Symptoms of Depression

Because the word "depression" is so ingrained in our culture, it's not uncommon for people to just come out and say, "I've been really depressed for the past 6 months." Depressed individuals (not all of who would meet criteria, incidentally, for a major depressive episode) often talk about the following symptoms:

1. Feeling down, sad, blue and not being able to just snap out of it
2. Being in a rut and not being able to function as they once did
3. Everything being much more difficult than it once was
4. Not being able to derive pleasure from practically anything, including the people in their lives
5. Having little to no motivation for anything
6. Having no energy
7. Feeling run down, exhausted
8. Feeling a heaviness or weight in their chest or shoulders
9. Feeling so much weight in their limbs that it is difficult to move them, literally
10. Feeling achy and experiencing new physical pains
11. Not wanting to get up in the morning
12. Not wanting to face the world or go into work
13. Not being able to sleep soundly or needing to sleep a lot more usual
14. Ruminating excessively about things in the past or future
15. Being more in their heads
16. Not being able to concentrate for any length of time on anything
17. Not being able to make decisions as easily as they once did; feeling indecisive, stuck
18. Feeling hopeless about life or that their condition will get any better
19. Feeling that they don't want to live anymore
20. Feeling that they would be better off dead
21. Feeling more angry, irritable or edgy; "snapping" more
22. Not wanting to be around people or interact with others and, consequently, becoming more isolative
23. Feeling anxious being around people or being outside
24. Having to put on a face at work
25. Crying for no apparent reason or being easily triggered to tears
26. Not having an appetite or eating more than usual and, therefore, possibly also losing weight or gaining weight
27. Feeling anxious or worried in general

Signs of Depression

Moreover, depressed individuals can give evidence of their depression simply in the way they look and behave. They may exhibit the following signs:

1. Appear noticeably despondent, with their face appearing very "flat" (or un-reactive) emotionally
2. Cry a lot or become easily tearful
3. Not smile or laugh at all – or even be able to invite any lightheartedness
4. Sigh frequently
5. Take a long time to answer questions
6. Seem slowed down in their thoughts
7. Seem slowed down physically
8. Have a feeble voice that sounds flat, otherwise, without any variation in tone
9. Look down frequently and make little eye contact
10. Talk about the same theme over and over again
11. Look disheveled and otherwise unkempt (compared to how they normally look when they are not so depressed)
12. Show evidence of weight loss
13. Show evidence of weight gain

They may also:

1. Appear restless or agitated
2. Seem dysphoric, irritable or edgy

Often, it's the case that these "physical" manifestations of depression correlate with the severity of depression. Someone who has lost 20 pounds, for example, because he has had no appetite, and been bed-ridden, more or less, for a month is someone who would be considered to have a severe major depressive episode. Similarly, if someone's thoughts and movements are so slowed down that he can barely hold a conversation or get about, he would be considered to have a severe major depressive episode.

Triggers of Depression

Many people are able to make a connection between this troubling mood state that they've arrived at and events in their lives, what I call "stressors" or "triggers". Common "triggers" include breakup of a romantic relationship, death of an important person in their lives, increase in responsibilities (e.g. birth of a first child, taking on someone else's workload in addition to one's own, job promotion), change in the ratio of pleasure and displeasure a certain situation brings (e.g. a new boss who is mean, making work much less pleasurable than before), and transitions (e.g. moving to a new city, starting college, etc.).

Others, however, do not see any connection between the depression they are facing now and the events preceding it. To these people, it's as though their depression just came out of the blue, sometimes gradually, sometimes abruptly. In fact, evidence suggests that, over time, distinct psychological stressors may play less important a role in precipitating a major depressive episode; it's as though, after several episodes, the illness can take a life of its own.

Other factors that can lead to or contribute to a new bout of depression – apart from psychological stress – include loss of efficacy of an anti-depressant medication and substance abuse (e.g. drinking excessively or abusing cocaine).

Sometimes, when a depression has gone untreated for a long period of time, people endure additional losses, such as the end of a marriage or job loss, because "functioning" in these areas could not be maintained.

Unless someone has had chronic, unremitting depression, most individuals will talk about this mood state as something very different from what they are normally accustomed to. People see it, usually, as a deviation from their usual baseline mood. Even those individuals with chronic low level depression (e.g. Dysthymic Disorder) or chronic major depression report deflections in their mood such that it is worse at times than others.