What are the signs and symptoms of depression?

Updated: Sep 02, 2020
  • Author: Louise B Andrew, MD, JD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Depression is a pernicious and all-encompassing disorder that generally affects the body, feelings, thoughts, and behaviors to varying degrees. [24, 25, 26] However, the condition is often difficult to diagnose because it can manifest in so many different ways. For example, some depressed individuals seem to withdraw into apathy, while others may become irritable or even agitated. Eating and sleeping patterns can be exaggerated to either extreme, either becoming excessive or being almost eliminated. Observable or behavioral symptoms may be minimal despite profound inner turmoil. Symptoms of depression may include the following:

  • Persistently sad, anxious, or empty moods

  • Loss of pleasure in usual activities (anhedonia)

  • Feelings of helplessness, guilt, or worthlessness

  • Crying, hopelessness, or persistent pessimism

  • Fatigue or decreased energy

  • Loss of memory, concentration, or decision-making capability

  • Poor abstract reasoning

  • Restlessness, irritability

  • Sleep disturbances

  • Change in appetite or weight

  • Physical symptoms that defy diagnosis and do not respond to treatment - (very commonly pain and gastrointestinal complaints)

  • Thoughts of suicide, death, or suicide attempts

  • Poor self-image or self-esteem - As illustrated, for example, by verbal self-reproach

To establish a diagnosis of major depression, a patient must express 1 of the first 2 items above and at least 5 of the other symptoms listed. Such disturbances must be present nearly daily for at least 2 weeks. Symptoms can last for months or years.

Symptoms can cause significant personality changes and changes in work habits, as well as social withdrawal or consistent irritable moods, making it difficult for others to empathize with the depressed individual. Some symptoms are so disabling that they interfere significantly with the patient's ability to function. In very severe cases, people with depression may be unable to eat, take care of basic hygeine, or even to get out of bed.

Symptomatic episodes may occur only once in a lifetime or may be recurrent, chronic, or longstanding; in some cases, they seem to last forever. Occasionally, symptoms appear to be precipitated by life crises or other illnesses; at other times, they occur at random.

Clinical depression commonly occurs concurrently with, or can be precipitated by, injury or other medical illnesses and worsens the prognosis for these illnesses. Even the diagnosis of concurrent illness is made much more difficult by the presence of depression.

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