Depression, also known as clinical depression and major depressive disorder (MDD), is one of the least understood disorders of our time.
People have a tendency to disregard what they can’t physically see as an occasional mood-swing or a short-lived bout of despondency, nothing a tub of chocolate ice cream and a good night’s sleep can’t fix.
For such people, “disorder” and “disease” are terms reserved for things that are more serious, and “feeling depressed” just doesn’t cut it.
Nothing is more harmful to a patient of depression than such ignorant and flippant views.
According to the World Health Organization (WHO), about 350 million people of various ages around the world suffer from depression. If left untreated, it can lead to suicide.
Yes, it’s normal to feel down when you face challenges in your everyday life, but these feelings usually subside with time and do not alter your life negatively in major ways.
However, depression is a lot more than a temporary emotional reaction.
Depression is a mental disorder. It can cause symptoms that do not get better with the passage of time, completely wreck your daily routine and severely deteriorate the quality of your personal, social and professional life.
Factors such as lack of information, lack of trained medical professionals, poor and incorrect diagnoses, and the general stigma surrounding mental disorders are the reason fewer than half the patients of depression seek and receive adequate treatment.
The first step toward combating any disorder is identifying its symptoms and generating awareness about it.
Here are 10 warning signs of depression you should not ignore.
1. Low Self-Esteem, Guilt & Hopelessness
Lack of self-confidence, feelings of guilt and a bleak vision of what the future holds are trademark symptoms of clinical depression.
Some people may not merely hold themselves in low regard, but may feel disgusted with who they are. Some may also express a heightened sense of guilt and blame themselves excessively for past mistakes.
Patients of depression are more unforgiving of themselves, and in only a few cases do they reportedly blame others or express negative feelings toward them. This proves that guilt and self-blame is central to clinical depression.
Out of 132 patients of MDD, 85 percent reported feelings of self-blame and inadequacy as the most troublesome and recurring symptoms, according to a 2015 study published in the Journal of Affective Disorders.
Self-disgust, guilt and shame were the next-reported frequently occurring symptoms, the study further notes.
Fatigue is a commonly occurring symptom in patients of depression, according to a 2004 study published in Psychiatry.
Serotonin is the neurotransmitter emitted by our brain responsible for creating feelings of happiness. Similarly, epinephrine is the neurotransmitter responsible for creating energy.
Biologically, clinical depression suppresses the levels of serotonin produced by the brain, which in turn triggers a lower production of other neurotransmitters, including epinephrine. This results in chronic fatigue.
Out of 78,463 respondents of the Depression Research in European Society study conducted in six European countries, 73 percent reported tiredness as a major symptom of depression, according to a 2000 study published in European Neuropsychopharmacology.
A patient of depression will feel physically tired even after an adequate night’s sleep and without much physical activity. This will cause mental tiredness as well, rendering the patient incapable of engaging in any activity.
Diagnosis and treatment of fatigue in patients of depression is poor, which leads to more severe and longer-persisting depression, according to a 2014 study published in Depression and Anxiety.
The homeostasis process of your body tells you when you have been awake long enough and require sleep. The circadian process of your body maintains the sleepiness and wakefulness during the day.
Depression messes up these twin systems that help you sleep.
Out of 531 patients of depression, 97 percent reported insomnia, out of whom 59 percent reported that lack of sleep severely undermined the quality of their lives, 40 percent admitted to daytime napping and 34 percent said insomnia was “very distressing”, according to a 2009 study published in International Journal of Psychiatry in Clinical Practice.
Moreover, non-depressed insomniacs present a two-fold risk of developing depression as opposed to people with no sleep problems, according to a 2011 study published in the Journal of Affective Disorders.
Lastly, insomnia that persists after depression increases the risk of becoming clinically depressed once again, according to a 2000 study published in Sleep Medicine Reviews. It is important to consider this possibility when seeking treatment for depression.
4. Anger & Irritability
Along with a prolonged, obvious and overwhelming sense of despair, there is one other emotion that is characteristic of the initial stage of depression – anger.
This is often accompanied with heightened irritability and a tendency to lose one’s cool over seemingly trivial things.
Any tiny and harmless thing can trigger an outburst from a depressed person, and they will not shy away from lashing out at family, friends and even strangers.
A depressed individual, even when they are not verbally expressing rage, might be consumed with anger internally.
Moreover, a depressive condition that is accompanied by anger is more severe in intensity than regular clinical depression and is likely to stay longer too, according to a 2013 study published in the Journal of the American Medical Association.
Such a serious, prolonged and rage-infested depression can also trigger other disorders, such as substance abuse and anxiety disorders, the study further notes.
Anxiety is not merely feeling nervous about something that has happened or is yet to occur. Anxiety disorders are capable of terribly interfering with a person’s peace of mind and making them obsess over little things to the point of paranoia.
When you are suffering from depression, an anxiety attack can put you on the edge and push you deeper into darkness.
A slight personal setback, for instance, will cause the depressed person to beat themselves over their failure to the point of hopeless despair.
They will be unable to distract themselves and may even display physical symptoms, such as sweating, palpitations and a rapid heartbeat.
Out of 255 patients of depression, 50.6 percent reported anxiety disorders, according to a 2000 study published in Comprehensive Psychiatry.
Out of this total, 27 percent reported fear of social situations, 16 percent reported fear/phobia of different things (including open spaces) and 14 percent reported panic disorder, the study further notes.
6. Lack of Concentration & Short-Term Memory Loss
Today’s fast-paced world may leave you overwhelmed and distracted from time to time. However, if along with constantly feeling miserable, you just cannot seem to concentrate on a single thing longer than a few seconds, you might be depressed.
Deteriorated concentration is one of the most frequently occurring symptoms of MDD, according to a 2004 study published in Psychiatry Research.
Patients of depression also reported difficulty recalling information on a short-term basis, according to a 2015 study published in Cognition and Emotion.
You might notice you have become less productive and are constantly forgetting where you put important things like your documents or your keys. This short-term memory loss may indicate depression.
7. Reckless Behavior
People who appear a little too wild and are constantly giving an impression of living life on the edge might just be suffering from depression, especially if this is not how they used to be in the past.
Of course, that does not mean that every adventurous person is depressed. However, if a person, who displays other symptoms of depression and is in an emotional turmoil, suddenly becomes interested in a night of binge drinking and substance abuse, you know something is not right.
Alcoholism, gambling, substance abuse and risky sexual behavior might be a person’s coping mechanism against inner suffering and simply a way of escaping unpleasant feelings.
Out of 923 people who frequently engaged in risky sexual behavior, 35.71 percent displayed moderate symptoms of depression while 5.62 percent showed severe depression symptoms, according to a 2015 study published in the Annals of General Psychiatry.
Sadly, these exploits only provide temporary relief and make depression worse over time.
8. Loss of Interest in Pleasurable Activities
A loss of interest in any social activity and social contact, as well as a severely diminished ability to experience pleasure, is medically known as anhedonia.
Depressed people may isolate themselves and spend time alone doing nothing since they just cannot seem to derive pleasure from any activity.
According to a 2009 study published in Neuroreport, when healthy people and depressed patients were made to listen to their favorite music followed by an MRI scan of their brains for comparison, the depressed patients showed less activity in the regions of the brain associated with pleasure and reward processing than the healthy people.
Anhedonia is a central characteristic of depression, as well as one of its earliest indicators. So if you or someone around you can no longer be talked into hitting the theater when all they could ever talk about is movies in their spare time, and have been sad lately too, take note and seek medical attention.
9. Weight Changes
Most patients of depression will suffer a sudden drop in appetite, apart from being constantly moody. Just the thought of eating a meal might make them queasy, even if they haven’t had a proper meal in a day. Consequently, they may begin to lose weight in an unhealthy way.
Appetite loss is one of the most commonly occurring symptoms of unipolar disorder (MDD), according to a 2002 study published in Progress in Neuropsychopharmacology & Biological Psychiatry.
Contrarily, although less frequent than weight loss, some people may begin to gain weight during depression as they turn to binge eating to comfort themselves.
Patients with severe depression reported a gradual increase in abdominal weight as well as overall body weight, according to a 2009 study published in the American Journal of Public Health.
If you or someone around you displays these symptoms, these might just indicate depression.
10. Recurring Thoughts of Suicide and Death
It is not uncommon for people to think of death, especially as they grow older. However, depression-triggered thoughts of death, especially suicidal death, are a grave cause for concern and need to be addressed urgently.
Suicidal thoughts are strongly associated with mood disorders like clinical depression, according to a 2002 study published in The American Journal of Geriatric Psychiatry.
Many factors contribute to an older person’s inclination to harm themselves, and clinical depression is the most common factor among those, according to a 2005 study published in the British Journal of General Practice.
Suicidal tendencies may range from recurrent thoughts, online searches and planning, role-playing and physical self-harm (slashing wrists, for instance).
Expert Answers (Q&A)
Answered by Dr. Danielle J. Johnson, MD, FAPA (Psychiatrist)
How can one pre-empt an episode of depression?
When someone has a known history of depression, it is helpful to identify triggers that contributed to previous episodes such as sleep disruption, physical health symptoms, or relationship stressors and reduce or prevent these triggers.
Participate in psychotherapy to gain coping skills to help reduce stressors and learn to identify and manage depressive symptoms. If one is on medication, stay on the medication and do not stop taking it without the guidance of the physician.
Adopt healthy habits that reduce stress and improve both physical and mental health – exercise, healthy diet, meditation, mindfulness, reducing or eliminating alcohol and other addictive substances, etc.
Are there any known triggers that can cause depression?
For women, hormonal changes are known triggers – menarche, premenstrual syndrome, pregnancy, postpartum, and peri-menopause. Change of seasons can be a trigger – depression symptoms are more common in fall/winter and less common in spring/summer.
Stressful life events like, death of a loved one, trauma/abuse, loss of a job, medical illness, etc. Certain medical illnesses have increased risk of depression – diabetes, obesity, cancer, heart disease, stroke, etc.
Is it possible to cure depression without any medication?
Psychotherapy, such as cognitive behavioral therapy and interpersonal therapy, are effective treatment modalities for depression. Certain CAM (complementary alternative medicine) treatments have been proven effective in treating mild to moderate depression but not severe depression. Many of these treatments can also be effective adjuncts to psychotherapy or medication.
Can anti-depressants have any long-term side effects?
The impacts of long-term use of antidepressants can include ongoing sexual side effects, discontinuation syndrome, and loss of medication effectiveness.
Some people stay on their antidepressant because some antidepressants (particularly paroxetine and SNRIs) can have “withdrawal’ symptoms and it seems easier to stay on the medication than to get off of it. For some people, a medication that worked well can eventually stop working for them.
Is it possible for a person to be depressed without realizing it?
Yes, people don’t always have a full understanding of what depression is. People will notice they are more down, sad, or blue but not realize they also have other symptoms of a major depressive episode. Five or more symptoms during the same 2-week period of the list provided below and at least one of the symptoms should be either (1) depressed mood or (2) loss of interest or pleasure.
- Depressed mood most of the day, nearly every day.
- Markedly diminished interest or pleasure in all, or almost all activities most of the day, nearly every day.
- Significant weight loss when not dieting, or weight gain, or increase in appetite nearly every day.
- A slowing down of thought and a reduction of physical movement (observable by others, not merely subjective feelings of restlessness or being slowed down).
- Fatigue or loss of energy nearly every day.
- Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
- Diminished ability to think or concentrate, or indecisiveness, nearly every day.
- Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
Please guide our readers with some useful tips and insights on fighting depression.
Know that you are not alone, worldwide more than 300 million people of all ages have depression. Depression is a medical illness, not a character flaw or life choice. The more people talk about it, the less stigma there will be about it and more people will get the treatment they need.
Taking care of your body/health includes both physical and mental health. Things that help physical health also help mental health and vice versa – exercise, diet, stress reduction, etc. Working with a therapist and/or psychiatrist can be very beneficial.
Danielle J. Johnson, MD, FAPA: Dr. Johnson completed her General Psychiatry Residency and Psychiatric Emergency Services Chief Residency with University of Cincinnati College of Medicine and University Hospital in Cincinnati. As a staff psychiatrist for Lindner Center of HOPE, Dr. Johnson’s interests include treatment of mood disorders, anxiety disorders, psychotic disorders, and ADHD in the inpatient and outpatient settings.