Signs of Depression - Variations on a Theme

The clinical symptoms of a depressive episode are specifically stated in the DSM-IV-TR, which is the psychiatrist's diagnostic handbook. But every person's personal signs of depression are likely to be different, even though common characteristics are shared.

When a person has a cluster of such signs and symptoms, and they go on for two weeks or more, he or she could be diagnosed with a major depressive disorder or, if the person also experiences mania or hypomania, bipolar disorder. Let's take a look at nine of the everyday signs of depression that, taken as a group, could lead to one of these disorders being diagnosed. We'll use four characters: John, Tina, Andy, and Lorna. Important to keep in mind: Andy has previously experienced mania and Tina hypomania. Each will have unique symptoms, leading to slightly different diagnoses -- so at the end of this article, you can find out what these four characters have been diagnosed with.


Low Mood

Lorna is crying a lot
Lorna's family often sees her crying. Tom Merton/OJO Images/Getty Images

While John simply says that he is depressed, the others describe their feelings differently. Tina feels sad most of the time and doesn't know why. Andy's way of describing it is to say that he feels emptiness inside, or sometimes that his life is empty. And Lorna doesn't say anything, but her family sees that she is moping around and crying a lot.

What they're all describing comes under the clinical heading of "depressed mood," but each of them experiences that mood in a different way.


Loss of Interest in Activities

Lorna's sink filled with dirty dishes
Lorna has lost her pride in her home. Bastun/E+/Getty Images

John's a high-powered executive who usually thrives on the work he does. But now he doesn't care. He misses deadlines. He doesn't return all his calls or even answer all his email. Instead of working, he plays computer solitaire as much as he can.

Tina's love is outdoor exercise. Normally, she walks five miles a few times each week, goes hiking or canoeing on weekends, and takes vacations where she can ski or go rock-climbing. But during a depression, she sits at home. If she does go out for a walk, she cuts it short.

For Andy, life is all about socializing. He gives parties often, goes to them even more, and if there isn't a party on a given night, he gets together with friends. But now he turns down invitations, or accepts them and then doesn't show up. His apartment, usually a model of neatness because it's on display so often, grows sloppy. He goes straight home after work and doesn't do much of anything.

Lorna, a homemaker, has always taken pride in her house and garden. But this year the plants she bought haven't been replanted into her garden, her kitchen floor hasn't been washed in weeks, and dishes are piling up in the sink because she hasn't even cared to take the clean ones out of the dishwasher for several days.

All of our subjects are experiencing their own forms of the clinical symptom "loss of interest in normally pleasurable activities."

In order for a person to be diagnosed with major depression or bipolar depression, he or she must have either a depressed mood, loss of interest in the activities they usually enjoy, or both. In our scenario, all four of our subjects have symptoms in both categories.

In addition, for a diagnosis of a depressive episode to be made, the person must show at least three to four other signs of depression out of the seven categories that follow.


Sleep Problems

John lies awake for hours
John lies awake for hours. Biggie Productions/Taxi/Getty Images

John lies awake for hours before finally getting to sleep. Andy has trouble falling asleep, then wakes a few hours later and remains awake for two or three hours before finally getting back to sleep. And Lorna sleeps 12 hours at night and then takes a three-hour or more nap in the afternoon. Only Tina doesn't have any problems with her sleep.

Insomnia - difficulty sleeping - is common during depression as is hypersomnia, which is what's happening to Lorna.


Appetite and/or Weight Changes

Tina is eating everything in sight
Tina is eating everything in sight. Tony Latham/The Image Bank/Getty Images

John and Tina are eating everything in sight, and Tina has gained 6 pounds in a month. Andy hardly eats a thing. Lorna hasn't had any changes in weight or appetite.

These situations - unusual increase or decrease in appetite, and/or a significant change in body weight in a month's time - comprise one category of the diagnostic symptoms for a depressive episode.


Tiredness/Lack of Energy

Andy makes mistakes at work
Andy is so tired he's making mistakes at work. Image Source / Getty Images

John and Andy, who have difficulty sleeping, feel tired most of the time. Lorna feels like she has no energy in spite of all the sleep she's getting. But Tina, who has no trouble with her sleep, also says she's tired and has no energy. John has begun calling in sick to work because of his fatigue, and Andy is making mistakes at work because he feels so tired all the time.

Fatigue is a frequent physical symptom of depression. It isn't made up - it's real, and it can be quite severe. A simple task like rinsing off dirty dishes can seem to be more effort than it's worth.


Restlessness or Sluggishness

Andy is physically slowed down
Andy's sluggishness is psychomotor retardation. Dusan Bartolovic / E+ / Getty Images

In spite of feeling tired, Tina is restless. Her fingers are always tapping on something; she'll get a burst of energy and start housecleaning, but tire of it after only five minutes; she walks back and forth in the living room. This is called psychomotor agitation - that is, restless or agitated movements occurring for psychological reasons.

While all our subjects feel fatigued, Andy in particular is having an additional problem. He speaks slowly and hesitantly, sometimes losing his train of thought in the middle of a sentence. He moves more slowly than usual. This is called psychomotor retardation - physical slowing that has a mental cause.

Neither John nor Lorna has either of these symptoms.


Loss of Self-Esteem or Guilt

Tina has lost her self-esteem and is full of guilt
Tina has lost her self-esteem and is full of guilt. drbimages/E+/Getty Images

Lorna spends a lot of time feeling guilty. Some of it's about all the things she should be doing, but some of it is over mistakes she made as a child and a young woman. There is nothing she can do about those mistakes, and because of her hypersomnia and lack of energy, there just aren't enough hours left in the day for her to get all her housework done. But guilt consumes a good portion of her waking hours nonetheless.

Tina, who is gaining weight and losing muscle tone from lack of energy, is racked with guilt about it most of the time, yet still can't get herself to get back on track.

Andy just hates himself, feeling he is worthless. John doesn't have a problem in this category.

Feelings of excessive guilt and/or worthlessness, or feeling guilty about things unrelated to your current situation, are another common symptom of depression.


Lack of Concentration / Indecision

Lorna just sits in front of the television
Lorna just sits in front of the television. Fabrice LEROUGE/ONOKY/Getty Images

John finds himself unable to make decisions much of the time, while Andy finds it extremely difficult to concentrate at all. Lorna has so much trouble concentrating that she will sit mindlessly watching TV for hours.

Tina doesn't show any signs of poor concentration or indecisiveness.

Lack of focus and trouble making decisions can become a serious issue. For both John and Andy, their jobs could be in jeopardy.


Thoughts of Death or Suicide

Andy is in a very dark place
Andy is in a very dark place. Ivo Berg (Crazy-Ivory)/Moment/Getty Images

Andy has made one suicide attempt since his mood became depressed. Lorna thinks a lot about how much better off her family would be without her and imagining her own funeral but doesn't think of taking her own life.

John has had fleeting thoughts about wishing he were dead, but nothing serious, and Tina has not thought about death or suicide.

Whether it's thinking about being dead, thinking about suicide, or planning or attempting suicide, these signs of depression can be dangerous.


Putting the Depression Symptoms Together

Four people, four expressions of depression
Four people, four expressions of depression. Julio Lopez Saguar/Getty Images

We've now taken our four subjects through each symptom category that is used to diagnose a depressive episode of bipolar disorder or clinical depression. Here's a recap and what the diagnosis for each is likely to be.

Diagnostic Symptom Groups:

Group 1 (must have symptoms from at least one category)

  • Lowered Mood
  • Loss of Interest in Activities

Group 2 (must have symptoms from at least 3-4 categories)

  • Sleep Problems
  • Increased or Decreased Appetite
  • Tiredness/Lack of Energy
  • Restlessness or Sluggishness
  • Loss of Self-Esteem/Guilt
  • Lack of Concentration/Indecisiveness
  • Thoughts of or Attempts at Suicide

John is depressed and has lost interest in his work. In addition, he has insomnia, increased appetite, and fatigue, and he has trouble making decisions. Thus, he has both of the first two signs of depression and four of the other seven.

Lorna is moping and crying much of the time, and no longer cares about the two things she took the most pride in - her home and her garden. She is also sleeping far too much, has no energy, feels inappropriate guilt, can't concentrate, and is thinking about what would take place if she were dead (see Suicidal Ideation). Like John, she has both of the first two symptoms, as well as five of the others.

Because neither John nor Lorna has had mania or hypomania in the past, they are likely to be diagnosed with major depression. However, since some treatments such as antidepressant medications may bring on hypomania or mania, they will both need to be monitored for symptoms that would change the diagnosis to bipolar disorder.

Tina: She has been hypomanic in the past, and thus is likely to be diagnosed with a depressive episode of bipolar II disorder. Like the others, she has symptoms from both of the first two categories - she is sad much of the time, and can't get herself interested in her favorite pastimes. Of the other symptom categories, she fits into four: increased appetite and weight gain, lack of energy, psychomotor agitation, and excessive feelings of guilt.

Andy: He has had manic episodes in the past and now is almost certainly having a depressive episode of bipolar I disorder. He shows signs of depression, many of them severe, in every category of diagnostic symptoms: Emptiness, loss of enjoyment in his social life, disturbed sleep, loss of appetite, tiredness, feeling he's worthless, psychomotor retardation, difficulty concentrating, and a suicide attempt.


Share Your Own Depression Symptoms

Sharing Your Symptoms
Sabrina Mazzocca/Getty Images

As we've seen, our subjects John, Tina, Andy and Lorna are all likely to be diagnosed with major depression or a depressive episode of bipolar disorder. They all have different signs of depression from the nine symptom categories and different issues to deal with.

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