Depression often disguises itself with subtle symptoms, warns Nigerian psychiatrist

Professor Taiwo James Obindo highlights how depression can manifest through the most inconspicuous signs, urging healthcare providers and the public to recognise its diverse presentations beyond traditional sadness.

Depression is often mistaken for simple sadness, but Professor Taiwo James Obindo says the condition can show itself in far less obvious ways, including irritability, persistent fatigue, body pain, withdrawal and even a polished public smile. In an interview with Tribune Online, the Nigerian psychiatrist and former president of the Association of Psychiatrists in Nigeria said many people never describe themselves as depressed at all, even when the illness is already affecting their mood, thinking, behaviour and physical health.

That wider clinical picture matters because depression can look different from one person to another. The Mayo Clinic, the Cleveland Clinic and Harvard Health all describe it as a mood disorder that can involve low mood, loss of interest, sleep disruption, appetite changes, fatigue, poor concentration and thoughts of death or suicide, with symptoms severe enough to disrupt daily life. Obindo said doctors should not rely on outward appearance alone, because some people continue working, laughing and posting on social media while struggling badly inside.

He also warned that depression can hide behind behaviour that is easily misread. A person may stop answering calls, leave messages unread, miss deadlines or appear lazy and unmotivated when they are actually exhausted and overwhelmed. Others may become perfectionistic, work excessively or seem unusually productive as a way of coping. In more severe cases, he said, depression can bring hallucinations, false beliefs and suicidal thinking, while in many African settings it may surface through headaches, chest heaviness, body aches or other physical complaints rather than obvious sadness.

The symptoms can vary by age and sex as well. Obindo said women are more likely to cry openly, while men may express depression through anger, irritability or risky behaviour. In children and teenagers, the condition may be mistaken for bad behaviour, stubbornness or poor discipline, when the warning signs are school refusal, falling grades, tantrums or withdrawal. Clinical sources also note that depression can present with irritability, guilt, appetite disturbance and sleep problems rather than tears alone.

Obindo said one of the biggest barriers in Nigeria is the belief that depression is caused by weak faith, spiritual attack or other non-medical explanations. He argued that clinicians should take those beliefs seriously as part of a patient’s experience while still checking whether the person meets the diagnostic pattern for depression. He also noted that anaemia, diabetes, thyroid disease, chronic pain and substance use can mimic depressive illness, which is why a proper history, examination and testing may be needed before a diagnosis is made.

His central message is that people do not need to be visibly unhappy to need help. Persistent changes in sleep, appetite, energy, concentration, relationships or functioning can all signal a problem that should be assessed. As Harvard Health and other clinical references note, depression is treatable, but only if it is recognised. Obindo’s warning is that the illness is often hidden in plain sight, and that missing it can delay care for months or even years.