “I’m so hot, I think I’m having my first hot flash in perimenopause,” before taking off her blazer and fanning herself.

The problem with hot flashes is that when one starts, women often feel embarrassed or anxious, which causes the body to produce more hormones on its own. That, in turn, increases flushing and further alters body temperature, creating a vicious cycle — the more you worry about it, the hotter and more jittery you become.

So well done, Drew, for doing exactly the right thing – taking it lightly and moving on.

We’re told it’s always important to say sorry – and it’s true that an apology can have a profound psychological impact. But I was shocked to learn that according to recent statistics, 1,000 sex offenders escape prison by apologizing to their victims. This included cases of child rape. What utter madness.

A poll last week of 4,000 smokers by independent smoking cessation initiative Riot Rehab and YouGov found that 80 percent of them were “desperate” to give up. I have often heard from doctors that smokers do not want to quit, but this result proves the opposite.

I think part of the problem is that many smokers are put off by what they perceive as judgmental and finger-wagging doctors berating them for their habit.

I’m working with Riot Rehab to reach smokers in a different way. We started in Milton Keynes by giving free haircuts to smokers. In this relaxed environment, we started quiet conversations about how people could quit.

The aim is to make Milton Keynes smoke-free by 2025 – and if successful, the plan is to roll out the model across the country.

The government’s 2030 smoke-free is an ambitious goal, but as a former smoker I really want the country to achieve it.

Dr Max prescribes… A free health check

In a bid to ease the pressure on the NHS, Boots has announced it will be giving free health checks to people over 40.

They can be booked in over 1,000 stores across the UK. The health checks will include blood pressure and any problems found will be passed on to the person’s GP. They also include advice on lifestyle changes.