Depression - Signs and Symptoms of Depression

What Is Depression?

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It is not uncommon for people with panic disorder, agoraphobia, or another anxiety disorder to experience co-occurring depression. In fact, several studies suggest a correlation between panic attacks and an increased risk of major depression.

What Is Depression?

We’ve all felt “sad” or “blue” at one time or another. Rare bouts of depression that last only a few days are usually not a problem for most people.

But, clinical depression – the type that people seek help for - is a different story. The DSM-IV-TR uses the term “major depressive disorder” to classify and diagnose clinical depression. Major depressive episodes are the hallmark features of this type of depression. These episodes are characterized by extreme symptoms that interfere with daily functioning.

What Are the Symptoms of Depression?

Clinical depression, or a major depressive episode, can include any of the following symptoms:

  • feeling sad most of the time
  • feeling tired or having low energy most of the day
  • loss of interest in activities once enjoyed
  • changes in appetite, weight loss or weight gain
  • trouble concentrating
  • difficulty sleeping
  • feeling worthless
  • feeling helpless or hopeless
  • feeling anxious or agitated
  • unexplained headaches, stomach problems or muscular/skeletal pain
  • thoughts of death or suicide

How Is Depression Diagnosed?

For clinical depression or a major depressive disorder to be diagnosed, criteria for a major depressive episode must be met.

These criteria are identified in the DSM-IV-TR as follows:

A) Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

Note: Do not include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations.

  1. depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood.
  2. markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)
  3. significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains.
  4. insomnia or hypersomnia nearly every day
  5. psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
  6. fatigue or loss of energy nearly every day
  7. feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
  8. diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)
  9. recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

B) The symptoms do not meet criteria for a mixed episode.

C) The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D) The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism)

E) The symptoms are not better accounted for by bereavement after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.

Treatment for Depression

Depression is a treatable disorder. Studies show that medications and/or psychotherapy (talk therapy) are effective for most individuals. But, before treatment begins, other medical causes for your symptoms should be ruled out.

As the name implies, antidepressants are used for the treatment of depression. It is believed that the brain contains several hundred different types of chemical messengers (neurotransmitters) that act as communication agents between different brain cells. These neurotransmitters are important in modulating a variety of body functions and feelings, including our mood. Antidepressants are believed to affect certain chemical messengers in the brain, resulting in less depression and anxiety.

Cognitive-behavioral therapy (CBT) is one form of psychotherapy that has been shown to be successful in treating major depression. CBT combines the fundamental concepts of behavioral therapy and cognitive therapy. The term “cognitive” refers to our thought process and reflects what we think, believe and perceive.

Put together, CBT focuses on our behaviors and thoughts and how they are contributing to our current symptoms and difficulties.

Help for Depression

Depression is a serious illness. If you are experiencing the signs and symptoms of a major depressive episode, it is important to see your doctor as soon as possible. Thoughts of suicide are a medical emergency. If you or someone you know is suicidal, talk to someone right away. You can call 911 or you can talk to someone at the following suicide prevention lines. You can call these numbers from anywhere in the United States, 24 hours a day: 1-800-SUICIDE (1-800-784-2433) or 1-800-273-TALK (1-800-273-8255).


American Psychiatric Association. "Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text revision" 2000 Washington, DC: Author.

National Institute of Mental Health. Depression. Department of Health and Human Services. National Institutes of Health. 2009.​

Goodwin, Renee D., Fergusson, David M., Horwood, L. John. “Panic attacks and the risk of depression among young adults in the community.” Psychother Psychosom 2004;73:158-165.

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