Let's Talk About the Symptoms of Depression
Everyone lives in The Dumps on occasion. But some experience sadness, and other issues, that go far beyond. Not sure where your feelings fall? We've got the doctor-vetted details to help you figure out if you have clinical depression.
Figuring out if you have depression isn't as easy as walking into a doctor’s office for a blood test, cheek swab, or X-ray. That's because the symptoms themselves are the diagnostic criteria. While major depressive disorder (MDD) is the clinical name for depression, there are multiple types of depression, and much of what separates them has to do with personal circumstances—the "why" of your feelings. Learning the symptoms of each can help you determine which type you might have and what to do next. HealthCentral is here for you.
Our Pro Panel
We asked some of the nation’s top depression experts to bring you the most up-to-date information possible.
Charles B. Nemeroff, M.D., Ph.D.
Chief Medical Officer of the Anxiety and Depression Association of America, Professor and Chair of Psychiatry at Mulva Clinic for the Neurosciences
Dell Medical School, The University of Texas
Jennifer L. Payne, M.D.
Director of the Women's Mood Disorders Center and Associate Professor of Psychiatry
Johns Hopkins School of Medicine
Carol A. Bernstein, M.D.
Psychiatrist, Vice Chair for Faculty Development and Well-Being in the Departments of Psychiatry and Obstetrics and Gynecology
Montefiore Medical Center/Albert Einstein College of Medicine
The Bronx, NY
When you wake up in the morning, you might not want to get out of bed. You think: What's the point? Your exhaustion knows no bounds. Every task feels overwhelming and impossible. Your old self—the person who was engaging, smart, funny—has vanished, leaving behind an empty husk who just wants to crawl back under the covers. You can’t concentrate, so you might make more mistakes and feel like you’ve let down your friends, family, and colleagues. You're paralyzed by decision-making. You feel like you suck at everything. As you slowly drown in your ocean of negativity, everyone else effortlessly swims around you, seemingly not noticing (or caring about) your distress.
Have you met a new mom? Odds are, she has spit-up on her shirt and unwashed hair. She might not recognize the signs of depression because she is recovering from the physical trauma of childbirth, is sleep-deprived, and feels overwhelmed with a tiny person whose every need she must meet and whose only means of communicating is desperate crying. Maybe she's not sure if this is her new normal. Maybe she's embarrassed that she's "failing" at her new job (a.k.a. motherhood). Maybe she's scared if she tells people the truth, they'll think she's a bad mom. If this is happening to someone you know, encourage her to see a psychiatrist ASAP.
Yes, though depression in kids looks a little different than it does in adults. First, instead of seeming deflated or sad, kids tend to be irritable or lash out in anger. Young children may complain of physical symptoms like tummy aches and headaches. Their performance in school might decline, while emotional outbursts and behavioral problems might increase. They may avoid playing with classmates and activities they used to think were fun, threaten to run away from home, or give away their prized toys or possessions.
If you're not sure who to talk to, your primary care physician is a great place to start. Make an appointment for a checkup and, when you're in there, tell them your concerns. It might feel awkward to open up but remember that depression is a health issue and they're a health professional. (Plus, thanks to HIPAA, this conversation is 100% private—your doc isn't allowed to reveal your medical info to anyone without your permission). Say something like, "I haven't been feeling like myself lately and I think I might have depression. What should my next steps be?" To help get you on your way to recovery, they'll ask a bunch of questions about how you've been eating, sleeping, and feeling lately, and whether you've thought about hurting or even killing yourself. Answer as truthfully as you can. They might try to rule out a possible vitamin deficiency, thyroid condition, or other medical issue with blood tests. They'll also likely refer you to a therapist, psychologist, or psychiatrist, who will be able to get more in-depth.
What Does Depression Look Like, Generally?
Many people say they're "depressed" when they're simply sad. True depression lingers and won’t go away on its own. Unfortunately, it's a common mental health issue: each year in the U.S. alone, 17.7 million people have MDD. If you're one of them, you may have issues with sleep, fatigue, even weight. You can be at higher risk for certain other conditions. You may no longer give a crap about your favorite activities. Which sucks the fun out of everything—and can interfere with your personal and work lives. That said, there are many treatments and lifestyle changes that can help you start feeling better.
Can Symptoms Vary Depending on the Type of Depression?
Yes, for sure. Mental health professionals must talk to their patients about their mood and lifestyle and ask specific questions to determine if their symptoms match up with the guidelines for clinical depression in the latest iteration of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), essentially the guidebook of all mental health conditions.
Regarding the variety of depression types: If it's the dead of winter and you feel this way every year, you may have seasonal affective disorder (SAD). Women who feel down after childbirth most likely have postpartum (a.k.a. peripartum) depression (PPD). However, the two most common types are major depressive disorder (MDD) and persistent depressive disorder (PDD, formerly called dysthymia). Worth clarifying: Treatment-resistant depression itself is not a type of depression; it's whatever variety you have being resistant to treatment.
So, What Are the Symptoms of Major Depressive Disorder and Persistent Depressive Disorder?
To be diagnosed with MDD, patients must experience five or more of the below symptoms during a two-week period or longer, with episodes that last less than two years. At least one symptom must be depressed mood or loss of pleasure, and they must be distressing or affect daily functioning.
People with PDD (also known as chronic depression) experience the same array of symptoms—the difference is that PDD lasts for at least two years. In cases of "double depression," people experience severe episodes of MDD within their usual state of chronic depression.
In both MDD and PDD, symptoms can be mild, moderate, or severe, though MDD episodes tend to have more intense side effects. The common signs of MDD and PDD include:
You're bummed out most of the time. Feeling hopeless, despairing, or apathetic more often than not—as in, nearly every day—is a hallmark of depression. Having unexplained crying jags or going emotionally numb, and saying things like, "what’s the point, anyway?" are all indicators of a depressed mood, and one of the two main symptoms that need to be present for a diagnosis of clinical depression.
Nothing is fun. The things that used to make you happy don't have the same joy they once did. Hiking enthusiasts might start hibernating indoors and social butterflies might avoid hangouts with friends. Passionate home chefs might wonder why they ever bothered cooking when they could have been eating stale Pop-Tarts over the sink. Losing interest in pretty much everything is a telltale depression symptom.
Your pants don't fit. Do your jeans seem a little tighter lately? Or have you dropped some pounds without really trying? A weight gain or loss of 5% of your normal body weight might be an indicator of MDD. (Less so for PDD.) Ditto for being hungry all the time or losing your appetite and forgetting to eat, even if those changes don't show up on the scale.
Sleeplessness or oversleeping. An out-of-whack sleep schedule can be a sign of depression. That can mean having a hard time getting to sleep, disturbed sleep, being unable to wake up in the morning, feeling drowsy even when you get a full night's sleep, and finding yourself dozing off during the day.
Life moves at the wrong speed. If you're becoming a human sloth who spends days in bed, it makes sense that depression is likely a factor. But did you know that hyper agitation (when you just can't relax your body and mind) and restlessness are also symptoms of depression? Other people might notice you’re more fidgety, doing things like pacing across the room or picking at your skin. Doctors call this psychomotor retardation or agitation.
Your middle name is "tired." Depressed people are chronically exhausted. It's difficult to muster the energy to do the things you need to do, from getting ready in the morning and getting to work on time to doing daily chores.
Feelings of worthlessness (even if you've done nothing wrong). Everyone messes up and everyone feels self-doubt, but every person has value. If the running commentary in your head is saying things like, "I can't do anything right" or "It's all my fault" and "Nobody loves me and they never will," it’s likely due to depression.
You can't concentrate on anything. And if anyone asks you to pick a restaurant, they might starve to death while waiting for you to make a choice. People with MDD and PDD often struggle to think clearly, which makes focusing on a task and making decisions—even simple ones—difficult.
Recurrent thoughts of death or suicide. Even if you've never made a specific plan to take your life, ruminating over your own death or fantasizing about suicide is a huge red flag. Repeated thoughts of suicide, creating a suicide plan, or making a suicide attempt are never "normal" behaviors, so get help ASAP.
Major and Persistent Depression in Children
Not everyone's childhood is fun and carefree. According to the Center for Disease Control and Prevention (CDC), 3.2% of kids ages 3 to 17 have depression—that's approximately 1.9 million young people. There's no telling how many children go untreated because parents and teachers can't recognize the warning signs, which are different in kids than adults. Instead of sadness, children’s top symptom is usually irritability, which they must experience for at least one year.
Children with a family history of depression or who experience stressors like a family death or bullying have a higher risk of depression. Their performance in school can plummet, they may suddenly struggle with handling their emotions, and they may be pegged as having behavioral problems. They might demonstrate signs of psychosomatics, such as complain of headaches and stomachaches.
Another tip-off is kids not growing to the expected height and weight for their age. (This is a better metric for kids than changes in hunger level or the number on the scale. Those are signs of adult depression, but kids go through growth spurts, which can explain those changes.) One thing to keep an eye on: Childhood depression can be an early sign of bipolar disorder, which is usually diagnosed later.
Major and Persistent Depression in Older Adults
Straining to read a restaurant menu, losing friends and family members, and noticing a never-ending parade of aches and pains all suck, but they’re a normal part of aging. Having depression is not.
Still, 7 million Americans age 65 and older suffer with MDD. In fact, the one silver lining about being an older person with depression is if you’ve experienced low mood and loss of interest before, you have a better chance of recognizing the symptoms again.
This go-round, symptoms may occur with other medical illnesses such as cancer, diabetes, cardiac problems, and Parkinson's disease—depression can make these conditions worse, and vice versa. There is also one subtype of depression that's unique to older adults: When a person age 60+ develops late-onset depression for the first time, it’s often due to vascular disease that restricts blood flow to their brain. This is a condition called vascular depression.
What Are the Symptoms of Seasonal Affective Disorder (SAD)?
Winter doldrums are par for the course when sunlight is scarce and it's freezing out. For some people, it's more severe than that. If you experience depression symptoms (see the above list) during the winter months but feel perfectly fine in spring, you may have Seasonal Affective Disorder. (P.S. The name of this type of depression has officially changed to Depression with Seasonal Pattern in the DSM-5.
Your symptoms of depression may match MDD but they begin and end during a specific season every year—usually winter but it can happen in summer too—and disappear during other seasons. This needs to happen for at least two consecutive years for a diagnosis.
What About the Symptoms of Other Types of Depression?
The nine symptoms of MDD and PDD we went over above are the basis for almost all of the subtypes of depression. Unfortunately, for some types, it doesn't stop there. Let's take a closer look at the additional symptoms that come with more specific types of depression.
What Are the Symptoms of Premenstrual Dysphoric Disorder (PMDD)?
If premenstrual syndrome (PMS) and depression had a baby, it would be PMDD. And if you feel like your period rules your whole life, you may have it.
PMDD symptoms include:
In PMDD, these symptoms are severe enough to interfere in your daily life. Every. Single. Month. For a diagnosis, you must experience a certain number of symptoms during most menstrual cycles over a year according to this schedule: symptoms appear the final week before your period, begin to improve a few days after your period starts, and vanish after your period ends.
Of note: Doctors can mistake PMDD for premenstrual exacerbation, which is when your period intensifies the symptoms of another illness. That's because many symptoms of PMDD overlap with PMS and with depression. The cliché is true: You know your body best. If you feel like you really have PMDD, bring this up to your doctor.
What Are the Symptoms of Peripartum Depression (PPD)?
It's no secret that pregnancy hormones can make you feel like you're losing your mind. For new mothers, having dramatic mood swings, feeling irritable, and panicking about what the heck you got yourself into is actually pretty common for the first couple of weeks. As many as 50 to 75 percent of new moms experience the "baby blues" after delivery. (Cute name for an emotional rollercoaster of crying jags, right?)
However, if you experience depression symptoms for more than two weeks—anytime during pregnancy through one month postpartum—you may have PPD. Nearly 12% of new moms have PPD, according to a CDC report.
In PPD, once known as postpartum depression but since expanded to peripartum depression—and also known as Depression with Peripartum Onset—symptoms are more severe and longer-lasting. If you experience depression symptoms (see the above list) during pregnancy through one month postpartum, you may have this subtype of MDD.
Signs of PPD may also include:
Listlessness. You're lethargic and probably can't imagine doing anything more ambitious than going from the couch to the fridge.
Postpartum psychosis, which can present with confusion, hallucinations, or delusions.
Trouble bonding with your baby or thoughts of hurting yourself or your child. This doesn't mean you'll actually hurt your child, or that you're a bad person, or you made a mistake—it means you need professional help.
PPD doesn't just go away. It can last up to a year and create a dangerous situation for you and your family.
What Are the Symptoms of Perimenopausal Depression?
The time leading up to menopause is called perimenopause. That's when the body spits out uneven levels of estrogen, and has low levels of estrogen, leading to a host of symptoms including hot flashes, sleep disruptions, and mood swings.
Dramatic hormonal shifts make perimenopause a risky time for women, especially those with a history of depression who have a 59% chance of developing it again at this life stage. That's more than half of perimenopausal women! Perimenopause symptoms may overlap with and exacerbate even low-level depression symptoms. Life stressors such as aging parents, work responsibilities, inadequate social support, and other health problems associated with mid-life are also factors. Even if you've never been depressed before, your odds of developing PMD are 28% after menopause.
Depression in Children Stats: Centers for Disease Control. (2019). "Data and Statistics on Children's Mental Health." cdc.gov/childrensmentalhealth/data.html
Symptoms of Depression in Children: American Academy of Child & Adolescent Psychiatry. (2018). "Depression in Children and Teens." aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/The-Depressed-Child-004.aspx
Depression in Older Adults Stats: Centers for Disease Control. (n.d.). "CDC Promotes Public Health Approach to Address Depression Among Older Adults." cdc.gov/aging/pdf/cib_mental_health.pdf
Seasonal Affective Disorder Diagnosis Requirements: Depression Research and Treatment. (2015). "Seasonal Affective Disorder: An Overview of Assessment and Treatment Approaches." ncbi.nlm.nih.gov/pmc/articles/PMC4673349/
PMDD in Relation to Premenstrual Exacerbation: UNC School of Medicine. (n.d.). "Menstrually Related Mood Disorders." med.unc.edu/psych/wmd/mood-disorders/menstrually-related/
PMDD Symptoms: Office of Women's Health. (n.d.). "Premenstrual Dysphoric Disorder." womenshealth.gov/menstrual-cycle/premenstrual-syndrome/premenstrual-dysphoric-disorder-pmdd
Baby Blues Stat: Cleveland Clinic. (2018). "Depression After the Birth of a Child or Pregnancy Loss." my.clevelandclinic.org/health/diseases/9312-depression-after-the-birth-of-a-child-or-pregnancy-loss
PPD and Your Family: American Family Physician. (2016). "Identification and Management of Peripartum Depression." aafp.org/afp/2016/0515/p852.html
Perimenopausal Depression Contributing Factors: ScienceDaily. (2018). "First-ever guidelines for detecting, treating perimenopausal depression." sciencedaily.com/releases/2018/09/180905083913.htm