The facial expressions that can reveal if someone is suffering severe depression

Doctors may soon be able to diagnose a severe form of depression simply by looking at someone’s face.  

This type of depression, called melancholia, is marked by a complete loss of interest in daily activities and inability to respond to any pleasure, sleep problems, slow movements, speech and thoughts, agitation, restlessness, body aches and trouble with concentration. 

According to researchers, about five to 10 per cent of people who are depressed have melancholia – which could represent as many as 2million Americans. 

Now, a study has discovered that people with early stage melancholia make different facial expressions when watching certain material.

Those afflicted with the severe condition show little to no emotion on their face when watching anything. By contrast, people with regular depression were still able to laugh and emote while watching funny videos.

Likewise, people with melancholia had less brain activity in regions responsible for producing emotion and some facial movements- suggesting the way they feel emotions is blunted. 

This could explain why some people with melancholia report a feeling of numbness and disinterest – because their emotions are diminished on a biological level. 

When watching clips from both happy and sad content, people with melancholia had no facial expressions. People with less severe depression still emoted during funny scenes

Study author Dr Philip Mosley, said the study shows the biology behind what scholars have suspected since the time of the ancient Greeks: some people’s depression makes them develop actual physical changes. 

Dr Mosley, a neuropsychiatrist at QIMR Berghofer Medical Research Institute in Australia, told Science Alert: ‘So they stop eating, they lose the ability to sleep, they seem slowed down as if they’re walking through concrete. Their speed of thought reduces markedly, and they are often very sick.’ 

The study, published in the journal Molecular Psychiatry, showed 70 depressed people, 30 of whom had melancholia and 40 of whom did not, two different videos.  

The first video was a clip from Ricky Gervais’ stand up comedy set ‘Animals,’ which involved funny skits about nature documentaries. 

The second video was a short film called ‘The Butterfly Circus’, which features a moving story about a circus troupe inspiring hope in Depression-era America. 

The researchers then recorded the brain and face activity of the participants as they watched each film, first using facial tracking machines then using an MRI scanner. 

The face tracking machine revealed that no matter what content the melancholic people were viewing, their facial muscles did not move. 

They didn’t laugh, frown or grimace. Their faces maintained an even expression throughout the test. 

The people with regular depression, however, still giggled and smiled during Gervais’ clips. 

Within the MRI machine, the participants brains’ revealed a similar story. 

Dr Mosley said of people with melancholia: ‘Those emotional regions of the brain – the ones involved in detecting and responding to stimuli with an emotional tone – were just doing their own thing, disconnected’. 

The 2011 film entitled Melancholia starred Kirsten Dunst as a woman with the condition. In it, her depression causes her an intense sense of apathy and emptiness, which she struggles to cope with initially

This was particularly visible in a region of the brain called the cerebellum, a ball-like structure that sits near the area of the head where the spine connects with the brain. 

The cerebellum is responsible for a number of automatic bodily functions, including balance, eye movement and some emotions. People with melancholia had less brain activity here, and correspondingly, less emotive faces from watching either videos.

Dr Mosley said spreading awareness about this lack of emotion could help doctors differentiate between melancholia and regular depression earlier – and while melancholia is a more severe condition, it’s still treatable.

These patients don’t tend to respond well to traditional talk therapy, so diagnosing them early could also help establish a more tailored treatment plan for them, Dr Mosley suggested. 

If a person with the condition is diagnosed early, Dr Mosley said most respond very well to medications, which work to balance the chemistry of the brain.

And quicker treatment can help them avoid the most invasive therapies that may be required if the condition has progressed.

These include electroconvulsive therapy – which uses an electrical current to induce a brief seizure and change the brain’s chemistry to improve symptoms – and transcranial magnetic stimulation – which uses magnetic pulses to stimulate certain areas of the brain to improve symptoms of major depressive conditions.