I’ve been feeling sad and tired but my doctor doesn’t think I’m depressed. What else could it be?


Recently I’ve been feeling sad and tired. My doctor doesn’t think I’m depressed, but I know something’s not right. What could it be?


Doctors typically define diseases by how they appear in their most extreme form. I call it the “tip of the iceberg” phenomenon. For example, you don’t have diabetes until your blood sugar reaches a certain level. You don’t have lupus until you have a certain combination of symptoms, physical examination and laboratory abnormalities. The same with multiple sclerosis.

Yet lots of people have “pre-diabetes”: Their blood sugar levels are not high enough to qualify for the diagnosis of diabetes, but they have a higher risk than those without “pre-diabetes” to develop the disease in the future. And many people have illnesses with some feature of lupus or multiple sclerosis. Sometimes they go on to develop the full-blown disease, and sometimes not.

The same is true with depression. In between a state of positive well-being and full-blown major depression lies a large gray area of persistent negative mood. A newly emerging term for this gray area is “almost depression.”

If you are almost depressed, you experience some symptoms of clinical depression, but your symptoms are not intense, frequent or persistent enough to be diagnosed as major depression. Still, these symptoms negatively impact your quality of life. And they affect your mood, perception, thought processes, emotions, physical condition, motivation, work performance and social life. Almost depression is not something you can simply “snap out of.”

Here’s a quick quiz to help determine whether you’re almost depressed. Check all statements that describe how you’ve been feeling in the past month:

  • I’m frustrated over little things that don’t usually bother me.
  • I’ve been avoiding my friends.
  • I have not been sleeping well lately.
  • Nothing tastes very good these days.
  • I’d like to just “stop the world” and get off for a while.
  • Nothing seems very funny to me.
  • Nothing seems very interesting or exciting to me lately.
  • My fuse seems shorter than it used to be, and I get easily irritated.
  • I’m not as interested in having sex as I used to be.
  • I’d really like just to be left alone.
  • I have trouble concentrating on a book or TV show.
  • I just feel tired all the time for no reason.

If you checked off two or more statements, you may fall somewhere on the depression spectrum.

The good news is that you can get your life back. One place to start is with an informative new book called “Almost Depressed,” written by my Harvard colleagues Dr. Jefferson B. Prince and Dr. Shelley Carson. In this book, Drs. Prince and Carson discuss proven strategies to help improve your mood, renew your energy and restore your spirit. You can find more information about the book at my website, below.

If you think you might be depressed, but your doctor says you don’t meet the criteria for depression, don’t let that mean that there is nothing to be done for you. You can get help.