What are the signs of depression?

What are the main signs of depression?

The main signs of depression are a low, empty or flat mood and a loss of interest or pleasure in things you used to care about, lasting most of the day on most days. Around those two sit other changes: tiredness that rest does not fix, sleeping too much or too little, changes in appetite, trouble concentrating or deciding, and a harsh sense of guilt or worthlessness.

Everyone has low days. The National Institute of Mental Health (NIMH) draws the line this way: ordinary sadness usually passes, while depression causes symptoms that affect how a person feels, thinks and handles daily activities such as sleeping, eating or working. What matters is the cluster, how long it lasts, and how much it gets in the way.

The signs NIMH describes

NIMH's plain-language guide to depression lists these common signs and symptoms. Not everyone has all of them. Some people have only a few, and some have many.

• Persistent sad, anxious or empty mood, and feelings of hopelessness or pessimism.
• Irritability, frustration or restlessness.
• Guilt, worthlessness or helplessness.
• Loss of interest or pleasure in hobbies and activities.
• Fatigue, low energy, or feeling slowed down.
• Difficulty concentrating, remembering or making decisions.
• Trouble sleeping, waking too early, or oversleeping.
• Changes in appetite or weight that you did not plan.
• Aches, headaches, cramps or digestive problems without a clear physical cause.
• Thoughts of death or suicide.

How long do symptoms have to last?

For a diagnosis of major depression, NIMH says the symptoms are present most of the day, nearly every day, for at least two weeks, and one of them has to be a depressed mood or a loss of interest or pleasure. That two-week marker is a clinical threshold, not a waiting period. NIMH adds that people with only a few symptoms may still benefit from treatment.

There is also a longer, lower-grade form. Persistent depressive disorder, once called dysthymia, involves milder symptoms that go on for much longer. It is easy to mistake for personality, which is why high-functioning depression has its own page in this guide.

Why depression does not always look like sadness

Many people expect depression to mean crying. Often it shows up as flatness instead, a sense that nothing much matters, or as irritability and a short fuse. NIMH notes that men, as well as women, may seem angry or irritable rather than sad, and that some people mostly feel it in the body: a tight chest, headaches or stomach trouble.

NIMH also describes how it can look different with age. Middle-aged adults may notice waking in the middle of the night or very early, and older adults may report a lack of feeling rather than low mood. Depression also travels with anxiety more often than not, which when depression and anxiety come together looks at in more detail.

Some things can mimic depression. NIMH points out that certain medications and medical conditions, such as thyroid problems, can cause the same symptoms, which is one reason a visit to your doctor belongs early in the process.

Can a questionnaire tell you if you are depressed?

You may come across the PHQ-9, a nine-question form that asks how often each depression symptom has bothered you over the past two weeks. It was developed for primary care, and a 2001 study by Kurt Kroenke and colleagues found it to be a valid measure of depression severity. The U.S. Preventive Services Task Force recommends that adults be screened for depression and names the PHQ among the commonly used tools.

A screening tool is a starting point for a conversation with a clinician, not a verdict. The Task Force is clear that a positive screen should lead to further assessment. A score cannot account for grief, a medical problem, a medication side effect or the rest of your life, and a low score does not mean your distress is not real. If you fill one out, take the result to your doctor or a therapist rather than deciding on your own what it means.

This page cannot tell you whether you have depression either. It can help you put words to what you have been noticing, which is useful in its own right.

When should you talk to someone?

NIMH's advice is simple: if signs of depression persist or do not go away, talk to a health care provider. You do not need to be sure it is depression, and you do not need to wait until it is severe. A primary care doctor can check for physical causes, and a therapist can help you understand what is going on and what might help.

If you are having thoughts of suicide, that is the time to reach out today rather than to read more. Call or text 988 to reach the 988 Suicide & Crisis Lifeline at any hour, and if you are in immediate danger call 911.

The practice's article when low mood will not lift looks at why a long low stretch is so hard to judge from the inside. For the practical question of timing, see when to get help for depression or anxiety.

Where counseling fits

Laura Bass is a psychotherapist in Charlotte, North Carolina, who works with adults, and depression and anxiety are among the concerns she works with in individual counseling. Counseling is a place to describe what has been happening without having to make it sound reasonable, and to work out what keeps it going.

Laura does not diagnose by checklist and does not prescribe medication. Questions about antidepressants belong with your doctor or a psychiatric prescriber, and the two kinds of help can work side by side. Contact Laura if you would like to ask how she works.

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