Autism and Depression

Depression is one of the most common diagnoses to co-occur with autism spectrum disorder. As many as 40% of autistic individuals will have depression at some point during their lives. Researchers don’t have a definitive answer as to why––but many believe social stigma, mistreatment and insufficient support have to do with it. 

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Understanding the link between autism and depression can go a long way toward helping autistic individuals manage, or even move past, depression.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that affects the development of a person’s brain and nervous system. It is a natural part of the diversity of human brains (i.e. neurodiversity) and is associated with different ways of thinking, communicating and experiencing. 

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Autism is dimensional, meaning each autistic individual experiences a unique combination of traits and behaviors associated with autism. They may exhibit these traits at different intensities and in different ways. They may also have varying support needs. Generally, autistic traits fall under a few broad categories:

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Information processing

Autistic individuals process information differently than neurotypical peers. This includes sensory input, to which many autistic people are hypersensitive (more sensitive than is typical) or sometimes hyposensitive (less sensitive than is typical). Autistic individuals also exhibit differences in cognitive processing—they tend to be  more detail-oriented, often have excellent pattern recognition skills, and tend to process information bottom-up.

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Social and communication styles

Neurotypical social norms and expectations are not intuitive for autistic people. Autistic individuals may interpret social cues differently than neurotypical people, and may experience differences in nonverbal communication, such as a preference against eye contact. They tend to prefer more direct communication styles and may also communicate more literally.

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Restricted or repetitive behavior and interests

Autistic people often exhibit intense interests and repeated behaviors. They may stick to their routines and have a strong preference for sameness. Interruptions to their routines or unexpected changes can be incredibly disrupting and taxing for autistic adults. Autistic individuals may also exhibit repeated self-regulating behaviors called stims. Additionally, autistic individuals may have a strong interest in specific subjects, also called special interests, which may lead them to hyperfixate and grow a deep expertise in their areas of interest. 

Depression is a mental health condition characterized by persistent feelings of sadness, emptiness or a low mood. Clinical depression is one of the most common mental health diagnoses in the United States. Estimates of its prevalence vary significantly, but researchers believe depression affects anywhere from 8.3% to 29% of US adults at some point during their lives.

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The term “depression” encompasses a few mental health conditions. When most people think of depression, they think of major depressive disorder (MDD) or persistent depressive disorder. Major depressive disorder encompasses acute symptoms of depression lasting for at least two weeks, while persistent depressive disorder consists of milder symptoms experienced for at least two years. The following diagnoses are also classified as depressive disorders:

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• Seasonal affective disorder (SAD)
• Premenstrual dysphoric disorder (PMDD)
• Perinatal and postpartum depression
• Perimenopausal depression

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Symptoms

Depression is associated with many symptoms, including:

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• Continual feelings of sadness, hopelessness or emptiness
• Loss of interest in activities one normally enjoys
• Fatigue
• Irritability
• Restlessness
• Difficulties with executive functioning, including difficulty making decisions, remembering, focusing and initiating tasks
• Changes in appetite
• Changes to sleep habits, like difficulty falling asleep or sleeping too much or too little
• Suicidal ideation or thoughts about death

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People with depression may experience these symptoms in different combinations and at varying intensities. Depressive disorders can have a very significant impact on a person’s quality of life and ability to complete activities of daily living.

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Causes

Both biological and environmental factors can cause depression. Depression has a genetic component, meaning individuals with a family history of depression are more likely to experience depression themselves. Some individuals may also have neurochemistry that predisposes them to depressive disorders—for example, some individuals’ bodies may produce less serotonin than others.

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Adverse experiences can also lead to depressive symptoms. People who have endured the following are more likely to develop depression:

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• Persistent stress
• Neglect
• Abuse
• Other traumatic experiences 

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Social determinants of health, like economic stability, safety and access to resources, can also contribute to depression. Similarly, social marginalization can play a role in depression—it’s worth noting that rates of depression are often higher among people with marginalized identities, like  women and transgender individuals.

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Age of onset and duration

Depression can affect people of any age, though symptoms of depression most often emerge during a person’s late teens to mid-20s. For some people, depression can be a lifelong condition; some people experience several episodes of depression with periods of remission throughout their lives, while other people may experience one depressive episode during their lifetime.

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Depression is one of the most common co-occurring diagnoses among autistic individuals––as many as 40% of autistic people receive a depression diagnosis. The persistent stress and sensory  overload autistic individuals confront likely contributes to the increased rates of depression. Autistic people face an overstimulating world designed for neurotypical brains while also experiencing a great deal of social stigma and misunderstanding. Autistic burnout, often a result of these stressors, can lead to or worsen depression, as well.

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Late-diagnosed autistic individuals are also more likely to experience mental health challenges like depression, and research suggests that autistic individuals diagnosed during adulthood experience more mental health conditions than those diagnosed during childhood. Another study on autistic adolescents suggests that getting diagnosed later in adolescence correlates with higher rates of depressive symptoms. For many late-diagnosed autistic people, these findings are no surprise––it can be incredibly demoralizing for an autistic adult or adolescent to move through life without understanding their neurodivergence and how it affects their experiences.

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Overlap in traits

Autism spectrum disorder and depression share a few traits, including:

• Both autistic individuals and people with depression can experience signs of executive dysfunction like difficulty starting new tasks, remembering and concentrating 
• Both groups may also find it difficult to recognize their emotions (alexithymia) or to notice physiological cues in their body, like hunger and thirst (issues with interoception)
• Both groups often also struggle with disordered sleep 

For autistic people with depression, these shared traits can feel intensified.

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Autistic presentations of depression

Depression can also present in unique ways in autistic individuals. Autistic people experiencing depressive symptoms may notice changes in their self-regulating behaviors. This might mean an individual finds themself stimming more regularly in ways they usually associate with distress or experiencing deeper-than-usual absorption in special interests. On the contrary, others may find they don’t have as much energy to stim in regulating ways or to engage in their special interests.

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Importantly, suicidal thoughts are associated with both autism and depression, and autistic individuals experiencing depression may be at increased risk of harming themselves or dying by suicide. If you or someone you know is thinking about hurting themself, call or text 988 for immediate support.

Depression is a serious condition that can show significant improvements with treatment. Many medical interventions, as well as social and personal support strategies, have been shown to help autistic individuals reduce and manage depression symptoms.

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Psychotherapy

Psychotherapy, also called “talk therapy,” is one of the main interventions used for depression in autistic individuals. Approaches like cognitive behavioral therapy (CBT), which works by helping a person replace negative beliefs or behavior patterns with more supportive ones, have been shown to help autistic people with symptoms of depression.

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Another therapeutic approach that can help autistic individuals with depression is dialectical behavior therapy (DBT). DBT uses similar approaches to CBT, but differs in its focus on emotional regulation and distress tolerance.

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Medication

Many autistic individuals also find medication helpful in treating depression. A psychiatrist can prescribe antidepressant medications like selective serotonin reuptake inhibitors (SSRIs), which work by changing the amount of serotonin available in the brain when taken everyday. They take time to begin to work––typically between four and eight weeks or more. They can make a significant difference in a person’s depressive symptoms, and they often work best in tandem with psychotherapy.

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Social support

Depression can feel isolating, especially for autistic people who may already feel misunderstood by their peers. It can help to talk to loved ones about how you’re feeling and simply connect with people who make you feel safe and supported. If this isn’t an option, support groups are a great way to connect with others who understand your experiences.

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Tend to your needs

Sometimes, depression can make activities of daily living––like showering, brushing your teeth or eating––feel insurmountable. It’s important to be gentle with yourself and work within your limits. It can help to try to complete some of these tasks, which can give you a boost of self-esteem and tend to your body’s needs.

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Autistic individuals may also need to nurture themselves in different ways from neurotypical people, which can help with symptoms of depression. Spending time on special interests, unmasking where possible and engaging in soothing sensory activities can help autistic individuals regulate depressive symptoms.

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Movement

Research shows that physical activity is highly effective at decreasing symptoms of depression. This could be especially true for autistic individuals, who often experience a greater need for movement as a tool for regulation and fulfillment.

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It can be difficult to get moving when you’re struggling with depression, which is why it’s important to find ways to move that you truly enjoy and that meet you where you are. Gentle movement like walking, stretching or low-intensity yoga can make a great difference. Stretching and yoga can even be adapted to do in bed if needed.

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Interventions for treatment-resistant depression

As many as 30% of people diagnosed with major depressive disorder have treatment-resistant depression. For these individuals, conventional approaches don’t make a significant difference in their symptoms. Several newer, less mainstream interventions, including brain stimulation therapies like transcranial magnetic stimulation (TMS) and medications like ketamine, can help people with treatment-resistant depression reduce or manage their symptoms. 

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Research on treatment-resistant depression in autistic people is limited, and it’s best to consult with a clinician who is familiar with autism and depression on which interventions might be right for your treatment-resistant depression.

Depression can feel hopeless—but Prosper Health can help. Our therapists have deep experience working with autistic adults and specialize in supporting patients with common challenges autistic adults face, including depression. Prosper Health clinicians can treat depression while accounting for its nuanced relationship to your experiences as an autistic person. Plus, they can support your individual goals for your well-being.

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With Prosper Health, therapy is entirely virtual, and you can schedule your first visit in a matter of days. Prosper Health accepts most major insurance, and 90% of all visits are covered by insurance. If you’re ready to get started, click the link below.