Autistic people become depressed more often than their neurotypical peers, research shows. Why could that be? How could the ways in which depression manifest differ among people on the spectrum? And what is the right treatment plan? Let's take a look.
How common is depression among autistic people?
Major depressive disorder is already rather prevalent in the general population, with around one in 10 people suffering at least one episode at some point in their lives. A large meta-analysis — that's a study that analyzes the results of numerous other studies on the same topic — found that people on the autistic spectrum become depressed in slightly higher numbers, with a lifetime prevalence of 14.4 percent. Studies that only included adults on the spectrum showed that they become depressed at three to four times the rate of their neurotypical peers.
Along with older age (which is logical, since older people will have had more time to develop a depressive episode), various studies also identified being white, having a higher IQ, and the severity of autism as indicated by the mothers of the study subjects as risk factors for depression.
Why do autistic people, children, adolescents, and adults alike, have a higher risk of depression? While depression — being a mood disorder — doesn't need an obvious trigger to develop, research has shown that people under a lot of stress and those who suffered trauma are more likely to become depressed, for obvious reasons, really.
Diagnosing depression in autistic people: Some challenges
Depression is diagnosed with the help of well-established diagnostic criteria that include such symptoms as feeling depressed, hopeless, and sad, changes in sleep patterns and appetite, difficulty with daily functioning, feelings of guilt and worthlessness, and suicidal thoughts.
When an autistic person becomes depressed, however, it often looks very different to onlookers — both clinicians and those in the person's social circle. The symptoms of depression may be missed, because:
- Autistic people are much less likely than others to wear their emotions on their sleeves, anyway, something clinicians would call a "flat affect". A very happy autistic person may appear to be depressed to outsiders, but that very same person may not seem much different when they do become depressed.
- Depression may sometimes manifest through an intensifying of autistic coping mechanisms, such as an even stronger need for sameness and stimming. Others won't necessarily catch on to the fact that this is because of depression.
- Some autistic people are non-verbal, which can interfere with the diagnostic process.
- Some autistic people have alexithymia, meaning they're not able to identify what emotions they are feeling. This can make realizing that you are, in fact, depressed a challenge.
People should know that self-injurious behaviors and irritability are more common in depressed people on the spectrum. In some cases, depressed autistic people who were previously unable to express their emotions clearly will start to display obvious symptoms of depression, such as crying — this should give them and others who support them a clue to look further.
What treatment is available for autistic people with depression?
Cognitive behavioral therapy has been found to be useful for many autistic people with or without depression, but if you or someone you're supporting is autistic and depressed, you will want to look out for a therapist who understands autism to maximize the odds that the therapeutic work done is constructive, offering solutions that actually work.
Antidepressants are another option, with SSRIs often being the first choice, just like they are for neurotypical people. One thing to be aware of, however, is that autistic people may be more vulnerable to some of the side effects associated with this class of antidepressants — such as dysfunctional sleep, irritability, and akathisia (in short, a need to fidget all the time). In some cases, mood stabilizers and antipsychotic medications can also be used.
For depressed autistic children and adolescents, as well as adults living with their families, it can also be helpful if other family members attend therapy, both for their own mental health and to allow them to better help the depressed person. Then, mindfulness-based therapy could be another option.