Is It Really Depression? 10 Commonly Overlooked Alternatives
July 16, 2025 | By Dana Harron
Misdiagnosed Depression: 10 Likely Culprits
Misdiagnosed depression seems to be running rampant. Insurance companies love it because it fits into the biomedical model of mental health and supposedly has a clear-cut treatment plan. Clients feel relieved that their suffering has a name and one that's fairly common. Clinicians love it because it feels easy to treat.
But we shouldn't be too hasty in making the depression diagnosis. Major depressive disorder (MDD), although a very real and often debilitating condition, has become something of a wastebasket diagnosis. That is, when doctors have difficulty identifying a clear cause for somebody's low energy, poor mood, and changes in eating and sleeping, they tend to diagnose depression due to a lack of clarity (or curiosity) about what's really going on.
There are many other conditions that have similar symptom profiles. It's important to get clear about what you're working with, because appropriate treatment can look radically different. Exploring alternative possibilities can prevent you from missing something important or even from engaging in a treatment that may do more harm than good.
Here are 10 things that are often mistaken for depression, starting with one we see all the time in trauma work.
1. The Collapse Trauma Response
When the nervous system is overwhelmed, it can shut down in order to survive. The dorsal vagal nerve gets activated and works to shift the body into energy conservation mode.
Source- Unsplash.com
Thinking that an inescapable attack is imminent, the body releases endorphins and other peptides meant to blunt your experience. You wouldn't want to be fully embodied and present for a predator attack that you can't win.
The collapse trauma response looks a great deal like depression. Energy is extremely low, and people often sleep more than they used to. They may eat less because it's hard to muster the energy to obtain food or they may eat more to aid in their dissociation.
The distinction between a collapse trauma response and depression is an important one. If a person is undergoing a trauma response, they need more of a body-based approach rooted in establishing a sense of safety. Depression is much more amenable to talk therapy techniques such as Cognitive Behavioral Therapy (CBT).
2. Bipolar Disorder
For people with bipolar disorder, depression is only one aspect of the experience. At other times, they are manic or hypomanic, experiencing an elevated mood with increased energy but often in an unsustainable or unhelpful way.
Judgment can be impaired in hypomanic or manic episodes. People may take inappropriate risks, like gambling or making big, sudden life choices without thinking them through. If someone reaches full mania, it can resemble psychosis. Antidepressants are not a good fit for someone who has periods of mania or hypomania because they can trigger or worsen these states. Similarly, talk therapy alone is not likely to fully address true bipolar disorder, which tends to be strongly physiological in nature.
3. ADHD (attention-deficit/hyperactivity disorder)
Many people with ADHD have difficulty with task initiation. It's hard to move from intention to action, to take the first step of an activity. Even thinking about doing something can feel totally overwhelming. This is tied to dopamine regulation as well as difficulty defining where to start.
For some, chronic overwhelm accumulates and a person can start feeling really low. They might even qualify for a diagnosis of major depressive disorder. But if ADHD is an element of the problem that remains unaddressed, they are likely to loop back into the same pattern again and again.
4. Eating Disorders
Source: Unsplash.com
When someone isn’t able to properly nourish their body, it eventually tries to conserve energy by slowing everything down. While this most easily calls anorexia nervosa to mind, it can also happen with bulimia, binge eating disorder, and other eating disorders & disordered eating patterns. Even if someone meets caloric needs, they may still not be getting the nutrients their body requires.
Mood swings, low self-esteem, shame, and cycles of isolation are common in most eating disorders, as well as in depression. These patterns are often tied more to dysregulated eating and body-based distress than to major depressive disorder itself. And remember, malnourishment can happen in a body of any size.
5. Hypothyroidism
In hypothyroidism, the thyroid is not as active as it should be. The thyroid regulates metabolism, and when it's underactive, everything in the body slows down.
Hypothyroidism can cause a wide range of symptoms that mimic depression: low energy, low mood, poor concentration, and slowed thinking. Many people are treated for depression for years before their thyroid function is tested. But without addressing the hormonal imbalance, the symptoms will not change.
6. Substance Use Disorders
Substance use disorders can look like depression. Many substances cause big surges of dopamine and other neurotransmitters, followed by a crash. Over time, the brain becomes less sensitive, leaving people feeling worse between uses. Sidestepping substance use when treating depression can lead to missing an important sustaining factor.
Downregulating substances (e.g., alcohol, sedatives, opiates) may make someone appear depressed.
Upregulating substances (e.g., cocaine) can cause a crash that looks like depression afterward.
It's also true that many people turn to substances to self-medicate depression or trauma, so a thorough understanding of the issue is essential.
7. Sleep Disorders
Source- Unsplash.com
I worked as a research assistant in a sleep lab during graduate school. What the patients I met with complained most bitterly about wasn’t difficulty sleeping, it was how they felt during the day. They described fogginess, irritability, lethargy, and memory problems.
This one is a tough differential because marked changes in sleep are a hallmark of a depressive episode. A client will need to consider: What came first, the lack of sleep or the depression?
But their memory may be impaired, making it hard to say. I always recommend regulating sleep first. Then you can address whatever remains, knowing you’ve checked that box.
8. Chronic Illness and Pain
Chronic illnesses and pain, often called “invisible illnesses” include conditions like autoimmune diseases and chronic fatigue syndrome, all of which can significantly impair the body. These conditions also share many symptoms with depression like low energy, cognitive fog, and physical pain.
Many providers aren’t familiar with the root causes of chronic illnesses and these symptoms may be misinterpreted. Especially if lab work results are within normal range, the symptoms may be dismissed as “just depression.” But many chronic illnesses are physiological, not psychological. Treatment usually requires medical support and nervous system regulation, not just talk therapy or antidepressants.
9. High-Functioning Anxiety
High-functioning anxiety refers to individuals who appear to manage day-to-day life with confidence, and ease on the outside. But on the inside they’re experiencing persistent anxiety and inner turmoil.
Unlike those with generalized anxiety disorder (GAD), who may try to avoid or reduce anxiety-provoking situations, people with high-functioning anxiety often push themselves to work harder in an attempt to outrun their anxiety. Over time, this constant internal pressure can lead to burnout, fatigue, and emotional numbness, all of which can closely resemble symptoms of depression.
When this form of anxiety goes unrecognized, especially in high achievers, the resulting exhaustion and disconnection is easily mislabeled as depression. Simply targeting the depressive symptoms will not bring that needed relief. When addressing the underlying anxiety and nervous system dysregulation, more lasting relief can occur.
Source: Unsplash.com
10. Grief and Complex Grief
Grief is not a mental illness. Grief occurs when someone experiences a loss, and many emotions may follow such as sadness, changes in sleep, fatigue, and social withdrawal. On paper, this can resemble the textbook definition of depression.
Grief often comes in waves of emotion and may include vivid reminders of the person or thing lost. Depression, on the other hand, typically feels more global and persistent. When someone is experiencing complicated or complex grief, they need a grief-informed approach. A standard depression treatment protocol will likely be ineffective in these cases.
A Deeper Look Matters
If you're struggling with symptoms of depression or have received a depression diagnosis that doesn’t feel quite right, it’s worth looking deeper. Many conditions mimic or overlap with depression, and getting the right diagnosis is essential for healing. Don’t settle for a quick label; you deserve an approach that is thoughtful and comprehensive.
Reach Out
If you’re considering professional support, we’re here to help. Please reach out to schedule a free, no-commitment consultation. There’s no fee and no obligation—just click the button below to get started.
You can also call or text us at 202-656-3681, or email us directly. Give yourself the opportunity for the support you deserve.