6+ Depression Signs Doctors May Miss

Feeling unattractive, forgetfulness and fitful sleep are some of the symptoms of the mood disorder that doctors sometimes miss in Black women.

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Published March 17, 2023

Have a short fuse? Feel unattractive? Don’t want to get out of bed? These feelings might be signs you’re having a bad day. Or especially in Black women, they could signal something more serious: depression.

A recent study published in Nursing Research found that depression, a common mood disorder, may look different in Black women. Depression is typically defined by a depressed mood or a loss of interest or pleasure in activities, in addition to other symptoms, over a two-week period or longer.

But those symptoms don’t necessarily track with how Black women experience and express depression. The researchers found that depressed Black women were more likely to report signs like irritability, self-criticism and physical symptoms such as changes in sleep habits, among others.

These subtle differences in symptoms, if undetected, could mean Black women are less likely to get diagnosed and treated for this potentially serious condition. “When Black women experience depression, it’s more likely to be chronic and severe,” says Nicole Perez, Ph.D., R.N., first author of the study and a psychiatric mental health nurse practitioner at NYU Rory Meyers College of Nursing.

These subtle differences in symptoms, if undetected, could mean Black women are less likely to get diagnosed and treated for this potentially serious condition.

So how do you know if the funk you find yourself in is depression? And what do you do about it for yourself or if you suspect it in a family member or friend? “I would say the biggest things for folks to be attuned to, for yourself and for people that [you] care about, is just a change, a change from what’s normal,” Dr. Perez notes.

It’s important for us to learn about depression and be alert to the signs that appear to be more common in sisters. “If we can recognize some early signs of depression,” Dr. Perez says, “then we can have intervention early and prevent some of this chronicity and severity that we’re seeing.”

Signs that a bad mood might be depression

While there are established symptoms of depression, Dr. Perez points out that they are based on research done by and on white men primarily. This mood disorder can also vary greatly from person to person. Take note of what is typical, as well as the signs Black women are more likely to report.

When Black women experience depression, it’s more likely to be chronic and severe.

Official signs of depression. According to the National Institutes of Health, a diagnosis of major depression is based on having at least five of the following symptoms for two weeks or more: depressed mood or loss of pleasure, plus three or more of the following: significant weight loss or gain; insomnia or hypersomnia (too much sleep or excessive daytime sleepiness); slower movement; fatigue or loss of energy; feelings of worthlessness or guilt; difficulty concentrating or making decisions; and suicidal thoughts. Having even a few symptoms might suggest a case of minor or mild depression that should also not be ignored.

Less common signs. In the study of Black women with depression, the symptoms were similar but distinct. They included self-hate or self-disgust, irritability, feeling unattractive and self-blame. These emotions may blend together, Dr. Perez says, and be expressed in therapy as feeling like a failure or that everything is your fault.

Physical complaints. Black women were more likely to report somatic, or physical, signs, the researchers found. These included diminished libido, fatigue and sleep disturbances. Dr. Perez cites research suggesting that in Black women, insomnia might be linked with experiences of discrimination.

Memory loss. Cognition might also be affected. “Difficulty with concentration, too, and poor memory can also be there,” she notes. “Often depression in older folks can actually mimic early signs, or what folks might perceive as early signs, of dementia. Oftentimes when we treat depression, that clears up.”

Being off or not one’s self. Some women might note they have a short fuse with a partner or with children, which is out of character for them. They might also get feedback from others that something is different. “It’s important that we don’t brush off some of that feedback,” Dr. Perez says. Depression “has an ability to kind of warp your perspective on things.”

If you’ve been struggling for a while or have a friend who exhibits some of these signs, take it seriously. Over time, depression can worsen other chronic conditions like heart disease or diabetes, Dr. Perez says. “Remember that you’re important enough to take care of, and look into it even if you don’t meet criteria,” she adds.

Start by making an appointment with your regular doctor. They might be more accessible and be able to rule out any medical cause of your symptoms. It’s important to be open and honest with your doctor about your symptoms so they can help you. Share this article with them so they are aware of how depression can affect Black women.

Consider medication. Ask your provider about taking an antidepressant, especially if the depression is interfering with your work or family life. If your primary health professional does not prescribe antidepressants, they can refer you to a specialist who does.

Get help finding a therapist. It can be a challenge and take some time to locate a mental health provider who is available and takes your insurance. Ask your doctor for recommendations, and see if a good friend can help you navigate a search, especially if fatigue or lack of energy is an issue.

Tap key resources. Psychology Today’s website has a national database of providers you can search by zip code and sort by gender, cost and other factors. The Black Emotional and Mental Health (BEAM) Collective also offers a directory of therapists, the BlackLine and other hotlines, and resources. Melanin and Mental Health is another site for connecting with Black therapists and resources, including a podcast.

Ziba Kashef is a freelance writer and author of four books. Formerly an editor at McCalls, Sesame Street Parents, Essence and Pregnancy magazines, she specializes in health, mental health and lifestyle topics.