Masked Depression: What It Is, Causes, Symptoms And Treatment

Masked depression: what it is, causes, symptoms and treatment

Psychological disorders are well-defined and studied categories. From these categories we know important data such as the impact it has on the population, its causes, the treatments that work best for the particular disorder, etc. In the definition of these disorders we also necessarily find the symptoms that compose them.

Sometimes, however, disorders can manifest in a different way than usual, appearing symptoms that are considered atypical for said disorders. An example of this is what is known as “masked depression”, an atypical form of depressive presentation. In this PsychologyFor article, we expose this particular form of presentation of depression: Masked depression: what it is, causes, symptoms and treatment.

What is masked depression

The Psychological Dictionary of the American Psychiatric Association (APA)(1) defines masked depression as that condition in which the person experiences a major depressive episode and reports physical complaints such as headaches or back pain instead of referring to mood disorders, which are more common in this disorder. For this reason, masked depression is also called somatized depression. In the following article we explain in depth what somatization is and how to cure it. Masked depression is also called silent depression.

Although the patient reports physical complaints, no biological causes of these symptoms are found. However, the patient does not attribute his symptoms to depression, but to a physical illness. It is, therefore, the depressive disorder itself that is causing the physical symptoms.

This is a type of depressive manifestation that is not very common in the population. Following Shetty, P., Mane, A., Fulmali, S., & Uchit, G. (2018)(2), Masked depression accounts for between 6 and 7% of depressive disorders and between 30% and 40% of patients seek medical advice. However, in the publication by Artiles Pérez, R. and López Chamón, S. (2009)(3) state that it is precisely the somatic presentation that occurs most in primary care consultations.

Regarding these data, the fact that depression manifests itself in an atypical way leads to it being an underdiagnosed phenomenon and frequently confused with other medical conditions.

It is important to make it clear that masked or somatized depression, as such, is not a psychological diagnosis. It is not included in the DSM-5 (APA) diagnostic classifications or in the ICD-11 classification (World Health Organization). This is a way in which it manifests itself, as the APA psychology dictionary points out.(4)major depressive disorder, which is a diagnostic category included in the classifications.

Causes of masked depression

Artiles Pérez, R. and López Chamón, S. (2009)(3) point out the importance of pain in masked depression since it is a very common symptom in this condition. In the same article, two hypotheses are proposed that try to explain why patients feel pain without a physical cause. Let’s see the causes of masked depression

  • This is a pathophysiological mechanism by which low mood amplifies somato-sensory sensations.
  • A pattern would develop physical symptoms in the face of denial to recognize a depressive condition.
  • Many patients with chronic pain have a depressive disorder, so the symptoms of both would overlap.
  • Depressed patients also have lower resistance to pain (due to its decreased nociceptive threshold).
  • The pathophysiological and neurobiological mechanisms Pain and depression share common features.

Etiological theories related to depression can also help us explain the origin and development of this type of condition. Among them we find:

  • Psychological theories such as the theory of learned helplessness or Beck’s cognitive theory.
  • Biological theories among which the monoaminergic theory stands out, which supports a deficit of serotonin, dopamine and norepinephrine. In this article we talk in depth about the neurotransmitters involved in depression.

Symptoms of masked depression

As we have already pointed out, the underlying disorder is a depressive disorder, whose typical symptoms (recorded in the DSM-5) are the following:

  • To feel down.
  • Loss or decrease of interest in all or almost all activities.
  • Weight loss or gain.
  • Insomnia or hypersomnia.
  • Psychomotor agitation or retardation.
  • Loss of energy.
  • Feeling of worthlessness or inappropriate or excessive guilt.
  • Decreased ability to think or concentrate or make decisions.
  • Recurrent thoughts of death or suicidal ideation.

However, these typical symptoms may (or may not) be present to a greater or lesser extent in cases of masked or somatized depression. How does silent depression manifest? Among the atypical symptoms, but more typical of this type of depression, we can find physical symptoms. The symptoms of masked depression are:

  • Dolores: head, back, musculoskeletal, etc.
  • Dizziness. In the following article, we explain the relationship between dizziness and anxiety.
  • Dyspnoea: feeling of lack of air.
  • Gastrointestinal symptoms: alterations of the gastrointestinal tract.

The authors also point out sleep disturbances, lack of energy, appetite and decreased libido although this type of symptomatology is also common in the typical manifestation of depression.

Treatment of masked depression

If the underlying cause of the symptoms corresponds to a depressive disorder, then this will be the one that must be treated to mitigate these symptoms. However, the case must be supervised by a doctor to rule out the presence of an organic cause of the pain (remember that it is a characteristic symptom of masked depression) and offer the best treatment for it.

Focusing on the treatment of depression, we have well-established psychological as well as medical or psychiatric treatments.

Following Carrobles, JA (2014)(5) psychiatric treatment would consist of:

  • Administration of drugs antidepressants. In this article we explain the Types of antidepressants and what they are for.
  • Prescription of mood stabilizers.
  • Electroconvulsive therapy. In the following article we talk about what Electroconvulsive Therapy is and how it is used.
  • Other techniques brain stimulation such as transcranial magnetic stimulation.

Cognitive-behavioral psychological therapy also offers good results for the treatment of depression. To do this, the professional can use different intervention techniques such as:

  • Behavioral activation or program of pleasant activities.
  • therapy troubleshooting.
  • Beck’s Cognitive Depression Therapy.
  • Coping program of depression (Lewinsohn).

In addition to these, the interpersonal therapy It has also shown good results in the treatment of depression.

This article is merely informative, at PsychologyFor we do not have the power to make a diagnosis or recommend a treatment. We invite you to go to a psychologist to treat your particular case.

If you want to read more articles similar to Masked depression: what it is, causes, symptoms and treatment we recommend that you enter our Clinical Psychology category.

  1. American Psychiatric Association (2014). DSM-5. Reference guide to the diagnostic criteria of the DSM-5-Breviary. Madrid: Panamericana Medical Editorial.
  2. Shetty, P., Mane, A., Fulmali, S., & Uchit, G. (2018). Understanding masked depression: A clinical scenario. Indian journal of psychiatry, 60(1), 97–102.
  3. Artiles Pérez, R. and López Chamón, S. (2009) Somatic Symptoms of Depression. Family medicine. SEMERGEN. 35 (S1). 39-42
  4. American Psychiatric Association (2020). APA Dictionary of Psychology. Retrieved from
  5. Carrobles, JA (2014) Depressive Disorders. En Caballo, VE, Salazar, IC and Carrobles, JA (2014) Manual of Psychopathology and Psychological Disorders. Madrid. Pyramid.

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