What depression may look like in autistic adults

Depression in autistic adults can include common signs of depression, but these signs do not always look the way people expect.

Signs and indicators that may be important

• Low mood may be felt more as anger, irritability, hopelessness, despair, emptiness, or numbness than sadness alone. It may also be felt through physical distress such as headaches, nausea, stomach problems, or body aches. Flat affect may not always be a reliable sign.

• Loss of pleasure or emotional connection may involve no longer wanting to do things that usually feel enjoyable, feeling that everything is a chore, losing joy in everyday activities, or still doing a favourite interest without feeling enjoyment, comfort, or connection from it. In more severe depression, nothing may feel enjoyable, meaningful, or worth doing at all.

• Fatigue may be felt as physical heaviness, being drained, or being worn out.

• Trouble concentrating may feel harder, including brain fog, slowed thinking, difficulty focusing, trouble holding things in mind, or difficulty getting started.

• Worthlessness may involve feeling like a burden, feeling defective, or believing that everything is your fault.

• Suicidal thoughts may be spoken about in a blunt, flat, very direct, or matter-of-fact way, sometimes with humour or joking, even when the distress is severe.

• Depression attacks may involve sudden, intense depressive feelings of hopelessness, feeling out of control, and fast-rising suicidal thoughts.

• Changes in autistic characteristics may include reduced communication, changes in deep and focused interests, increased need for routine or structure, changes in stimming, more literal thinking, or stimming that becomes more physically intense or harmful.

Important note

Not every autistic adult will show the same signs. Some signs are more internal and may not be easy to see from the outside. Looking for changes from the person’s usual baseline, and listening to their own report where possible, is important.