Symptoms of Depression

It’s a perfectly human experience to feel sad or down at times. But for some people, these feelings go further than everyday sadness. For people who suffer from a depressive disorder, their symptoms severely disrupt their lives. Depression is a lot more serious than sadness, and it requires treatment.

When mental health professionals talk about “depression,” they’re usually referring to a disorder called Major Depressive Disorder. Here are the officially recognized symptoms of Major Depressive Disorder, along with the symptoms of some other, lesser-known types of depression.

Symptoms of Clinical Depression (Major Depressive Disorder)

Major Depressive Disorder, or MDD, is one of the most common types of depression. It’s often referred to as clinical depression. Around 19 million people go through a major depressive episode every year. ^[1]

To diagnose MDD, mental health clinicians use a book called the Diagnostic and Statistical Manual (DSM). According to the most recent edition of the DSM, the symptoms of Major Depressive Disorder are:

• Depressed or irritable mood
• Diminished interest or loss of pleasure, even in previously pleasurable activities
• Significant weight changes or appetite disturbance
• Sleep disturbance
• Psychomotor agitation or retardation
• Fatigue
• Feelings of worthlessness or guilt
• Inability to concentrate; indecisiveness
• Recurrent thoughts of death or suicide

To be diagnosed with depression, a person must have experienced at least five of these symptoms for at least two weeks. The symptoms must not be able to be explained by another reason, like substance use or schizoaffective disorder.

The symptoms must also be significantly detrimental to your life, or cause severe emotional distress, to meet the criteria for depression. For example, perhaps your depression symptoms have caused you to struggle at work or school. Maybe they’ve caused you to push the people around you away.

But what do these symptoms actually look like in real life? Let’s break each of these symptoms down into layman’s terms.

1. Depressed or irritable mood

Most people who have depression feel down or sad almost all the time. Everyone gets down in the dumps at times, but for people with depression, this mood almost never goes away. They feel this way almost every minute of the day, usually even when “happy” events are going on around them.

This depressed mood is a common identifying factor of major depressive disorder. A low mood might cause someone to cry a lot more than usual, or to feel hopeless about their future.

Children and teens with depression often present with an irritable, not low, mood. Men with depression also often present with irritability. Irritability might cause depressed people to snap at others or easily lose their temper.

2. Diminished interest or loss of pleasure

Depression robs people of the love and excitement they feel for the activities in their lives.

Take the example of someone who loves music. Before becoming depressed, they loved creating and listening to music, and it brought them a lot of joy. After becoming depressed, the same musical activities may no longer hold any interest for them whatsoever.

In psychological terms, this inability to feel joy or pleasure is called anhedonia. This may be one of the most painful symptoms of depression. The things that used to make you feel happy no longer do, which may bring your mood down even further.

3. Significant weight changes or appetite disturbance

People with depression often experience changes in their eating habits. They may completely lose their appetite, or they might overeat even when they aren’t hungry. This often leads to weight changes.

Most often, people with depression gain weight — partly because depression also tends to make people more sedentary. People with atypical depression, however, may lose weight due to a loss of appetite.

Any weight or appetite changes at all are important to pay attention to, especially if they’re coupled with other symptoms of depression.

4. Sleep disturbance

Depression and sleep problems are highly linked. Studies show that up to three-fourths of people with depression also suffer from insomnia. ^[2]

Even if you don’t have an actual sleep disorder, problems or changes in sleep are a common symptom of depression. Some people with depression may not be able to fall or stay asleep at night.

Others sleep too much; they suffer from what’s known as hypersomnia. They may have a hard time getting out of bed in the morning, or choose to sleep over participating in other activities.

5. Psychomotor agitation or retardation

This symptom means that you move more quickly or more slowly than usual. Depression typically causes people to slow down. You may be moving so slowly (like having slowed speech or walking slowly) that other people around you start to notice.

Other people with depression may have agitated movements. They may feel restless, or like they can’t sit still. This is especially true for people who have anxiety on top of their depression. However, “psychomotor retardation,” or slowed movement, is more common.

This symptom is especially common in the melancholic subtype of depression.

Research shows that psychomotor retardation is at least partly biological in nature. This symptom is associated with changes in specific regions of the brain, especially the basal ganglia system. ^[3]

6. Fatigue

Many people with depression experience fatigue or a loss of energy. If you have depression, you may feel exhausted all the time, even if you’re getting enough (or too much) sleep.

Fatigue alone is a characteristic of many different health conditions (both physical and mental), not just depression. Chronic fatigue syndrome can also cause people to feel fatigued with no underlying medical reason. ^[4] If you’re feeling a chronic loss of energy, it’s important to see a medical provider so you can know for sure whether depression, or another condition, is causing it.

One big difference between chronic fatigue syndrome and depression is that people with chronic fatigue usually feel upset that their fatigue prevents them from engaging in their hobbies or social activities. People with depression, on the other hand, typically have no interest in these activities.

The sleep problems that often come along with depression can also lead to fatigue. This can trap people with depression in a vicious cycle of sleep deprivation and depression.

7. Feelings of worthlessness or guilt

People with depression tend to have a very low opinion of themselves. They may feel like they are worthless, or that the world would be better off without them.

Often, depression makes it difficult for people to see their own strengths. This is because depression distorts your thoughts. For example, imagine you made a mistake at work. If you don’t have depression, you may think something like, “I feel terrible about this mistake, but I know no one’s perfect. I do great work, and this one mistake doesn’t define me.”

If you do have depression, though, you might think something like, “I’m a total failure. I can’t do anything right, and I don’t even deserve to work here. They should fire me.”

This, naturally, can lead people with depression to feel worthless or have low self-esteem.

8. Inability to concentrate

People with depression often struggle with concentration and focus. It may feel like you’re always in a daze, unable to truly focus on whatever is right in front of you. Sometimes, this difficulty with concentration is because of other thoughts that are running through your mind. Other times, you may simply feel “out of it.”

Research shows that depression literally changes the way you think. Depression affects your brain’s executive functioning and cognitive flexibility, which can lead to trouble concentrating and even making decisions. ^[5]

People with depression may feel “stuck,” as if they can’t adapt to the world around them. The effects of depression may make them feel like they can’t make, focus on, or take steps towards long-term goals.

7. Recurrent thoughts of suicide

Sometimes, people with depression have frequent thoughts about death or suicide (ending their own lives). Although depression isn’t the only mental illness that can lead to death by suicide (others include substance use disorder and borderline personality disorder), it’s one of the most common ones that do.

2% of people treated for depression on an outpatient basis (and 4% of those treated for depression in an inpatient setting) end up dying by suicide. ^[6] Most people with depression do not die by suicide, but it’s still a risk that we need to take seriously.

Sometimes, suicidal thoughts come with a specific plan, like how or when someone wants to end their life. Other people with depression may have suicidal thoughts or feelings without a plan. For example, they may have thoughts like, “The world would be better off without me,” or “I wish I could just sleep forever.”

No matter what, suicidal thoughts should always be taken seriously. If you (or a loved one) are thinking about ending your own life, call the National Suicide Prevention Lifeline at 1-800-273-8255, contact your mental health provider, or visit your nearest emergency room.

Other Signs of Depression

On top of the symptoms listed in the DSM, there are other signs that might point towards someone having depression.

Some of the other signs of depression include:

• Withdrawing from friends and family: People with depression often push loved ones away.
• Substance use: Studies show that many people with depression also use drugs and alcohol. Someone might use substances to try to escape from the emotional pain of depression.
• Decreased sex drive: The anhedonia described above often leads people with depression to lose interest in sex or have a decreased libido.
• Feeling numb or empty: The “low” mood that comes along with depression can feel like numbness or emptiness. Sometimes, people with depression don’t feel “sad.” They don’t feel anything at all.
• Feeling physically sick or achy: If you have aches and pains that don’t go away, or feel sick and run down all the time, this could be a sign of depression. See a healthcare provider to rule out other causes.

Again, the only way to know for sure that you’re depressed is to see a mental health provider for an assessment and diagnosis. Our intake team at The Center • A Place of HOPE can provide you with a full assessment and point you towards which treatments may be the most effective for you.

Symptoms of Depression Subtypes (Specifiers)

The DSM also recognizes subtypes of depression, which are called “specifiers.” If you have certain features on top of the common depression symptoms, then a specifier may be added onto your diagnosis.

Here are some of the specifiers for Major Depressive Disorder that are included in the DSM, as well as their symptoms.

1. With anxious distress

This is a new specifier that is only included in the newest edition of the DSM.

On top of the symptoms of Major Depressive Disorder, additional symptoms of major depression with anxious distress include:

• Feelings of nervousness or tension
• Restlessness
• Difficulty concentrating because of worries
• Extreme fear that something terrible is going to happen
• Feeling out of control

It’s important to note that major depression with anxious distress is not the same thing as having both depression and anxiety. People with the anxious distress subtype of depression still primarily present with symptoms of depression, but have additional features that look like anxiety.

2. With melancholic features

People who have depression with melancholic features feel a deep sense of despondency or emptiness. Their symptoms are worse in the morning, and they tend to wake up earlier than they used to (before they became depressed). Instead of eating more, people with melancholic features may lose their appetite or even start presenting with symptoms of anorexia.

As mentioned before, depression with melancholic features is the type that’s most likely to have “psychomotor retardation,” or slowed movements.

3. With psychotic features

Psychosis is a mental health symptom that causes people to lose touch with reality. They may start experiencing hallucinations (seeing or hearing things that aren’t there) or delusions (having thoughts that aren’t based in objective reality).

We usually associate psychosis with psychotic disorders like schizophrenia or delusional disorder. However, depression can sometimes come with psychotic features, as well. Some estimates say that over 10% of people with major depression experience psychotic features. Rates are even higher for people who are hospitalized for depression.

Symptoms of depression with psychotic features include the main symptoms of Major Depressive Disorder. On top of these symptoms, people with psychotic features experience hallucinations, delusions, and slowed movements that may bring the person to a point of stupor.

4. With mixed features

This specifier is given when someone has symptoms of depression mixed with some hypomanic or manic episodes, but doesn’t meet the criteria for bipolar disorder.

When we talk about “depression,” we’re usually talking about Unipolar Depression, or Major Depressive Disorder. However, people with bipolar disorder go through depressive episodes; the difference is that they go through manic episodes as well.

To be diagnosed with depression with mixed features, you must experience some symptoms of a manic episode while you’re going through a major depressive episode. These include symptoms like elevated mood, recklessness, and a reduced need for sleep.

5. With atypical features

People with Atypical Depression present with a specific set of symptoms. These include:

• Increased appetite and weight gain
• Hypersomnia, or sleeping too much
• Heaviness in the limbs (arms and legs)
• A pattern of having a high sensitivity to personal rejection

People with major depression with atypical features may also experience a temporary lifting of their mood when they receive good news. For example, their depression symptoms might go away when they’re about to go on vacation.

It’s important to note that the “atypical” in Atypical Depression doesn’t mean that this subtype of depression is rare. In fact, this type of depression is quite common, especially in young people.

6. With peripartum onset

This specifier is most commonly known as Postpartum Depression. Although some people have advocated for the creation of a separate diagnosis for Postpartum Depression, for now, it’s still considered a subtype of Major Depressive Disorder.

People with Major Depressive Disorder with peripartum onset display the same symptoms as anyone going through Major Depressive Disorder. The difference for this subtype is that depression symptoms come on either during pregnancy or in the month after giving birth.

7. With catatonia

People with “catatonic depression” display characteristics of a catatonic disorder while they’re going through a major depressive episode. Symptoms of catatonia include a rigid posture, refusal to eat, or an inability to move or speak.

8. With seasonal pattern

Major depression with seasonal patterns is also often referred to as Seasonal Affective Disorder, or SAD. People with this type of depression experience symptoms of a major depressive episode, but only along with seasonal changes. The depressive episode goes into complete remission when the season ends.

Most people experience symptoms of this type of depression during the cold, dark winter months, but others may experience it during the summer.

9. Chronic depression, or Persistent Depressive Disorder

Lastly, the “chronic” specifier for depression used to be given when someone’s depression symptoms have lasted for over two years. Previously, this was also known as dysthymia. People with dysthymia were said to have less intense, but longer-lasting, symptoms.

In the newest edition of the DSM, chronic depression has been given its own diagnosis (separate from Major Depressive Disorder), called Persistent Depressive Disorder. You must have had symptoms of depression for over two years to qualify for this diagnosis.

Depression Treatment at The Center • A Place of HOPE

If you recognize these symptoms of depression in yourself, don’t lose hope. Depression is a treatable illness, and recovery is possible. The Center has been voted a top ten facility for depression treatment, and we’re ready to help you start working toward recovery.

Our unique Whole Person Care approach offers depression treatment that addresses the physical, emotional, intellectual, relational, and spiritual elements of your life. In this way, you heal from all of the different ways that depression has affected you.

Don’t let the symptoms of depression hold you back in life. Contact us today to learn more about how we can help you and your family.

[1] https://www.nimh.nih.gov/health/statistics/major-depression
[2] https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC3181883/
[3] https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC3830759/
[4] https://www.cdc.gov/me-cfs/index.html
[5] https://www.health.harvard.edu/blog/sad-depression-affects-ability-think-201605069551
[6] https://www.hhs.gov/answers/mental-health-and-substance-abuse/does-depression-increase-risk-of-suicide/index.html