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When Depression Isn’t Depression: How Misdiagnosis Impacts Treatment
- Dr Titilayo Akinsola
- Oct 21, 2025
- 4 min read
You’re tired, disconnected, and just trying to hold it together. The diagnosis says depression—but treatment doesn’t seem to help.
The antidepressants dull your emotions but not the emptiness. Therapy gives you tools, but something deeper still feels unresolved.
What if the problem isn’t your effort or your willpower—what if it’s the wrong diagnosis?
At Favor Mental Health, we see this every week across Maryland: patients treated for depression for years, when the real root cause is something entirely different. Getting that diagnosis right is not just a clinical matter—it’s the difference between surviving and truly healing.
The Complexity of Depression
“Depression” isn’t a single illness—it’s a cluster of overlapping symptoms that can stem from multiple biological, psychological, or environmental sources.
The most common signs—fatigue, low mood, hopelessness, sleep problems, poor concentration—can also occur in:
ADHD
Bipolar disorder
Post-traumatic stress disorder (PTSD)
Anxiety disorders
Thyroid dysfunction
Vitamin deficiencies
Hormonal imbalances (like PCOS or menopause)
In other words, feeling depressed doesn’t always mean you have depression.
ADHD Masquerading as Depression
Adult ADHD often presents as low motivation, poor focus, and emotional fatigue—which looks a lot like depression.
But there’s a key difference:
People with depression can’t find joy even in things they once loved.
People with ADHD still enjoy those things—but struggle to start or stay engaged.
This mismatch leads many adults to receive antidepressants that provide little relief. Once the ADHD is treated, their energy, drive, and outlook often rebound dramatically.
Example from Practice
A 34-year-old software engineer from Baltimore sought care for “chronic depression.” After three antidepressant trials, no change. Upon further evaluation, she was diagnosed with ADHD, inattentive type. Once treated with a low-dose stimulant and coaching, her “depression” vanished.
Bipolar Disorder: The Hidden Side of the Mood Spectrum
About 40% of individuals with bipolar disorder are first diagnosed with unipolar depression. That’s because people often seek help during their “low” periods—while the elevated (hypomanic) episodes go unnoticed or misinterpreted as productivity bursts.
Why It Matters
Treating bipolar depression with standard antidepressants can:
Trigger mania or hypomania
Cause rapid mood cycling
Increase impulsivity or irritability
Key Clues It Might Be Bipolar, Not Depression
Mood swings that last days or weeks
Periods of high energy, decreased sleep, and racing ideas
Spending sprees, risky behavior, or impulsive decisions
Family history of bipolar or mood instability
At Favor Mental Health, we perform longitudinal mood mapping—examining your mood patterns over time, not just a single snapshot—to avoid misdiagnosis.
Trauma-Related Disorders Disguised as Depression
When trauma isn’t fully processed, the nervous system can stay “stuck” in a shutdown state that mimics depression.This is particularly common in complex trauma (C-PTSD) or chronic stress survivors.
The Difference
Depression: Persistent low mood not linked to specific memories.
C-PTSD: Emotional numbness, guilt, or hopelessness tied to past experiences.
Treating trauma-induced depression requires more than medication—it needs trauma-informed psychotherapy, such as EMDR or somatic approaches, to rewire the body’s stress response.
Medical Conditions That Mimic Depression
Sometimes, the problem isn’t psychiatric at all.Medical issues can create biochemical imbalances that manifest as depression.
Condition | Common Overlap with Depression | Why It Happens |
Hypothyroidism | Fatigue, low mood, weight gain | Low thyroid hormones slow metabolism and mood regulation |
Vitamin D or B12 Deficiency | Brain fog, fatigue, low motivation | Nutrient deficiency impairs neurotransmitter function |
PCOS | Mood swings, irritability | Hormonal fluctuations affect serotonin and insulin levels |
Insulin resistance | Energy crashes, irritability | Glucose instability affects mood and concentration |
Sleep apnea | Cognitive fog, sadness, fatigue | Oxygen deprivation mimics depressive fatigue |
A thorough diagnostic workup—including labs, sleep screening, and hormone evaluation—can prevent years of unnecessary antidepressant use.
The Emotional Cost of Misdiagnosis
When treatment doesn’t work, patients often blame themselves:
“Maybe I’m just broken.”“Nothing ever helps me.”“What’s wrong with me that medications don’t work?”
But it’s not that you are failing treatment—it’s that treatment is targeting the wrong thing.
Misdiagnosis can lead to:
Emotional burnout from ineffective care
Side effects from unneeded medications
Loss of trust in providers
Hopelessness and self-doubt
Reframing your experience starts with accurate evaluation, not assumptions.
Why Favor Mental Health Prioritizes Diagnostic Precision
Our Maryland-based clinicians combine medical, psychological, and functional assessments to reveal the full picture of your mental health.
Our Process Includes
Comprehensive psychiatric evaluation: exploring emotional, medical, and lifestyle factors.
Medication review: identifying potential interactions or ineffective combinations.
Screening for ADHD, bipolar, and trauma: to capture hidden contributors to mood symptoms.
Collaborative feedback sessions: ensuring patients understand and participate in their care.
We don’t just label symptoms—we look for the story underneath them.
Maryland’s Growing Demand for Second Opinions
Many Marylanders are now seeking psychiatric second opinions after years of plateaued progress.Whether in Columbia, Silver Spring, Rockville, or Baltimore, patients are realizing the value of re-evaluating their diagnosis before switching medications again.
Favor Mental Health offers:
Expert diagnostic reassessment
Review of previous treatment history
Integration of lab and medical findings
Personalized medication management
Our goal is clarity, not complexity.
Recovery After Rediscovery
When the right diagnosis finally emerges, everything changes:
Medication starts working the way it should
Therapy feels relevant and empowering
Energy and motivation return naturally
Self-blame begins to fade
This transformation isn’t just medical—it’s emotional liberation.
If your “depression” hasn’t improved despite treatment, it’s time to ask why.
At Favor Mental Health, we specialize in uncovering what’s been overlooked—so you can start a treatment plan that actually fits.
Schedule your comprehensive diagnostic reevaluation today. Let’s uncover the real story behind your symptoms—and finally move forward with confidence.
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