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Depression is one of the most common mental health disorders in the United States. In fact, an estimated 7.1% of all U.S. adults experienced a major depressive episode within that past year, according to a 2017 National Institutes of Health survey[1].
There’s no physical test to diagnose depression—which is also known as major depressive disorder or clinical depression—but it presents itself as a cluster of symptoms. Recognizing the symptoms of depression is the first step in seeking help and receiving treatment. Read on for more information about what to look for in yourself or a loved one who may be suffering from depression.
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What Is Depression?
Depression is a mood disorder that causes ongoing feelings of sadness and loss of interest in normal activities. It may impact how you feel, think and behave. At its worst, clinical depression makes some people feel as if life isn’t worth living.
To diagnose major depressive disorder, clinicians use standards set out by the American Psychiatric Association’s Diagnostic and Statistical Manual for Mental Disorders (DSM).
“According to our diagnostic manual you have to have at least five individual symptoms of depression in order to qualify for having what we would call a major depressive episode,” says Andrew Leuchter, M.D., professor of psychiatry and biobehavioral sciences at the University of California, Los Angeles’ Semel Institute for Neuroscience and Human Behavior. Symptoms of depression are physical and psychological. “Commonly, people have depressed mood or a lot of anxiety, but they can also have other symptoms—like body aches or loss of energy,” he says.
The American Psychiatric Association notes that in order to receive a diagnosis of depression, symptoms must be present for at least two weeks and represent a change in your previous level of functioning. Your doctor might also run blood or urine tests to rule out other causes, such as thyroid conditions or vitamin deficiencies, that have similar symptoms.
Common Depression Symptoms
Depression symptoms are wide and varied—there may be up to 52 different symptoms of major depression, according to a 2017 study in the Journal of Affective Disorders[2]. One person’s depression may look different from another’s. “It is possible for two patients to share no symptoms at all and still get the same major depression diagnosis,” says Eiko Fried, Ph.D., associate professor in the department of clinical psychology at Leiden University in the Netherlands and author of the study.
In fact, according to Fried’s research, there are 10,377 unique ways to meet the DSM criteria for major depression. “You can have 10,377 different patients who all differ from all other patients in their symptoms, and yet get the same diagnosis of major depression,” says Fried.
Here are some of the most common symptoms that factor into a depression diagnosis.
1. Significant Impact on Mood
A depressed mood might include feelings of sadness, emptiness and hopelessness. Depression can also manifest as irritability and angry outbursts. In his experience, Dr. Leuchter notes men may come across as angry rather than outwardly sad.
2. Loss of Interest in Usual Activities
Anhedonia, or the reduced ability to experience pleasure, is also a common symptom of depression. Low or no libido or interest in sex is also recognized as a sign.
3. Feelings of Worthlessness
Some depressed people have persistent feelings that they’re not contributing to the world, that they’re a failure or that others don’t care if they exist. These feelings may or may not be precipitated by an actual life event (such as a breakup or job loss).
4. Appetite and Weight Problems
Unintended weight loss and a loss of appetite, as well as overeating and major weight gain, can be indicators of depression.
5. Sleep Disturbances
Some depressed people can barely get out of bed, but sleeping too much is not the only issue of concern. “Sleep disturbances can also include difficulty falling asleep, waking up too early in the morning or waking frequently during the night,” says Dr. Leuchter.
6. Psychomotor Problems
Psychomotor refers to the relationship between thinking (cognitive function) and movement. People who are depressed might exhibit extremely slow reaction times and walk or move slowly. They might be constantly agitated and on overdrive. A patient feeling this way and reporting it usually is not enough—clinicians will want to know that outside observers have noticed the person exhibiting unusual psychomotor problems as well.
7. Fatigue
Fatigue, loss of energy or frequent unexplained body aches are depression red flags. “There’s a lot of stigmas attached to depression and to being depressed in our society,” says Dr. Leuchter. “Some people don’t want to come forward and talk about the fact that they’re feeling depressed. They may focus more on their physical symptoms.”
8. Difficulty Concentrating
If someone’s ability to think or concentrate has diminished significantly or they’re unable to make decisions, it’s considered worrisome. This has to be happening nearly every day to be a concern, says Dr. Leuchter.
9. Anxiety
Anxiety looks different for everyone. It can be general, such as random, unwarranted and debilitating fears or worrying, and it can be specific—like increased anxiety involving social situations or an inability to be in enclosed spaces like public transportation or an elevator. People with depression often have a history of anxiety disorders earlier in life.
10. Suicidal Ideation
Recurrent thoughts of death, obsessing about suicide, developing a suicide plan and attempting suicide are all serious indicators of depression.
Dr. Leuchter emphasizes we should be careful judging people’s mental health by outward appearance. “I’ve had patients come into my office who look perfectly cheery and well-adjusted who will just sit down and tell me ‘I’m terribly depressed and I think about ending my life all the time,’” he says. “We should not hold against somebody the fact that they can put up a brave front and look good, but can still be very depressed.”
Connect With A Counselor
If you’re in crisis or having suicidal thoughts, call Mental Health America’s 24-hour hotline at 1-800-273-8255 or message its live online chat service for immediate support from a trained counselor. If you’re in immediate danger, call 911.
How to Get Help for Depression
The first step in getting help is to admit to yourself—and perhaps to a family member or friend—that you may be depressed. Quite often people around you may see signs but hesitate to say anything. “Once you’re open to the possibility of diagnosis, there are lots of ways to get help,” says Dr. Leuchter.
Start with talking to your primary care physician or asking friends about a therapist they might recommend. You can also find a therapist through the American Psychological Association psychologist locator or by calling your insurance company for a list of providers in your network. Online teletherapy may also be an option, and some platforms are covered by insurance.
Treatment for depression can vary. “We should not pretend everybody is the same or has the same issues or requires the same treatment just because they are labeled with MD [major depression],” says Fried. There are a variety of approaches, including various talk and behavioral therapies, many different types of medications and even newer therapies such as transcranial magnetic stimulation (a therapy that involves electromagnetic energy). Some people may need one form of therapy, while others might benefit from multiple.
Getting help for major depression doesn’t mean you need treatment forever. “Depression is a very treatable illness,” says Dr. Leuchter. “One can recover from it and go on to never have another episode in their lives.” Some people may have repeat episodes, but he adds, “the most important thing is getting help.”
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