What are the symptoms of depression?
* Sleep Disturbance
A cardinal symptom of depression is sleep disturbance. This usually takes the form of insomnia, which is so characteristic of depression that the illness should be considered in anyone who suffers from persistant insomnia. The insomnia of depression may occur as initial insomnia, difficulty getting to sleep; as terminal insomnia or early awakening; or as recurrent awakings throughout the night. Less frequently, depressed individuals have hypersomnia or an increased need for sleep.
* Sadness
The fundamental symptom of depression is a pervasive feeling of sadness. Other persons suffering from depression experience irritibility, loss of interest or become preoccupied with feelings of guilt or physical symptoms. What is common to all, however, is a profound and painful change in mood.
* Lack Pep and Engergy
Not surprisingly, depressed people lack pep and energy. Their productivity on the job, in school, and at home begins to suffer. Many with more severe depression return to bed during the day because they feel to tired to remain up.
* Appetite and Weight Change
Depression typically causes disturbances in appetite and weight as well. The usual pattern is loss of appetite with an accompanying weight loss. The weight loss can be considerable. Clinicians who treat depression have all seen patients who have lost 30 or 40 pounds over a year. Some depressed people experience an increase in appetite with an accompanying weight gain, and the weight gain with depression can be as great as the weight loss. People who gain weight with depression are often the same ones who sleep more.
* Lose Interest and Motivation
Depressed people lose their interest and motivation in almost all of their life activities. Their lack of drive is independent of their low energy, but it compounds it to further compromise their productivity. They withdraw from friends and social events, lose interest in their families; even their interest in sex wanes. Depression can create a severe strain on a marriage, particularly if it becomes chronic.
* Slowed Pace
Often people are slowed by depression. Their thoughts and movements simply proceed at a slower pace than usual. In conversation there may be a short pause before they respond. They may take longer to make decisions or complete a task. In its extremes this slowing can reach the point where patients lie motionless in bed and fail to respond to others. Rarely seen today, such patients were a common feature of psychiatric hospitals before effective treatments became available. Depression can also cause anxiety and agitation. The diagnosis should be suspected in anyone who has a recent onset of an anxiety disorder. The agitation can be so uncomfortable that it is difficult to remain seated for an interview, and some patients will rise and pace the room to relieve the tension.
* Poor Concentration and Memory
Poor concentration and memory can be particularly troubling symptoms of depression. The complaints of memory impairment can be so persistant that elderly persons with depression can be misdiagnosed as having Alzheimer’s disease. Because of their poor concentration and preoccupation with their depressive symptoms they often do not remember well, and for this reason can appear demented. Elderly persons with a recent onset of memory disturbance should always be checked for depression.
* Lose Self Confidence / Experience Feelings of Guilt
Depressed people lose their self confidence and often feel guilty. The guilt can reach delusional proportions, where individuals believe they are responsible for harming others. Delusional guilt can also cause persecutory beliefs such as the feeling that others are critical of the individual.
* Thoughts of Suicide
Suicide is the most serious symptom of depression. These feelings are so common among depressed individuals that they should always be inquired about when a depressed patient is evaluated. The symptom begins with thoughts that life is no longer worthwhile, and if the illness is not treated it can progress to actual plans and attempts. The lifetime risk of suicide among persons who have or have had a depression is 15%, compared with approximately 1% for the general population. Most persons who do commit suicide have communicated their dispair to others in some manner, so it is important to be alert to these messages. The old adage that people who talk about suicide don’t attempt it is simply wrong. Likewise, the concern that talking about suicide with a depressed patient might plant the idea in their mind is misplaced; most depressed patients have thought of suicide already, and a frank discussion about how they are feeling may be lifesaving. Suicide is a medical emergency and should be referred for medical evaluation and treatment immediately.
For a diagnosis of depression, the American Psychiatric Association requires a disturbance of mood or loss of interest in addition to at least four of the other symptoms listed above occurring together over a period of at least two weeks. A common question is what should be done when someone is showing definite signs of depression but doesn’t meet criteria for an official diagnosis. Should they be treated? One could consider two strategies. Wait and see: the symptoms may not be a depressive illness, particularly if the person has not had depression in the past, and in this case, treating them could subject the individual to an unnecessary treatment. Treat: if the person has had depression in the past the chances are much greater that this is the beginning or a true depressive illness and treating it early could prevent it from developing into a more serious problem. Since the current generation of antidepressants are relatively free of serious adverse effects many clinicians prefer to err on the side of treatment.
Tags: Appetite and Weight Change, Lose Interest, Poor Concentration and Memory, Sadness, Sleep Disturbance, Thoughts of Suicide
