Depressive Symptoms: Signs, Causes and When to Get Help

Signs and symptoms of depression

Depression affects feelings, thoughts, behavior and the body. Doctors look for these symptoms:

Emotional symptoms

• Persistent sad, empty or hopeless mood, or in children and teenagers, often irritability
• Loss of interest or pleasure in activities you used to enjoy (anhedonia)
• Feelings of worthlessness or excessive guilt
• Anxiety and tearfulness

Thinking symptoms

• Poor concentration and indecisiveness
• Negative, self-critical thoughts and rumination (going over the same worries)
• Thoughts of death or suicide

Physical symptoms

• Fatigue and low energy
• Sleep changes: trouble falling asleep, waking early, or sleeping too much
• Appetite and weight changes, up or down
• Slowed movement and speech, or restlessness and agitation
• Unexplained aches, headaches and digestive problems
• Reduced sex drive

Some people, especially men and older adults, notice mainly irritability, anger, physical complaints, heavy drinking or withdrawal rather than sadness.

Sadness vs depression

Causes of depressive symptoms

Depressive disorders

• Major depression: at least 2 weeks of five or more symptoms, including low mood or loss of interest. See depression.
• Persistent depressive disorder (dysthymia): milder symptoms lasting 2 years or more.
• Postpartum depression: begins in pregnancy or within weeks to months after birth.
• Seasonal affective disorder: depression that returns each fall and winter.
• Premenstrual dysphoric disorder: severe mood symptoms in the week or two before periods.
• Bipolar disorder: depressive episodes alternating with periods of high mood or energy. Antidepressants alone can trigger mania, so it matters to recognize.

Adjustment disorder with depressed mood

This is a reaction to a specific stressful event, such as a breakup, job loss, illness or move, that causes more distress than expected or interferes with life. Symptoms start within 3 months of the stressor and usually settle within 6 months once the stress resolves or you adapt. It is diagnosed when symptoms do not meet the criteria for major depression. Short-term talking therapy and practical support usually help. See adjustment disorder.

Grief

Grief after a death brings sadness that comes in waves, often mixed with good memories. Depression is more likely when there is pervasive worthlessness, inability to feel any pleasure, or symptoms that do not ease over many months.

Physical causes

• Underactive thyroid
• Anemia and vitamin B12 or vitamin D deficiency
• Chronic pain and chronic illness, such as diabetes, heart disease, MS and Parkinson's disease
• Stroke and other brain conditions
• Hormonal changes in perimenopause, after childbirth and with low testosterone
• Sleep apnea

Medicines and substances

Alcohol, cannabis and withdrawal from stimulants are common contributors. Some medicines are linked to low mood, including isotretinoin, some hormonal contraceptives, corticosteroids, interferon and certain beta-blockers in some people. Do not stop a prescribed medicine without talking to your doctor.

Risk factors

• Family history of depression or bipolar disorder
• Previous episodes
• Childhood trauma, abuse or neglect
• Loneliness and lack of support
• Ongoing stress such as debt, caring duties or discrimination

How depression is assessed

Your doctor will ask about your symptoms, how long they have lasted and how they affect your life, often using a questionnaire such as the PHQ-9. They will ask directly about suicidal thoughts; this does not put ideas in your head and helps keep you safe. They will ask about high moods to rule out bipolar disorder, and about alcohol, drugs and medicines. Blood tests such as thyroid function and a blood count may check for physical causes.

Treatment and support

• Talking therapies: cognitive behavioral therapy (CBT), behavioral activation, interpersonal therapy and problem-solving therapy are effective for mild to severe depression.
• Antidepressants: often recommended for moderate to severe depression, usually alongside therapy. They take 2 to 6 weeks to work, and dose or medicine changes are common.
• Physical activity: regular exercise has a meaningful effect on mild to moderate depression.
• Combination treatment works best for severe or recurrent depression.
• Specialist treatments for depression that does not respond include other medicines, esketamine, transcranial magnetic stimulation and electroconvulsive therapy.

Things you can do now

• Tell someone you trust how you feel.
• Keep a simple daily routine, including getting up at the same time.
• Plan one small, achievable activity each day, especially one you used to enjoy.
• Get outside and move, even for 10 minutes.
• Cut back on alcohol and avoid drugs.
• Contact 988 (US) by call or text at any time if things feel overwhelming.

Frequently asked questions

What are the main signs of depression?

The two core signs are persistent low mood and loss of interest or pleasure in most activities. Others include tiredness, sleep and appetite changes, poor concentration, feelings of worthlessness or guilt, slowed movement or restlessness, and thoughts of death. Five or more for 2 weeks suggests depression.

What is adjustment disorder with depressed mood?

It is an emotional reaction to a stressful life event in which low mood, tearfulness and hopelessness are stronger than expected or interfere with daily life. It starts within 3 months of the event and usually improves within 6 months. Talking therapy and support help.

Can depression cause physical symptoms?

Yes. Depression commonly causes fatigue, sleep problems, appetite and weight changes, headaches, back pain, digestive symptoms and low sex drive. Some people notice the physical symptoms first. Doctors should consider depression when unexplained physical symptoms persist.

How long do depressive symptoms last?

Without treatment, an episode of major depression often lasts several months or longer. With treatment, many people feel better within weeks to a few months. Depression can come back, so continuing treatment for some months after recovery reduces the risk of relapse.

Where can I get help for depression right now?

In the US, call or text 988 to reach the Suicide and Crisis Lifeline any time. For ongoing help, contact your primary care doctor, who can assess you and refer you for therapy. In an emergency, call 911 or your local emergency number.