A reader asks:
My wife thinks I have subclinical depression because my mood is frequently “flat” and I’m not very energetic. I’ve felt like this for about as long as I can remember but never considered it depression because I’m not super unhappy or suicidal or anything. Is this something I should be more worried about?
I’m going to answer this question in two parts:
- First, I’ll try to explain what subclinical depression is and how to think about it.
- Then, I’ll share three of the most common causes of subclinical depression and how you can use those as a starting point for addressing the issue.
What Is Subclinical Depression?
Subclinical depression means that you are experiencing symptoms of depression but that you don’t technically meet the criteria for being diagnosed with major depressive disorder.
- Sometimes this happens because the quantity of the symptoms isn’t high enough. You have persistently low mood, for example, but none of the other classic symptoms of depression.
- It can also happen because the duration of the symptoms isn’t long enough. You might have very low mood along with trouble sleeping, hopelessness, and several other depression symptoms, but if they only last for a few days, that doesn’t meet criteria for a depressive disorder.
- Another way this can happen is if the intensity or impact of the symptoms is low. Maybe you have many symptoms of depression from low mood and anhedonia (lack of pleasure) to hypersomnia (sleeping too much) and poor appetite. But if all of them are very minor and not that intense, and they don’t significantly impair your life, you would not meet criteria.
- Finally, if your depression symptoms are better explained by another medical issue or substance abuse, that would also disqualify a diagnosis of depression. Someone withdrawing from painkiller dependence, for example, would very likely experience many of the symptoms of depression but wouldn’t be diagnosed with depression unless those same symptoms were also present outside of the painkiller withdrawal.
With that in mind, I think the way to start thinking about subclinical depression is by reflecting on the following question:
How much of a problem is this causing in your life?
Because if it’s not causing any significant problems, frankly, I wouldn’t worry about it too much.
It’s very possible that, though well-intentioned, your wife is falling into what I call personality pathologizing. With the rise of therapy culture and increased mental health awareness, it’s becoming much more common for people to start putting mental health labels on more and more normal but uncomfortable parts of human nature.
In other words, what your wife perceives as low energy and flat mood may simply be a part of your personality. And while it might be uncomfortable, annoying, or inconvenient for her or others, that doesn’t mean you have a pathology.
The mere existence of a mental health label is not a justification for using it.
That being said, if you do feel like those things are abnormal or that they’re a problem for you, then the question becomes:
How significant are those problems?
If you lack so much energy that you’re frequently missing work, or if your mood is so flat that you literally never experience pleasure, that’s pretty significant. And I’d say it’s probably a good idea to at least consult with a health professional.
But what if you’re somewhere in the messy middle?
What if your depression-like symptoms are causing mild to moderate problems in your life?
- Maybe your lack of energy and enthusiasm is negatively impacting your marriage because you have comparatively little interest in sex relative to your wife?
- Maybe your flat mood makes it difficult for your employees to work with you, and in subtle but important ways it’s impacting your business?
- Or maybe, even though you don’t feel bad, you have a hunch that you could be feeling a lot better…
If that’s the case, I think it’s worth reflecting on why you might be feeling this way, and as a result, what you could do to improve things.
3 Causes of Subclinical Depression
While there are dozens or even hundreds of potential causes of or contributors to subclinical depression, in my own experience there are three very common ones I saw over and over again with my own clients.
1. Poor Physical Health
Most of the classic symptoms of depression are also symptoms of poor physical health more generally.
For example:
- Trouble sleeping, low mood, weight gain, and chronic fatigue can all be symptoms of thyroid dysfunction.
- Concentration problems, diminished pleasure or enjoyment, and even recurrent thoughts of death can be symptomatic of chronically poor sleep.
- Fatigue, insomnia, low mood, and trouble concentrating can all be the result of an overly-sedentary lifestyle and lack of physical activity.
In other words…
If your physical health is poor, it would be surprising if you were not experiencing symptoms of subclinical depression.
So, before you assume the causes of your subclinical depression are psychological in nature, you need to take seriously the possibility that what you experience as subclinical depression is a manifestation of poor physical health more generally.
Of course, there are a lot of reasons why for some people with specific vulnerabilities, conditions, or disabilities, taking care of their physical health is quite challenging. Nevertheless, the first place almost anyone with subclinical depression should focus on is their body and physical wellbeing.
Personally, I find it helpful to break this down into a few key categories:
- Diet and Nutrition. This includes not just the quantity and quality of food you consume, but perhaps just as important, the quantity and quality of foods you don’t consume.
- Drugs. Obviously you want to think about things like alcohol, marijuana, and nicotine, but also prescription drugs like antidepressants, pain killers, sleep aids, etc.
- Physical Activity. While deliberate exercise is an important piece of physical health, it’s probably more helpful to think even more generally about how active vs sedentary your lifestyle is.
- Sleep. While 95% of the advice out there for better sleep focuses on either sleep hygiene or medication, by far the most important factor is the quality and consistency of your sleep habits.
Of course, there’s a lot to keep in mind when it comes to taking care of your body. And for many, this probably feels overwhelming. So here’s one modest but practical suggestion…
Progress over intensity.
Most health interventions fail because they’re not sustainable. We go hard for a little while, but then fall off the wagon, only to end up more discouraged than we were to begin with.
So instead of trying to tackle the biggest issue first, look for the issue that’s the most doable—the one where you have the greatest likelihood of making some initial progress. Because progress is the most motivating thing out there. And the more progress you achieve, the more motivated and resilient you’ll be to tackling increasingly challenging issues.
For example:
- Maybe you suspect that your alcohol consumption (2-3 drinks per night) is the biggest cause of your sub-clinical depression. And yet, you’ve tried many times to cut back and not been successful.
- Instead, you might look around for opportunities to be successful at initially smaller or more modest goals. Maybe, for example, you focus on physical activity and building in a short 15-minute walk each evening after dinner.
- Because this is a much more doable goal, your odds of success and progress are much higher. And once you achieve some success there, you’ll be more motivated and confident taking on a slightly larger goal—cooking more meals from scratch rather than eating out so much, for example.
- While it takes some patience, this strategy is likely to be much more sustainable and effective in the long-term.
So, look at each aspect of your physical health and try to map out a game plan that harnesses the principle of progress over intensity.
2. Unmet Needs
One of the most helpful ways to think about depression—including subclinical depression—is that it’s a natural response to significant unmet needs. Like a fever trying to stave off an infection, depression can be your mind’s way of addressing—or convincing you to take notice of—significant unmet needs in your life.
For example:
- Unhealthy Relationships. Many people become depressed when they are in a committed relationship that’s unhealthy but they feel powerless to either improve things or leave. In this sense, their depression is an indicator that they have, for example, a significant unmet need around intimacy and connection in their primary romantic relationship.
- Work-Values Misalignment. Depression is also common when people feel “stuck” doing work that is misaligned with their values—the lawyer who actually wants to teach music, or the music teacher who actually wants to practice law.
- Overwork. Finally, I frequently see depression in situations where people are overworking themselves but also can’t bring themselves to stop. In this case, the unmet need is essentially rest and revitalization. But because the person is unwilling or unable to do it consciously, the mind throws the emergency-brake (so to speak) as a last ditch effort to get what it needs.
Now, there are two big reasons why this approach to thinking about depression is helpful:
- It’s compassionate. Many people with depression often assume that depression itself is a bad thing, and as a result, end up falling into unhelpful patterns of self-judgment and criticism which only make the depression worse in the long-run. On the other hand, when you train yourself to see depression as information—a signal trying to tell you something—you’re much less likely to criticize yourself for it, and instead, get to work on addressing it. Speaking of which…
- It’s actionable. By asking yourself what the underlying need your depression is responding to you can gain clarity on what you need to be doing to improve your situation. Of course, the message is often not an easy one to hear since it likely involves making significant changes to your life—like fundamentally rethinking the kind of work you do or the nature of an important relationship. Still, better to be clear-eyed about the true state of things than lost and overwhelmed in a haze of uncertainty.
So, if you suspect that this dynamic might be at the root of your depression, here’s a reflection question to consider:
What’s a significant need in my life that I’m ignoring or afraid to acknowledge?
If you spend some time really reflecting on the question, you’ll likely discover at least a few potential candidates. And once you do, the next step almost always involves becoming more assertive, particularly in your relationships.
- Sometimes this means getting more courageous about asking for what you really want from people (e.g.: a boss, a spouse, a parent, etc.)
- Sometimes it means getting serious about setting and enforcing healthier boundaries with difficult people in your life.
- And sometimes it means simply being willing to express yourself and how you feel honestly and clearly.
If you’re interested in becoming more assertive, I created a brief guide called The Assertiveness Cheat Sheet that walks you through the key steps in communicating more assertively.
3. Emotional Reasoning
Emotional reasoning is a type of cognitive distortion where you think and make decisions based exclusively on how you feel (or want to feel) rather than what is true.
For example:
- Telling yourself you can’t exercise because you feel tired and unmotivated.
- Rationalizing another “just one more” drink because you feel stressed and want to feel calmer.
- Declining an invitation to hang out with friends because you feel anxious meeting new people.
To be clear, there’s nothing wrong with feeling tired, or stressed, or anxious. Those are perfectly normal and valid things to feel. What’s problematic is when you let those feelings dictate your actions.
You should listen to your emotions, but don’t take orders from them.
When it comes to depression, emotional reasoning is especially problematic because it deprives you of what is arguably the strongest antidote to depression: behavioral activation
Behavioral activation means systematically doing things that activate or energize you regardless of how you happen to feel.
In a sense, it’s the reverse of emotional reasoning…
- In emotional reasoning, you sacrifice what will make you feel good long-term in order to feel good in the moment.
- With behavioral activation, you commit to doing things that will make you feel good long-term, despite them feeling difficult in the moment.
For example:
- If you struggle with sleep and chronic fatigue as part of your depression, exercising more frequently feels like the last thing you want to do. But if you can get yourself to do it anyway, it actually leads to better sleep and more energy.
- Similarly, if you struggle with low mood and feelings of worthlessness or inadequacy as part of your depression, socializing may sound like a terrible idea because—for example—you don’t want to burden your friends with your unhappiness. But if you can get yourself to socialize despite your initial resistance, you get the chance to feel the benefit of having friends who care about you.
In one way, what I’m suggestion with this idea of behavioral activation should sound so obvious as to be almost trite:
Do what’s good for you long-term even though it’s uncomfortable now.
The problem is that people with depression are especially vulnerable to emotional reasoning which biases them toward over-valuing their emotions at the expense of their values.
To break this cycle, you have to prove to yourself that it actually does feel better to engage and do things that are meaningful and energy-giving despite being initially uncomfortable.
And as usual, the trick is to start small. In fact, when it comes to behavioral activation with depression, you want to start ridiculously small.
Here’s an example:
- Suppose you struggle with a mild amount of anhedonia (lack of enjoyment or pleasure for things you normally enjoy) and low energy.
- First, brainstorm a list of activities that you believe will be energy-giving and enjoyable despite how they might feel initially.
- Now, pick one of those activities that seems like a good combination of being highly energy-giving and doable. For example: Let’s say you choose exercise.
- Well, instead of saying: Okay, I guess I’ll exercise for an hour every day. Try Each weekday, I’ll spend 15 minutes of my lunch break doing a short walk and listening to my favorite podcast.
- Do this for a week, then up it to 20 minutes. Then 30 minutes the next week. Then 30 minutes at lunch and 15 minutes after dinner the next week. Then the following week, maybe you add in yoga in the living room once per week. Etc.
Not only will you build a habit of engaging in energy-giving activities, you’ll also be breaking the emotional reasoning mindset keeping you stuck in the depression cycle.
Learn More
If you’d like to learn more about depression and related concepts, here are a few resources from me that might be helpful:
- 5 Things About Depression Everyone Should Know →
- 3 Hidden Risk-Factors for Depression: Video → or Article →
- 4 Ways to Navigate Grief in a Healthy Way: Video → or Article →