Most people think depression is obvious and often when I make a diagnosis of depression in a patient, they are surprised. Typical responses are, ” but it’s just when I think about my money worries” or “I feel really great when I’m at work” or “she’s always happy when she’s with her friends”. When someone is particularly defensive they might say, “it’s only when I talk to you!” If you think about it, that’s pretty natural because when you speak with a psychologist is when you should be talk about your innermost feelings, things you may not reveal to others or even yourself much of the time. So let’s try to clarify the symptoms of depression.
SYMPTOMS OF DEPRESSION
1) Depressed mood most of the day, nearly every day. This can be a subjective feeling of sadness or emptiness or something others observe. Often when I work with couples the spouse may see it more than the individual. In teenagers and often in men, the mood may be primarily irritable.
2) Diminished interest or pleasure in most activities. People with depression often avoid friends and family and decline invitations. They stop doing things they used to enjoy such as hobbies, reading, sports because they no longer experience pleasure in these activities. ‘Depression also robs people of their motivation to initiate activities. Thus there is often a cycle of loved ones urging the person t get out and do things, “it will make you feel better” and the depressed person resisting these admonitions. These leads others to inaccurately conclude that the person is choosing to be miserable or not working to make their life better but the reality is that former pleasures no longer feel enjoyable when you are depressed or it is difficult to imagine that anything will relieve the feelings of sadness or emptiness.
3) Feelings of worthlessness and guilt. A depressed person typically ruminates about any losses or failures in life to the exclusion of positive memories. We all have had problems-the depressed person can’t stop thinking about them and usually feels overly responsible even when there are circumstances beyond their control. Also, as mentioned in #2 above they realize they should go back to the gym, start dating again, go out with friends and when they cannot develop sufficient motivation or enthusiasm to try they feel even worse about themselves.
4) Fatigue and loss of energy are common. This contributes to the loss of motivation. Tackling solutions can feel overwhelming and the person remains paralyzed, unable to follow through on the suggestions loved ones make and feeling further guilt and resentment that they don’t do what they need to do.
5) Indecisiveness, diminished ability to think or concentrate. Teenagers often have deterioration in their school performance as a result of depression. In fact, when I meet a formerly high achieving student or even one who has a marked change from their previous record, my first concern is to investigate the possibility of depression. Adults can hide poor concentration from others but bills that are late, decisions that can’t be made, books that can’t hold our attention any more-these are all how these symptoms manifest in adults. Sometimes the indecisiveness can be paralyzing leading to further difficulty and trouble in the depressed person’s life. In failing relationships a person often becomes too depressed to make a decision to leave. Friends become frustrated and annoyed when the depressed person remains in a situation which is so obviously making them miserable.
6) Changes in sleep. This is the most common physical symptom of depression and it can be sleeping too much or too little.
Either extreme occurs. In depression people can often fall asleep without difficulty but then wake up in the middle of the night or off and on in the night and, most commonly, wake up hours before they really need to get up to start the day. Conversely, many people with depression sleep too much, staying in bed most of the day when they have the opportunity.
7) Being agitated or excessively slow. This is another symptom where either extreme is possible. The depressed person is visibly jittery, pacing, moving hands, legs, tapping or similar. Contrarily, some people appear almost in slow motion. Speaking and moving more slowly than normal to a noticeable degree.
8) Changes in weight. Depressed people lose their appetite and lose weight without trying. People who tend to be overweight to begin with may gain weight and over-eat. Weight changes may be quite dramatic.
9) Thoughts of death. This does not necessarily mean the person has specific thoughts of ending their life but they may feel vaguely like they wish they were dead, that life is not worth living or that they wouldn’t mind if something happened to them to end their life. Many people express this to me as “just wishing I could go away.” They mean away from life. Of course specific thoughts of suicide are ALWAYS and indication of suicide.
By technical medical standards a person needs 5 of these 9 symptoms to qualify for a diagnosis of depression. Having even a few to a significant degree is an indication that your condition should be evaluated by a professional. Reading about symptoms of depression can alert you to avoid denying the seriousness of a problem. An experienced and qualified clinician is the best person to make an accurate diagnosis.