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. Across the three studies, the most consistent signs were low mood, loss of pleasure or connection, fatigue, trouble concentrating, feelings of worthlessness, and suicidal thoughts. The studies also found other important signs that may help with recognition.

Signs and indicators that may be important

• Low mood may look like hopelessness, despair, irritability, anger, numbness, or emptiness, not only sadness. Flat affect on its own may not be a reliable sign.

• Loss of pleasure or connection may include feeling less emotionally connected to deep and focused interests, even if the person still does them.

• Fatigue may feel like being physically heavy, drained, or worn out. It may be reported more clearly by the person than seen by other people.

• Trouble concentrating may be an important sign, even when it is not obvious from the outside.

• Worthlessness may sound factual or justified, especially when shaped by repeated exclusion, invalidation, or social failure.

• Suicidal thoughts may be spoken about in a flat, matter-of-fact, or very direct way, with little visible distress.

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

• Irritability and anger may be stronger and more persistent than sadness, and may sometimes build into intense outbursts.

• Other important changes may include increased withdrawal, loss of routines or coping skills, emotional or sensory numbness, self-injury, changes in masking, and darker or death-related themes in deep and focused interests.

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.