How depression may look in autistic adults

This page brings together findings from all three studies to describe how depression may look in autistic adults. Across the thesis, the most consistent signs were low mood and loss of interest or pleasure. Other common signs included fatigue, trouble concentrating, worthlessness, suicidal thoughts, and changes in autistic characteristics. These signs were often more internal and were not always easy to see from the outside.

For depression to be diagnosed, one of these two main signs is usually present:

  • Low mood in autistic adults may not look like sadness alone. Across the three studies, low mood was often described in broader ways, especially as hopelessness or despair, anger or irritability, and emotional numbness or emptiness. Flat affect may not always be a reliable sign, because some autistic adults described strong internal distress without obvious signs in voice, facial expression, or body language.

    Low mood may be felt as:

    • hopelessness or despair

    • anger or irritability

    • numbness, emptiness, or feeling emotionally shut down

    • sadness or low mood

    • physical distress, such as headaches, nausea, stomach problems, or body aches

    “This is something that I’m feeling, but I don’t necessarily carry the emotional content in my voice.”

    “I actually feel angry, like I want to fight the world.”

    “Depression isn’t sadness, it’s just emptiness.”

  • Loss of pleasure or emotional connection was also a key sign across the thesis. This included more familiar forms of anhedonia, such as losing interest in activities or feeling that everything is a chore, as well as a more autism-salient form in which a person may still do a favourite activity but no longer feel enjoyment, comfort, or emotional connection from it. The broader synthesis also found that changes in deep and focused interests, including darker or death-related themes, could form part of depressive change.

    Loss of pleasure or emotional connection may involve:

    • no longer wanting to do things that usually feel enjoyable

    • feeling that everything is a chore

    • losing interest in everyday activities

    • no longer feeling joy from deep and focused interests

    • still doing a favourite interest, but no longer feeling enjoyment, comfort, or connection from it

    • changes in deep and focused interests, including a shift towards darker or death-related themes

    • in more severe depression, feeling that nothing feels enjoyable, meaningful, or worth doing at all

    The key change is not always stopping the activity. Sometimes the person keeps doing it, but the sense of joy and connection is gone. This pattern was especially important in the thesis because emotional disengagement could occur even when outward behaviour looked unchanged.

    “No longer interested in special interests ... that’s a sign of deep depression.”

    “I still do it because I’m committed to it.”

    “When I’m depressed, there’s nothing that is of any interest to me at all.”