Understanding Depression:

What is depression?

We all go through ups and downs in our mood. Sadness is a normal reaction to life’s struggles, setbacks, and disappointments. We’re down in the dumps for a short time, then gradually the painful feelings dissipate and we move on with our lives—often the wiser for the experience. But when the low mood persists, interfering with your ability to work, study, eat, sleep, and have fun, it’s no longer normal. It’s depression.

Signs and symptoms of depression

There’s a vast difference between “feeling depressed” and suffering from clinical depression. The despondency of clinical depression is unrelenting and overwhelming. Some people describe it as “living in a black hole” or having a feeling of impending doom. They can't escape their unhappiness and despair. However, some people with depression don't feel sad at all. Instead, they feel lifeless and empty. In this apathetic state, they are unable to experience pleasure. Even when participating in activities they used to enjoy, they feel as if they're just going through the motions. The signs and symptoms vary from person to person, and they may wax and wane in severity over time.

Depression Signs and Symptoms
Feelings of helplessness and hopelessness	A bleak outlook—nothing will ever get better and there’s nothing you can do to improve your situation.
Loss of interest in dailly activities	No interest in or ability to enjoy former hobbies, pastimes, social activities, or sex.
Appetite or weight changes	Significant weight loss or weight gain—a change of more than 5% of body weight in a month.
Sleep changes	Either insomnia or oversleeping (also known as hypersomnia).
Psychomotor agitation or retardation	Either feeling “keyed up” and restless or sluggish and physically slowed down.
Loss of energy	Feeling fatigued and physically drained. Even small tasks are exhausting or take longer.
Self-loathing	Strong feelings of worthlessness or guilt. Harsh criticism of perceived faults and mistakes.
Concentration problems	Trouble focusing, making decisions, or remembering things.
Irritability	Easily annoyed or frustrated. Lashing out in anger or snapping at others.
Aches and pains	New or worse physical symptoms, including headaches, backaches, diarrhea or constipation, abdominal pain, and aching joints.

People suffering from depression often show distorted thinking. Everything looks bleak to them, and they hold extremely negative views about themselves, their situation, and the future. Trapped in their pessimism, they obsess over their problems and blow them out of proportion. Unable to see a light at the end of the tunnel, they may even start to see suicide as their only way out.

Gender and age differences

Depression is often expressed differently according to one's age, sex, and culture. For example, a young woman is unlikely to exhibit the same signs and symptoms of depression as an elderly man. An awareness of these differences helps ensure that the problem is recognized and treated.

• Depression in teens - Depression in teenagers can look different than it does in adults. Irritability—rather than depression—is frequently the predominant mood. A depressed adolescent may be hostile, grumpy, or easily lose his or her temper. Unexplained aches and pains are also common symptoms of depression in children and teens.
• Depression in older adults - The difficult changes that many older adults face—such as bereavement, loss of independence, and health problems—can lead to depression, especially in those without a strong support system. However, depression is not a normal part of aging. Older adults tend to complain more about the physical rather than the emotional signs and symptoms of depression, and so their mood disorder often goes unrecognized. But depression in the elderly is associated with poor health, a high mortality rate, and an increased risk of suicide, so diagnosis and treatment are extremely important.
• Depression in Women - Rates of depression in women are twice as high as they are in men. This is due in part to hormonal factors, particularly when it comes to premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD), postpartum depression, and perimenopausal depression. As for signs and symptoms, women are more likely than men to experience pronounced feelings of guilt, sleep excessively, overeat, and gain weight. Women are also more likely to suffer from seasonal affective disorder.
• Depression in Men - Depressed men are less likely than women to acknowledge feelings of self-loathing and hopelessness. Instead, they tend to complain about fatigue, irritability, sleep problems, and loss of interest in work and hobbies. Other signs and symptoms of depression in men include anger, aggression and violence, reckless behavior, and substance abuse. Men may also try to cope with their depression by throwing themselves into their work.

Types of depression

There are several different types of depressive disorders. Many of the symptoms overlap, but each type of depression has distinct signs and effects.

• Major Depression - Major depression is characterized by a persistent sad mood and/or an inability to experience pleasure. These symptoms are constant, interfering with the ability to lead a productive and enjoyable life. Left untreated, a major depressive episode typically lasts for about six months. Some people may experience just a single episode of depression in their lifetime, but more commonly, major depression is a recurring disorder.
• Atypical Depression - Atypical depression is a common subtype of major depression. It features a specific symptom pattern, including a temporary mood lift in response to positive events. You may feel better after receiving good news or while out with friends. However, this boost in mood is fleeting. Other symptoms of atypical depression include weight gain or significant increase in appetite, sleeping excessively, a heavy feeling in the arms and legs, and sensitivity to rejection.
• Dysthymia - Dysthymia, or dysthymic disorder, is a type of “low-grade” depression that lasts for at least two years. Dysthymia is less severe than major depression, but the chronic symptoms prevent one from leading life to the fullest. If you have dysthymic disorder, you are mildly to moderately depressed on more days than not, although you may have brief periods of normal mood. Many people with dysthymia also experience major depressive episodes, a condition known as “double depression”.
• Seasonal Affective Disorder (SAD) - Some people who experience recurring episodes of depression show a seasonal pattern known as seasonal affective disorder (SAD). SAD is a major depression that occurs in the fall or winter when the amount of sunlight is limited. In SAD, the depression goes away once the seasons turn again in the spring. SAD is more common in northern climates and in younger people.
• Postpartum Depression - Many new mothers suffer from some fleeting form of the “baby blues.” Postpartum depression, in contrast, is a longer lasting and more serious depression thought to be triggered by hormonal changes associated with having a baby. Postpartum depression usually develops soon after delivery, but any depression that occurs within six months of childbirth may be postpartum depression.

Depression causes and risk factors

There is no single cause of depression. Early life experience, genetic predisposition, lifestyle factors, and certain personality traits all play a part in causing depression. Something that causes depression in one person may have no effect on another.

Certain risk factors, however, make people more vulnerable to depression. For example, people who are isolated and have few friends or family members to turn to in times of stress are more likely to develop depression. Additionally, if you’ve been clinically depressed before, you’re at a higher risk of becoming depressed again. The odds increase with each major depressive episode.

Other risk factors for depression:

Loneliness Lack of social support Recent stressful life experiences Family history of depression Marital or relationship problems

Financial strain Early childhood trauma or abuse Alcohol or drug abuse Unemployment or underemployment Health problems or chronic pain

Treatment and help for depression

	Self-help for depression - By definition, depression involves feelings of helplessness and hopelessness. This makes it difficult to take the steps needed to heal. The key is to start small and build from there. If you develop your own recovery plan and stick to it, making positive choices for yourself every day, you will feel better.
	Helping a depressed person - Overcoming depression is much easier with the support and understanding of family and friends. If someone you care about is depressed, you can speed his or her recovery by learning what you can do to help (as well as what you shouldn’t). Your help, however, should never come at your own emotional expense. If you look after your own needs, you’ll be in a better position to take care of your depressed friend, partner, or relative.
	Professional help for depression - If you think you or someone you care about has depression, seek professional help right away. Other medical conditions can sometimes look like depression, so it’s important to get a complete evaluation. If depression is diagnosed, your doctor or therapist will help you start on a personalized treatment plan. The most common approach involves therapy, medication, or a combination of the two.

Related links for depression signs and symptoms

Signs and symptoms of depression

What Does Depression Feel Like? – Provides a list of signs and symptoms and ways you might feel if you're depressed. (Wings of Madness)

When Depression Hurts – Article on the painful physical symptoms of depression, including what causes them and how treatment can help. (Psychology Today)

Nine Classic Symptoms of Depression – Describes the classic signs and symptoms of depression, including changes in the way the body functions. (University of Pennsylvania Health System)

Depression in men and women

Stories of Depression: Does This Sound Like You? - Read personal stories of depression, review the signs and symptoms, and learn how to get help. (National Institute of Mental Health)

Men and Depression – Overview of the signs, symptoms, causes, and effects of depression in men. Includes self-help tips. (The Royal College of Psychiatrists)

Male Depression: Don't Ignore the Symptoms – Learn about the distinct symptoms of depression in men and the dangers of leaving them untreated. (Mayo Clinic)

Depression: What Every Woman Should Know – Article on female depression, including symptoms, reasons behind the high rates, effective treatments, and risk factors. (National Institute of Mental Health)

Depression in the young and old

Depression in Older Persons – Learn about the causes, risk factors, symptoms, and consequences of depression in older adults and the elderly. (National Alliance on Mental Illness)

Depression in Children – Article looks at childhood depression, including symptoms, prevalence, treatment, and support. (BBC Health)

Teen Facts: Depression – Describes the signs and symptoms of depression in teenagers. Includes treatment advice. (The National Youth Violence Prevention Resource Center)

Types of depression

The Different Faces of Depression – Discussion of the different subtypes of depression, including atypical depression, melancholic depression, and psychotic depression. (Psychology Today)

Atypical Depression: What's in a Name? - Article on the symptoms, diagnosis, and treatment of atypical depression. (American Psychiatric Association)

Dysthymia: Psychotherapists and patients confront the high cost of “low-grade” depression – In-depth look at the causes, effects, and treatment of dysthymic disorder. (Harvard Health Publications)

Seasonal Affective Disorder: Winter Depression – Guide to seasonal affective disorder and its symptoms, causes, and treatment. (Northern County Psychiatric Associates)

Melinda Smith, M.A., Robert Segal, M.A., and Jeanne Segal, Ph.D., contributed to this article. Last modified on November 6, 2007.