Occasional feelings of sadness, irritability or pessimism are a normal part of life. Although many people associate depression primarily with feeling sad or “down,” the disorder often involves a range of symptoms. Depression can be caused by a combination of factors, including genetic, biological, psychological and environmental influences and may be indicated, if symptoms occur regularly for two weeks or longer and begin to interfere with daily life. Depression can also manifest differently across the life span, sometimes in unexpected ways. For example, in children and adolescents, symptoms of depression might include irritability or acting out.
Not everyone who is depressed experiences every symptom. Some people experience only a few symptoms while others may experience many. Several persistent symptoms in addition to low mood are required for a diagnosis of major depression, but people with only a few – but distressing – symptoms may benefit from treatment of their “subsyndromal” depression. The severity and frequency of symptoms and how long they last will vary depending on the individual and his or her particular illness. Symptoms may also vary depending on the stage of the illness.
According to the National Institute of Mental Health (NIMH), symptoms of depression can include:
- Persistent sad, anxious, or “empty” mood
- Feelings of hopelessness, or pessimism
- Feelings of guilt, worthlessness, or helplessness
- Loss of interest or pleasure in hobbies and activities
- Decreased energy or fatigue
- Moving or talking more slowly
- Feeling restless or having trouble sitting still
- Difficulty concentrating, remembering, or making decisions
- Difficulty sleeping, early-morning awakening, or oversleeping
- Appetite and/or weight changes
- Thoughts of death or suicide, or suicide attempts
- Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment
Postpartum depression is much more serious than the “baby blues” (relatively mild depressive and anxiety symptoms that typically clear within two weeks after delivery) that many women experience after giving birth. Women with postpartum depression experience full-blown major depression during pregnancy or after delivery (postpartum depression). The feelings of extreme sadness, anxiety, and exhaustion that accompany postpartum depression may make it difficult for these new mothers to complete daily care activities for themselves and/or for their babies.
Symptoms: See general "Depression" topic for symptoms.
Seasonal affective disorder is characterized by the onset of depression during the winter months, when there is less natural sunlight. This depression generally lifts during spring and summer. Winter depression, typically accompanied by social withdrawal, increased sleep, and weight gain, predictably returns every year in seasonal affective disorder.
SAD is not considered a separate disorder but is a type of depression characterized by its recurrent seasonal pattern, with symptoms lasting about 4 to 5 months per year. Therefore, the signs and symptoms of SAD include those associated with major depression, and some specific symptoms that differ for winter-pattern and summer-pattern SAD. Not every person with SAD will experience all of the symptoms listed below.
Symptoms of major depression may include:
- Feeling depressed most of the day, nearly every day
- Losing interest in activities you once enjoyed
- Experiencing changes in appetite or weight
- Having problems with sleep
- Feeling sluggish or agitated
- Having low energy
- Feeling hopeless or worthless
- Having difficulty concentrating
- Having frequent thoughts of death or suicide
For winter-pattern SAD, additional specific symptoms may include:
- Oversleeping (hypersomnia)
- Overeating, particularly with a craving for carbohydrates
- Weight gain
- Social withdrawal (feeling like “hibernating”)
Specific symptoms for summer-pattern SAD may include:
- Trouble sleeping (insomnia)
- Poor appetite, leading to weight loss
- Restlessness and agitation
- Episodes of violent behavior