Living with autism and depression

Depression is one of the most common mental health conditions in the U.S. Recent data shows it affects over 8% of adults age18 and older. However, for people living with autism spectrum disorder (ASD), or autism, this rate is estimated to be nearly four times higher.  

Depressive symptoms can manifest differently in people with autism, so getting an accurate diagnosis can be a challenge. Left untreated, depression can worsen over time and lead to significant challenges in daily functioning.

But fortunately, researchers are working to create new tools to identify depression in people with autism. It’s hoped that through increased awareness and new options for specialized care, more people living with autism can access the mental healthcare they need.  

Why do so many people with ASD also have depression?

We don’t yet have a full understanding of the relationship between autism and depression. But to better understand the connection, it might be helpful to examine some of the symptoms these conditions share, including:

• Depressed mood
• Challenges with social communication
• Frequent worry
• Diminished sense of mastery, or not feeling in control of one’s life
• Difficulty coping with stress
• Flat affect, or a lack of expressiveness
• Social withdrawal

Technically, if a person has these symptoms, it could be a sign of depression, autism, or both, depending on other factors. But it’s important to remember that autism symptoms like flat affect or social difficulty don’t automatically indicate depression. 

We can’t assume that a person’s outward appearance or communication style directly correlates with their inner experience. This is one of the reasons why it’s so important that providers use specialized tools to screen for mood disorders like depression when working with autistic people.

There’s no established causal relationship between depression and autism. But it’s worth mentioning that the stress of being a neurodivergent person in a world designed for neurotypical people can have an effect on mental health. For example, a person with autism may have a hard time “fitting in” with their peers. Feeling like an outsider can lead to increased worry and stress and put a person at greater risk for depression. 

Genetics also may help explain why autism and depression co-occur so frequently. Evidence shows that both depression and autism tend to run in families. So, you may have a greater likelihood of developing one or both conditions if you have a close relative who lives with them.

What does depression look like in autistic people?

People living with autism and depression experience many of the same depression symptoms as non-autistic people. These include:

• Persistent sad, anxious, or empty mood
• Feelings of hopelessness and worthlessness
• Irritability, frustration, or restlessness
• Fatigue
• Sleep problems
• Changes in appetite or weight 
• Loss of interest in activities or hobbies
• Trouble with focus and concentration
• Difficulty making decisions

In addition to these symptoms, people with autism and depression may be more likely to exhibit:

• Social withdrawal
• Reduced emotional or behavioral regulation (i.e. more meltdowns)
• Increase in compulsive or repetitive behaviors
• A shift in interest, specifically toward thoughts of death or dying
• Greater risk of self-harming or suicidal thoughts*

People living with co-occurring autism and depression may also be at greater risk for experiencing something called autistic burnout. Autistic burnout is caused by intense and ongoing stress brought on by a mismatch of expectations and abilities without adequate support. It typically lasts over three months and leads to exhaustion, loss of function, and greater sensory sensitivities. 

Again, some of these symptoms mirror those associated with depression, emphasizing the importance of working with a provider who can identify the underlying causes and provide support that accurately reflects your experiences. In addition, depressive symptoms can evolve across the lifespan. Children and adults may need different forms of support for autism and depression.

*A note on safety: If you’re having thoughts of harming yourself, don’t hesitate to ask for help. Dial 988 from any phone to contact the National Suicide and Crisis Lifeline. Their counselors will provide confidential support and resources to help keep you safe.

Five tips for dealing with co-occurring depression and autism

If you’re living with co-occurring depression and autism, know that there are things you can do to advocate for yourself and manage your symptoms. 

First, begin familiarizing yourself with the signs of depression. As we’ve discussed, these can be mistaken for symptoms of autism. So, the more information and detail you can give your therapist about what you’re experiencing, the easier it’ll be for them to provide an accurate diagnosis. We recommend taking notes on your symptoms in a journal or on your phone. That way, it’s easier to keep track of changes and share them with your provider. 

From there, your therapist can create a treatment plan that reflects your unique needs and any other co-occurring conditions you’re living with. Many depression treatments used for non-autistic people can be used for people with autism. However, these treatments must be delivered by a provider who can modify them effectively. Depending on the severity of your symptoms and your exact diagnosis, you may benefit from a combination of talk therapy and medication. 

In addition, the following self-care strategies can help you strengthen your mental health and navigate the symptoms of co-occurring depression and autism:

1. Expand your support network. Whether it’s talking to a friend, family member, or a support group, sharing your experiences can help you feel less isolated and alone.
2. Find a group activity. Think about the hobbies and interests you most enjoy. Look for ways to build connections with other people who share your passions.
3. Prioritize your physical health. Getting plenty of rest, eating a balanced diet, and staying hydrated are good for your body and your mind. 
4. Go outside. Even if it’s just a quick walk around your neighborhood, leaving your house can boost your mental health.
5. Get moving. Making time for movement you enjoy can help you manage stress and improve your mood.

Find care with Rula

Living with co-occurring autism and depression can be challenging. It can complicate the treatment process, and it can be difficult to find the right provider for your needs. 

But with Rula, you can access affordable care for whatever mental health challenges you’re facing in just a few clicks. Use our therapist-matching program today to find an in-network therapist who offers the specialized care you deserve. Then, you can make your first appointment and meet with your therapist as soon as tomorrow. And if medication becomes a part of your treatment plan, we can also connect you with a psychiatrist who can provide medication management services and ensure continuity of care.

Find a therapist with Rula