There are many symptoms of depression, and no two people will experience the same combinationÂ of them, or to the same degree.
The set of symptoms clinicians use for diagnosing depression are usually based on the DSM-IV criteria Â (see Further readingÂ below for details). In the UK, guidance for NHS health professionals is based on DSM-IV (see Further Reading for details).
Key symptoms of depression (DSM-IV):
- persistent sadness or low mood; and/or
- marked loss of interests or pleasure
One or both of these, lasting longer than two weeks, plus three or more from the list below, indicate clinical depression:
- disturbed sleep (decreased or increased compared to usual)
- decreased or increased appetite and/or weight
- fatigue or loss of energy
- agitation or slowing of movements
- poor concentration or indecisiveness
- feelings of worthlessness or excessive or inappropriate guilt
- suicidal thoughts or acts
Further symptoms of depression (NHS Choices)
NHS Choices expands onÂ the DSM-IV symptoms, and groups them as psychological, physical orÂ social, as follows:
Psychological symptoms include:
- continuous low mood or sadness
- feeling hopeless and helpless
- having low self-esteem
- feeling tearful
- feeling guilt-ridden
- feeling irritable and intolerant of others
- having no motivation or interest in things
- finding it difficult to make decisions
- not getting any enjoyment out of life
- feeling anxious or worried
- having suicidal thoughts or thoughts of harming yourself
Physical symptoms include:
- moving or speaking more slowly than usual
- change in appetite or weight (usually decreased, but sometimes increased)
- unexplained aches and pains
- lack of energy or lack of interest in sex (loss of libido)
- changes to your menstrual cycle
- disturbed sleep (for example, finding it hard to fall asleep at night or waking up very early in the morning)
Social symptoms include:
- not doing well at work
- taking part in fewer social activities and avoiding contact with friends
- neglecting your hobbies and interests
- having difficulties in your home and family life
How severe is theÂ depression?Â
Guidance for NHS clinicians, based on the DSM-IV criteria (the ‘key symptoms’ above) gives the following definitions:
‘Subthreshold’ depressive symptoms
Fewer than 5 symptoms of depression. Â Technically this does not meet the criteria for clinical depression but it is increasingly recognised that subthreshold symptoms can be distressing and disabling if persistent, and so NICE guidance covers patients with this level of symptoms.
Few, if any, symptoms in excess of the 5 required to make the diagnosis, and symptoms result in only minor functional impairment.
Symptoms or functional impairment are between ‘mild’ and ‘severe’.
Most symptoms, and the symptoms markedly interfere with functioning. Can occur with or without psychotic symptoms.
When to seek help
If you experience symptoms of depression for most of the day, every day for more than two weeks, you should seek help from your GP/primary healthcare provider.
Depression in adults: The treatment and management of depression in adults, NICE guidance CG90, 2009,Â Appendix C: Assessing depression and its severity