Autism and depression: recognising changes and getting support

Depression may be expressed through words, but it can also appear as withdrawal, loss of interest, disrupted routines, reduced self-care, sleep changes or a noticeable fall in everyday functioning. These changes should not automatically be attributed to autism.

An autistic person with depression may show persistent low mood or irritability, less enjoyment in preferred activities, fatigue, altered appetite, difficulty concentrating, hopelessness or thoughts of death. Communication differences can make internal feelings harder to describe, so a trusted person's observations may add useful context.

Overload or burnout can overlap with depressive features, but they are not interchangeable diagnoses. Clinicians consider the pattern, duration, triggers and degree of impairment, as well as anxiety, sleep problems, physical illness, medication effects and stressful life events.

Arrange an appointment if changes persist or interfere with eating, sleep, hygiene, education, work or relationships. Beforehand, note what has changed from the person's baseline and when it began. Request communication adjustments such as direct language, written questions, extra processing time, a quieter waiting area, or attendance by a chosen supporter.

Treatment is individualised and may include adapted talking therapy, practical changes to reduce overwhelming demands, support for sleep and routines, or antidepressant medicine. Discuss sensory needs, difficulty identifying emotions, current medicines and preferred ways to monitor benefits or unwanted effects.

Get emergency help if the person may act on suicidal thoughts, has made a plan, has seriously harmed themselves, cannot stay safe, is severely agitated or has stopped responding normally. Stay with them when safe to do so, reduce access to means of harm, and use clear, calm language while help is arranged.

Ask directly about self-harm and suicide if you are concerned; asking does not create the idea. A prompt clinical review is also warranted for worsening withdrawal, repeated self-injury, inability to manage basic needs or a marked change in sleep and eating.

Discuss how the current behaviour differs from the person's baseline, which assessment adaptations are available, how treatment can account for sensory and communication needs, and who to contact if safety deteriorates. Ask for a follow-up plan with concrete signs of improvement or concern.