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Living with depression as an autistic adult.
CW: mentions of suicidality

Autistic people are over four times more likely to develop a mood disorder, such as unipolar or bipolar depression, than neurotypical people.

The chance of developing a mood disorder increases with age and intelligence.

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Autistic people are five times more likely to attempt suicide than neurotypical people, and yet are less likely to actually be diagnosed with depression prior to the attempt.

In fact, many autists who do not meet the criteria for clinical depression still experience suicidal ideation. This can be a real struggle.

There are a number of reasons why depression can be under-diagnosed in autists.

From the outside, some symptoms of depression (such as social withdrawal) can look similar to autism traits (such as requiring less socialisation). This can cause some confusion to clinicians.

Many autists have alexithymia – a condition where one isn’t always able to recognise the emotions they are experiencing. In this way, one can tell they are experiencing something negative and intense, but might not be able to discuss their depression in any more specific terms.

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Even if one does not have alexithymia, realising that you are suffering from depression can be difficult.

Often, we think of depression as being a type of pervasive sadness. However, this is not always how depression presents.

Sometimes, depression just feels like an emptiness. It feels like a void where you once had feelings, but there’s very little left. Nothing brings you joy, and there’s no real purpose to get out of bed.
But because this doesn’t feel like the overwhelming sadness that one might expect, people can have depression and not realise that they are suffering from it.

Some characteristics of autism, like speaking with a flat affect, and increased rumination, can also look like depression symptoms. Also, executive dysfunction can prevent people from motivating themselves in similar ways to the low motivation in a depressive episode. This can make it hard for a clinician to tell which symptoms are autism and which are depression.

There is currently no form of assessment which can accurately and specifically diagnose depression in autistic individuals.

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However – treatment for depression can be effective as long as treatment is tailored to the individual.

For example, autists typically experience more side effects from SSRI’s than allistic people, and may fare better with a combination of medication.
Some autists find little to no use in CBT, and may fare better with autism-specific psychotherapy or mindfulness-based therapies.

Tailoring recovery to an individuals specific needs is always the best way to ensure a positive outcome.

Further reading:
– Spark for Autism – treating depression
– Spectrum News – autism and depression