Depression isn’t always obvious – it doesn’t just open the door and announce itself. Instead, depression is different for everyone and can include a range of feelings and experiences. According to Julia Hoffman, PsyD,
“Depression looks different for everyone. Although depression can come on suddenly, it can also be a constant state of mind that builds over time. People also experience different types of depression symptoms: to some it can feel like profound sadness and to others like a complete lack of emotions. Some people may sleep all day and others have trouble sleeping at all.”
A lot of people experience depression without being sure that’s what’s going on. Understanding what you are experiencing to see if it is consistent with the signs and symptoms of depression is the first step toward doing something about it.
Symptoms of depression include:
- Having little interest or pleasure in doing things
- Feeling down, depressed, or hopeless
- Having trouble falling or staying asleep, or sleeping too much
- Feeling tired or having little energy
- Poor appetite or overeating
- Feeling bad about yourself or feeling like a failure
- Trouble concentrating on things
- Moving or speaking so slowly that other people could have noticed. Or being fidgety/restless.
- Thoughts that you would be better of dead, or thoughts of hurting yourself
But these aren’t the only feelings associated with depression. People who are depressed commonly say they feel overwhelmed, burnt out, inadequate, ashamed, and more. Many say they feel nothing at all, empty and flat. Depression can include a sense of pain, not unlike physical pain, that makes people give up on their interest in the outside world.
You don’t have to have every symptom to be depressed – everyone has their own pattern and symptoms can come and go. “Most people expect that depression means feeling sad or down during the episode but you could also feel irritable or disinterested in things that you usually enjoy and skip sadness altogether,” Hoffman explains.
Beyond the presence of symptoms, depression also needs to be persistent, lasting continuously for at least two weeks. Depression can appear in episodes, which may come and go over time, or may settle in and stay.
Depression changes your body and brain
Depression includes changes to your body and brain. Parts of the limbic system, the brain’s center of basic emotions, actually shrink in size and have reduced function with depression. And an area called the Dorsolateral Prefrontal Cortex (DLPFC), in the front part of our brain central to motivation, judgment, and sophisticated emotions, shows lower amounts of activity with depression.
People with depression also tend to have reduced immune function, constricted blood vessels, lower energy, sleep disturbances, weight changes, and increased risk of heart attack.
Depression symptoms are gauged by how much they impact your life.
Having depressed feelings often leads to depressed behaviors, which has a significant impact on the lives of people with depression. It’s common for depression to make us feel withdrawn, less confident, overwhelmed, irritable, and more. Because of this, it can have a major impact in important areas of life:
- Ability to be productive at work or school
- Ability to get along in our close relationships
- Ability to participate in social activities
- Ability to complete daily tasks like going to the grocery store or doing laundry
These effects can be difficult and self-perpetuating. For example, going to fewer social gatherings can make us feel more lonely and depressed, which makes us not want to go to social gatherings.
How is depression assessed and diagnosed?
Completing a self assessment can be a helpful starting point to determine if clinical care is right for you. The core symptoms of depression are often assessed using the Patient Health Questionnaire, or PHQ-9, the gold standard for self reported depression measurement. This can provide a helpful starting point and a way to measure progress with treatment.
Only a doctor can diagnose depression. The guidelines of the American Psychiatric Association (The DSM-5) state that to diagnose depression:
- A patient must be experiencing at least five of the nine core symptoms and that this must include feeling down, depressed, or hopeless; or having little interest or pleasure in doing things.
- The symptoms need to be persistent for at least two weeks
- The symptoms need to be causing difficulty in a patient’s life
This formula is a guideline that is only part of the picture. A doctor takes symptoms, history, and context into consideration when diagnosing depression.
Once I recognize the signs of depression, what’s next?
Depression does not indicate any kind of weakness or flaw – it’s a common illness that affects millions of people. If you suspect you might have depression, it’s important to do something about it. Treatment is effective and can change your life.
The first step is to complete an assessment or visit a professional.
Julia Hoffman adds,
“If you’re feeling stressed or just generally not like yourself for a few weeks then checking in with your doctor is a good place to start so that they can help figure out what’s going on. Sometimes people think if they can point to a reason for their stress that they don’t need help. The trick is trying to see if your worries or mood are out of proportion.”
Confirming a depression diagnosis can be both upsetting and empowering. Nobody wants to have depression. But understanding what’s going on is the first step on your path to doing something about it.