Breaking the Silence: Startling Insights About Autism and Depression

Autism and depression are two complex conditions that can often coincide in individuals. Recent research increasingly suggests that people with Autism Spectrum Disorder have a significantly higher risk of developing depression compared to the general population.

Estimates vary, but some studies find clinically significant depressive symptoms in over 50% of adults with autism. Autism and depression appear to have a bi-directional relationship, meaning that autism may predispose an individual to depression, while depressive symptoms can also exacerbate autism-related difficulties.

Autism and depression are two complex conditions that can often coincide in individuals.There are several reasons why autism and depression appear so intertwined. Here are some of the factors that may link the two conditions and what individuals with both can do to improve their quality of life.

Social Challenges

One of the core characteristics of ASD is difficulty with social communication and interaction. Many people with autism struggle with skills like initiating conversations, reading social cues, making eye contact, engaging in reciprocity, and inferring others’ perspectives. As a result, individuals with ASD often feel socially isolated, have trouble making and keeping friends, and can experience frequent rejection from peers.

This chronic loneliness and isolation is a major risk factor for autism and depression. Humans are inherently social creatures, so ongoing social disconnection and exclusion tends to erode self-esteem over time.

Additionally, those with autism have a harder time turning to social support networks that may help mitigate depressive feelings. Reaching out to family, friends, or mental health professionals requires social-communication abilities that are impaired in ASD. Without meaningful social connections or ability to gain support, autism and depression together become more likely. 

Learn more:

Sensory Sensitivities

Many people with ASD are hypersensitive to certain sensory stimuli like sounds, touch, smells, tastes, and light. Sensory issues like these can stem from differences in neurological wiring. But constantly coping with sensory overload or sensitivity in daily life is extremely fatiguing and stressful.

Being overwhelmed by external stimuli day after day often triggers anxiety and depressive symptoms. Sensory sensitivities also lead to avoidance of activities, environments, and social situations, resulting in more isolation and in the end can lead to autism and depression.

Learn more about Managing Autism and Sensory Issues.

Difficulty Communicating Internal Experience

Those with autism often struggle to identify, process, and describe their emotions and inner experiences. Alexithymia, meaning lack of words or emotions, is very common among people with ASD.

Without the language or constructs to express distress, negative feelings can become bottled up inside. Not having an outlet for inner turmoil can cause autism and depression to spiral out of control.

Even for individuals with autism who can articulate their mental health struggles, conversations about emotions do not flow naturally and easily. They may not think to initiate such discussions or know how to secure helpful support from loved ones.

Learn more about autism and mental health and pathologizing autism.

Anxiety Disorders

Anxiety disorders like generalized anxiety disorder, social anxiety, panic disorder, and OCD frequently co-occur with ASD. Autism and depression can go hand in hand more than people originally thought. Be sure to seek help if feeling depressed.

Around 50% of people with autism also meet criteria for one or more anxiety disorders. Feeling constant irrational fear, nervousness, panic, and obsessive rumination is emotionally and physically taxing. This relentless anxiety, whether or not it is justified by actual circumstances, often contributes to or worsens depression.

Additionally, the depression itself can become a source of anxiety. Feeling out of control of one’s own negative thoughts and emotions is scary and can set off the body’s fight-or-flight response. The interplay between anxiety and depression makes both conditions harder to overcome.

Learn more autism and anxiety and OCD.

Bullying and Trauma

Children and teens with autism are much more likely to be bullied at school and even face abuse at home or in their communities. Being the frequent target of bullying, ridicule, exploitation, or other traumatizing mistreatment can lead to severe psychological damage. Internalizing this bullying as truth often results in very low self-esteem and self-worth. Unresolved traumas like these are linked to increased risks for both post-traumatic stress disorder and depression later in life.

Learn more about why autistics often employ autism masking and code switching.

Transition Challenges

Individuals with autism and depression often struggle to navigate major life transitions that neurotypical people take in stride. For example, starting school, changing schools, entering college, starting jobs, independent living, and other transitions are especially anxiety-provoking and challenging when you have ASD. Facing heavy demands and upheaval during major transitions leaves people already vulnerable to anxiety and depression even more psychologically depleted. Even positive life changes can be distressing, depleting cognitive resources and worsening depressive feelings and isolation.

Learn more:

Genetic and Neurobiological Factors

Autism and depression appear to share some genetic and neurobiological abnormalities, according to experts. There also seems to be some overlap in brain region differences seen in MRI studies of both conditions. While more research is needed, it appears autism and depression may sometimes arise from similar genetic susceptibilities and atypical brain development. 

There are also intriguing links between the two conditions within neurotransmitter systems and hormonal factors in the human body. For example, high levels of serotonin in the brain are associated with autism traits. Meanwhile, low serotonin levels are one of the most consistent biological findings in depression. Possible commonalities are being explored and may indicate autism and depression may share common causal mechanisms.

Keep in mind that I am not a medical expert, and am an autistic myself, but this is information that is being noted among autism researchers, so I am passing it on.

Treatments May Inadvertently Worsen Symptoms

Ironically, some of the most commonly prescribed treatments for ASD may directly worsen depressive symptoms as a side effect, according to some experts. This includes certain psychotropic medications like antidepressants and anxiety medications. For example, antidepressants may help improve mood at therapeutic doses.

However, they often can also exacerbate autism symptoms like repetitive behaviors. This sometimes leads to individuals having to choose between reducing depression or reducing autism traits when taking such medications.

Other autism interventions don’t work for everyone, and can sometimes backfire, according to some parents of autistic children and therapists.

Rewards and conditioning that teach individuals with autism socially acceptable behaviors and skills can sometimes result in a severe mental toll. Therapies working on “normal behavior” can undermine self-esteem in autistic individuals and worsen pre-existing depression.

Depression Itself May Exacerbate Autism Traits

Autism and depression is something that should be treated, so that an individual can better cope with life and any challenges.Mental health issues like chronic depression can sap cognitive resources like memory, concentration, motivation, and problem-solving.

Coping with depressive thoughts and feelings takes a lot of mental energy each day for those with ASD. This leaves less cognitive reserves available to process sensory stimuli, navigate social situations, transition between activities, communicate effectively, and complete tasks of daily living. In this way, pre-existing autism traits may worsen whenever depression flares up.

Treating the depression may help stabilize or improve baseline functioning in autism and depression.

Screening and Diagnostic Challenges

There are numerous barriers to accurately diagnosing the presence of both autism and depression in the same individual. Depressive symptoms like isolation, sleep/appetite changes, limited speech, and flat affect can also occur in ASD without depression.

So these symptoms alone may not signal a mood disorder is also present. Many screening tools rely on self-reporting of thoughts and feelings, which is difficult for those with alexithymia or fluid communication challenges. Overlapping signs and symptoms complicate both conditions and make teasing apart what is autism-related versus depression-related tricky.

Obtaining any diagnosis often requires self-advocacy skills and access to healthcare services with trained medical experts, which both sometimes present barriers to the autism community. According to some studies, the average age of ASD diagnosis is still delayed until around 4 years old because of lack of universal screening due to it being a spectrum disorder.

There are also disparities in autism identification for women, girls, people of color, and those in underserved communities. Without an autism diagnosis already in place, depression may be misattributed as the primary issue. Additionally, the communication challenges inherent in ASD mean affected individuals cannot always self-report depressive episodes and seek help independently.

Many who would benefit from treatment fall through the cracks entirely undiagnosed of having both autism and depression.

Treatment and Management Approaches 

Treating co-occurring autism and depression presents complex challenges for patients and clinicians alike. There are no quick fixes or simple solutions given the many bi-directional factors at play between the two conditions.

According to autism experts, examples of tailored integrative treatment plans may include:

– Psychotherapy approaches can help patients reframe negative thought patterns. Therapy equips individuals with healthier coping tools and ways to articulate emotions. However, therapists require training in adapting these modalities to be more concrete and autism friendly.

– Certain antidepressant medications can help in some cases. However, sensitivities to side effects can occur. It’s important to find a doctor you trust and follow their advice about any medications.

– Social skills groups and support networks create community and reduce isolation. Autism-specific groups are preferable.

– Stress management and self-care techniques help mitigate sensory overload, anxiety, and burnout. Regular exercise boosts serotonin and endorphins too.

– Life coaching and skills training assist with major life transitions that trigger added stress.

– Family therapy equips parents/caregivers to better support their loved one with autism and depression.

– For young children, early intensive behavioral intervention may prevent emergence of later mood disorders.

Practical Strategies for Coping with Both Conditions

Living with the day-to-day challenges of autism and depression concurrently can feel overwhelming at times. However, there are practical strategies individuals, parents, educators, and clinicians can implement to make symptoms more manageable.

Some tips include:

  • Maintain structure through routines, schedules, timers, and visual supports. Consistency and predictability help reduce anxiety and sensory overload from an unpredictable world.
  • Make time for special interests and hobbies that provide enjoyment and fulfillment. Special interests boost mood through stimulating brain chemicals like serotonin and dopamine.
  • Limit social media use if it exacerbates social comparison, anxiety, depression, or loneliness. Apps like Facebook can worsen mood disorders.
  • Create a sensory friendly living environment tailored to individual sensitivities. Accommodations like noise cancelling headphones, weighted blankets, low lighting, and fragrance-free spaces can help.
  • Try journaling, art therapy, or music therapy as alternative ways to express emotions that may be hard to verbalize. This provides a constructive emotional outlet.
  • Exercise regularly as it releases feel-good endorphins, relieves stress, improves sleep, and boosts self-esteem. Even light exercise like walking is beneficial.
  • Maintain relationships with supportive friends and family who understand autism. Social support aids mental health, even if socializing is hard.
  • Explore calming strategies like deep breathing, progressive muscle relaxation, mindfulness, and meditation to relieve anxiety. Yoga can be especially helpful for integrating mind and body.
  • Communicate needs clearly and be patient with processing delays during conversations. Don’t force constant eye contact. Keep communication concrete and allow processing time.
  • Join autism-focused support groups either online or in person. Connecting with similar others reduces isolation and validates experiences.
  • Advocate for accommodations at school or work that account for sensory needs, social difficulties, or other autism-related challenges.
  • Work with therapists trained specifically in adapting CBT and other therapies to be more autism-friendly and less abstract.
  • Keep a mood journal to identify triggers and patterns related to both autism and depression. Track symptoms day-to-day.

Finding A Balance Between Autism and Depression

With compassion, understanding, and targeted supports, individuals dealing with both ASD and a mood disorder can find balance. While each person’s path is unique, these strategies help many better manage mood and function at their best.

Autism and depression are increasingly common conditions in today’s modern world, and you don’t need autism to have depression and you don’t need depression to have autism. These conditions are getting more and more common every day. There are many reasons for this but one of the biggest ones is the ability to diagnose co-occurring autism and depression is getting better.

Autism has already been very common in society but people didn’t know how to identify it or what to do about it (you can read more about this and the history of autism here).

Doctors’ ability to diagnose it is what made the rate of autism increase; it’s not necessarily because more people were getting autism than ever before. But depression on the other hand is a different story.  Many medical experts believe  that depression rates in society are the highest they’ve ever been in human history.

 Individuals suffering from autism, depression, or the co-occurring autism and depression need to keep hope that future generations will be free of depression and those with autism will be loved and accepted.  By better managing autism and depression, everyone can live happier, healthier lives.

Other Common Autistic Behaviors

There are many behaviors associated with having autism. Keep in mind that everyone presents differently, which is why it is caused a spectrum disorder. However, there are common autism behaviors. Learn more about them. 

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Connor McClure

I'm a young adult navigating life with autism. By sharing my experiences and views, I hope to create a better awareness, understanding, and compassion for those on the spectrum. Let's connect!
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