Hi, I’m Dr. Craig Sawchuk, a clinical psychologist at Mayo Clinic. And I’m here to talk with you about depression. Whether you’re looking for answers for yourself, a friend, or loved one, understanding the basics of depression can help you take the next step.
What is depression?
Depression is a mood disorder that causes feelings of sadness that won’t go away. Unfortunately, there’s a lot of stigma around depression. Depression isn’t a weakness or a character flaw. It’s not about being in a bad mood, and people who experience depression can’t just snap out of it. Depression is a common, serious, and treatable condition. If you’re experiencing depression, you’re not alone. It honestly affects people of all ages and races and biological sexes, income levels and educational backgrounds. Approximately one in six people will experience a major depressive episode at some point in their lifetime, while up to 16 million adults each year suffer from clinical depression. There are many types of symptoms that make up depression. Emotionally, you may feel sad or down or irritable or even apathetic. Physically, the body really slows down. You feel tired. Your sleep is often disrupted. It’s really hard to get yourself motivated. Your thinking also changes. It can just be hard to concentrate. Your thoughts tend to be much more negative. You can be really hard on yourself, feel hopeless and helpless about things. And even in some cases, have thoughts of not wanting to live. Behaviorally, you just want to pull back and withdraw from others, activities, and day-to-day responsibilities. These symptoms all work together to keep you trapped in a cycle of depression. Symptoms of depression are different for everyone. Some symptoms may be a sign of another disorder or medical condition. That’s why it’s important to get an accurate diagnosis.
What causes depression?
While there’s no single cause of depression, most experts believe there’s a combination of biological, social, and psychological factors that contribute to depression risk. Biologically, we think about genetics or a family history of depression, health conditions such as diabetes, heart disease or thyroid disorders, and even hormonal changes that happen over the lifespan, such as pregnancy and menopause. Changes in brain chemistry, especially disruptions in neurotransmitters like serotonin, that play an important role in regulating many bodily functions, including mood, sleep, and appetite, are thought to play a particularly important role in depression. Socially stressful and traumatic life events, limited access to resources such as food, housing, and health care, and a lack of social support all contribute to depression risk. Psychologically, we think of how negative thoughts and problematic coping behaviors, such as avoidance and substance use, increase our vulnerability to depression.
The good news is that treatment helps. Effective treatments for depression exist and you do have options to see what works best for you. Lifestyle changes that improve sleep habits, exercise, and address underlying health conditions can be an important first step. Medications such as antidepressants can be helpful in alleviating depressive symptoms. Therapy, especially cognitive behavioral therapy, teaches skills to better manage negative thoughts and improve coping behaviors to help break you out of cycles of depression. Whatever the cause, remember that depression is not your fault and it can be treated.
To help diagnose depression, your health care provider may use a physical exam, lab tests, or a mental health evaluation. These results will help identify various treatment options that best fit your situation.
Help is available. You don’t have to deal with depression by yourself. Take the next step and reach out. If you’re hesitant to talk to a health care provider, talk to a friend or loved one about how to get help. Living with depression isn’t easy and you’re not alone in your struggles. Always remember that effective treatments and supports are available to help you start feeling better. Want to learn more about depression? Visit mayoclinic.org. Do take care.
depression
Depression Symptoms and Warning Signs
Are you depressed? Here are some of the signs of depression to look for—and how they can vary according to your age, gender, and other factors.
What is depression?
Feeling down from time to time is a normal part of life, but when emotions such as hopelessness and despair take hold and just won’t go away, you may have depression. More than just sadness in response to life’s struggles and setbacks, depression changes how you think, feel, and function in daily activities. It can interfere with your ability to work, study, eat, sleep, and enjoy life. Just trying to get through the day can be overwhelming.
While some people describe depression as “living in a black hole” or having a feeling of impending doom, others feel lifeless, empty, and apathetic. Men in particular can feel angry and restless. However you experience the problem, left untreated it can become a serious health condition. But it’s important to remember that feelings of helplessness and hopelessness are symptoms of depression—not the reality of your situation.
No matter how hopeless you feel, you can get better. By recognizing the different symptoms of depression, you can take the first steps to feeling better and overcoming the problem.
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Signs and symptoms
Depression varies from person to person, but there are some common signs and symptoms. It’s important to remember that these symptoms can be part of life’s normal lows. But the more symptoms you have, the stronger they are, and the longer they’ve lasted—the more likely it is that you’re dealing with depression.
10 common depression 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 daily activities. You don’t care anymore about former hobbies, pastimes, social activities, or sex. You’ve lost your ability to feel joy and pleasure.
- 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, especially waking in the early hours of the morning, or oversleeping.
- Anger or irritability. Feeling agitated, restless, or even violent. Your tolerance level is low, your temper short, and everything and everyone gets on your nerves.
- Loss of energy. Feeling fatigued, sluggish, and physically drained. Your whole body may feel heavy, and even small tasks are exhausting or take longer to complete.
- Self-loathing. Strong feelings of worthlessness or guilt. You harshly criticize yourself for perceived faults and mistakes.
- Reckless behavior. You engage in escapist behavior such as substance abuse, compulsive gambling, reckless driving, or dangerous sports.
- Concentration problems. Trouble focusing, making decisions, or remembering things.
- Unexplained aches and pains. An increase in physical complaints such as headaches, back pain, aching muscles, and stomach pain.
Am I depressed?
Take this depression quiz to find out:
Depression test
Over the last 2 weeks, how often have you been bothered by any of the following problems?
- Little interest or pleasure in doing things:
- Feeling down, depressed or hopeless
- Trouble falling or staying asleep, or sleeping too much:
- Feeling tired or having little energy:
- Poor appetite or overeating:
- Feeling bad about yourself—or that you are a failure or have let yourself or your family down:
- Trouble concentrating on things, such as reading or watching television:
- Moving or speaking so slowly that other people could have noticed:
- Thoughts that you would be better off dead, or of hurting yourself:
Not at all (0 points) Several days (1 point) More than half the days (2 points) Nearly every day (3 points)
Not at all (0 points) Several days (1 point) More than half the days (2 points) Nearly every day (3 points)
Not at all (0 points) Several days (1 point) More than half the days (2 points) Nearly every day (3 points)
Not at all (0 points) Several days (1 point) More than half the days (2 points) Nearly every day (3 points)
Not at all (0 points) Several days (1 point) More than half the days (2 points) Nearly every day (3 points)
Not at all (0 points) Several days (1 point) More than half the days (2 points) Nearly every day (3 points)
Not at all (0 points) Several days (1 point) More than half the days (2 points) Nearly every day (3 points)
Not at all (0 points) Several days (1 point) More than half the days (2 points) Nearly every day (3 points)
Not at all (0 points) Several days (1 point) More than half the days (2 points) Nearly every day (3 points)
Score:
Interpreting the score:
1 to 4: Minimal depression.
5 to 9: Mild depression.
10 to 14: Moderate depression.
15 to 19: Moderately severe depression.
20 to 27: Severe or major depression.
This questionnaire is not intended to replace professional diagnosis.
Source: Patient Health Questionnaire-9 (PHQ-9) ADAA
Depression vs. anxiety
While anxiety and depression are different conditions, they stem from the same biological vulnerability so often go hand-in-hand. Anxiety can both appear as a symptom of depression or it can trigger depression in the first place. In fact, studies suggest that over 40 percent of people with major depression also suffer with an anxiety disorder.
Some of the symptoms between the two conditions can also look very similar, making it difficult to distinguish between the conditions. Irritability, anger, unexplained aches and pains, and changes in energy, focus, and sleeping patterns can occur in both depression and anxiety. Even the persistent dark, negative thoughts commonly associated with depression can look a lot like the endless worry of anxiety.
[Read: Anxiety Disorders and Anxiety Attacks]
However, there are also some marked differences. While the symptoms of both depression and anxiety can look very different in different people, the following may help to distinguish between the conditions:
- In depression without anxiety, you’re likely to feel sluggish and lifeless with little motivation to do anything. With anxiety, you’re more likely to feel tense and jittery with a racing mind.
- In depression without anxiety, you may feel hopeless and helpless about what you see as an inevitably bleak future. With anxiety, you’re more likely to worry over and over about what the future holds, feeling frightened and nervous but thinking that your worry may hold the key to easing those fears.
If you recognize symptoms of anxiety co-occurring with your depression, it’s important to seek treatment for both conditions. Since they’re so closely related, a lot of the self-help and treatment options that work for anxiety will also help manage symptoms of depression.
Is it depression or bipolar disorder (manic depression)?
Bipolar disorder, also known as manic depression, involves serious shifts in moods, energy, thinking, and behavior. Because it looks so similar to depression when in the low phase, it is often overlooked and misdiagnosed. This can be a serious problem as taking antidepressants for bipolar disorder can actually make the condition worse.
[Read: Bipolar Disorder Signs and Symptoms]
If you’ve ever gone through phases where you experienced excessive feelings of euphoria, a decreased need for sleep, racing thoughts, and impulsive behavior, consider getting evaluated for bipolar disorder.
Other conditions that can mimic the symptoms of depression
Anxiety and bipolar disorder aren’t the only conditions that can be mistaken for depression. Just as depression can be triggered by other health problems, there are also mental and medical conditions that can mimic the symptoms of depression. These include:
Attention deficit hyperactivity disorder (ADHD). Symptoms such as restlessness, trouble concentrating and staying focused, irritability, and a loss of motivation can occur in both depression and ADHD. Even if your ADHD symptoms weren’t recognized in childhood, that doesn’t mean they’re not impacting you as an adult.
Chronic fatigue syndrome or long COVID. Persistent fatigue, changes to your sleep patterns, and difficulty focusing could also point to chronic fatigue syndrome (myalgic encephalomyelitis) or long-haul COVID, where the effects of COVID-19 linger even when you’re no longer testing positive for the virus. While there is still a lot that medical professionals don’t fully understand about these conditions, there are still things you can do to ease symptoms and improve how you feel.
Parkinson’s disease. The lack of energy, slow movements, and changes to mood and memory that often accompany Parkinson’s disease can look a lot like depression symptoms in older adults.
Fibromyalgia. The widespread musculoskeletal pain of fibromyalgia syndrome (FMS) is often accompanied by sleep, fatigue, and mood changes that can be mistaken for depression. Other sources of chronic pain can also leave you feeling hopeless and exhausted.
Other physical conditions such as diabetes, hypothyroidism, anemia, low blood sugar (hypoglycemia), and vitamin D deficiency can also trigger depression-like symptoms. Blood tests and other screening methods from a healthcare professional can help identify if these conditions are causing your symptoms.
Depression and suicide risk
Depression is a major risk factor for suicide. Deep despair and hopelessness can make suicide feel like the only way to escape the pain. If you have a loved one with depression, take any suicidal talk or behavior seriously and watch for the warning signs:
- Talking about killing or harming one’s self.
- Expressing strong feelings of hopelessness or being trapped.
- An unusual preoccupation with death or dying.
- Acting recklessly, as if they have a death wish (e.g. speeding through red lights).
- Calling or visiting people to say goodbye.
- Getting affairs in order (giving away prized possessions, tying up loose ends).
- Saying things like “Everyone would be better off without me,” or “I want out.”
- A sudden switch from being extremely down to acting calm and happy.
If you think a friend or family member is considering suicide, express your concern and seek help immediately. Talking openly about suicidal thoughts and feelings can save a life.
If you are feeling suicidal…
When you’re feeling suicidal, your problems don’t seem temporary—they seem overwhelming and permanent. But with time, you will feel better, especially if you get help. There are many people who want to support you during this difficult time, so please reach out!
Read Are You Feeling Suicidal?, call 988 in the U.S., or visit IASP or Suicide.org to find a helpline in your country.
How depression symptoms vary with gender and age
Depression often varies according to age and gender, with symptoms differing between men and women, or young people and older adults.
Men
Depressed men are less likely 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. They’re also more likely to experience symptoms such as anger, aggression, reckless behavior, and substance abuse.
Women
Women are more likely to experience symptoms such as pronounced feelings of guilt, excessive sleeping, overeating, and weight gain. Depression in women is also impacted by hormonal factors during menstruation, pregnancy, and menopause. In fact, postpartum depression affects up to one in seven women following childbirth.
Teens
Irritability, anger, and agitation are often the most noticeable symptoms in depressed teens—not sadness. They may also complain of headaches, stomachaches, or other physical pains.
Older adults
Older adults tend to complain more about the physical rather than the emotional signs and symptoms: things like fatigue, unexplained aches and pains, and memory problems. They may also neglect their personal appearance and stop taking critical medications for their health.
Next step
In addition to age and gender, depression symptoms can also vary according to the type or severity of your depression. Understanding the type of depression you’re dealing with can help to find the most effective ways to overcome the problem and start to feel better again. Read: Depression Types, Causes, and Risk Factors.
Authors: Melinda Smith, M.A., Lawrence Robinson, and Jeanne Segal, Ph.D.
- References
Belmaker, R. H., & Agam, G. (2008). Major Depressive Disorder. New England Journal of Medicine, 358(1), 55–68. https://doi.org/10.1056/NEJMra073096
Kessler, R. C., Birnbaum, H. G., Shahly, V., Bromet, E., Hwang, I., McLaughlin, K. A., Sampson, N., Andrade, L. H., Girolamo, G. de, Demyttenaere, K., Haro, J. M., Karam, A. N., Kostyuchenko, S., Kovess, V., Lara, C., Levinson, D., Matschinger, H., Nakane, Y., Browne, M. O., … Stein, D. J. (2010). Age differences in the prevalence and co-morbidity of DSM-IV major depressive episodes: Results from the WHO World Mental Health Survey Initiative. Depression and Anxiety, 27(4), 351–364. https://doi.org/10.1002/da.20634
Depressive Disorders. (2013). In Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association. https://doi.org/10.1176/appi.books.9780890425787.x04_Depressive_Disorders
