People often ask, “How can I know whether I have depression or not?” This is a valid question, especially considering that the Anxiety and Depression Association of America says that Major Depressive Disorder (MDD) affects more than 16.1 million American adults, or about 6.7% of the U.S. populationWhen you have been depressed, people may have told you, “Just get over it” or that you must be having a “blue day.” Some well meaning friends may have said, “Just have more faith.” These people may be well meaning but probably have never dealt with genuine major depression.
One thing is for sure: Depression is no respecter of persons. Christians, non-Christians, and people from all walks of life get depression. Often, depression happens in the brain and may be related to deficiencies in brain chemistry.
Not all depression appears in the same way. Some people get depressed during a certain season of the year. For some individuals, depression will lift and then return time after time. Others will complain of a constant low-grade depression that is always present.
Symptoms of Depression
While there are numerous reasons for and types of depression, this article is designed more to help identify depression when it is present. There are some common tell-tale signs and symptoms of depression that affect everyone with this condition.
People often say they are depressed but do not know what it looks like or how a depressed person behaves. This article is not for self-diagnosis as much as to help one get a sense of how depression acts in a person when it occurs.
An awareness of these symptoms of depression can help a person know when it is time to get help from a professional. If you, a friend, or a loved one appears to have some of the following symptoms, get help immediately.
In Major Depressive Disorder (MDD) there can be as many as nine symptoms of which the DSM-5 says, “[at least] five or more of the following symptoms have been present in a two-week period and represent a change from previous functioning.”
Five symptoms qualify as Major Depressive Disorder. You do not have to have all nine symptoms to qualify for depression. When depressed, you actually have a “depressed mood (feel sad) or loss of interest or pleasure.”
Feeling sad is not just a blue moment but it is often as sad as one has ever felt and usually it just does not go away on its own. Losing interest can include social interaction as well as activities and events that have been regular in your life but have now stopped.
Following are the nine symptoms of Depression (MDD) with some explanation that could help you figure out if it is time to get help for you or a loved one. Get a checklist out and see how many appear to apply to your situation.
(All symptom quotes from the DSM-5 Diagnostic manual.)
1. “Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful).”
People who are depressed often feel hopeless and sometimes say so to others. Others may tend to keep to themselves. This can be a dark time for someone and there may be tears or no tears at all. A person can be depressed and never cry. Everyone is different.
The “sad” feeling is often one of hopelessness, which may be overwhelming, and difficult to describe. People who get depression often start to isolate and act different than usual. They may also get despondent or angry. Many emotions can be present or appear absent when someone is depressed.
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).”
Activities that a person used to do, whether it be work or social, just cease to happen. Depressed people lose motivation to do the activities that used to be interesting and fun.
For example, people quit doing hobbies, stop going on walks, stop playing their favorite video games, and tend to isolate from social activities. Most people with depression have a desire to isolate from other people as well. Watch for isolation. It is often a sign that someone might be depressed.
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.”
Not everybody who gets depressed stops eating. Some people eat more when they are depressed. Usually in depression the weight loss or gain is significant. For example, 5% in a 200-pound man would be 10 pounds in a 4-week period (gain or loss).
Be careful, there can be other reasons besides depression that a person gains or loses weight. People on diets can lose this much weight and more. There can also be a physical and/or medical reason for the weight change. This is one symptom, when it comes to depression, that does not stand alone. Remember, it is just one symptom and there needs to be other indications as well that someone is depressed.
4. “Insomnia or hypersomnia nearly every day.”
People who are depressed often have sleep problems. It is fairly common for a person with depression to want to sleep all day (hypersomnia) and it can be just as common to not be able to sleep (insomnia) or be able to get to sleep and stay asleep.
The average person should get seven to nine hours of sleep a night. It may be helpful to see the doctor who can look for a physical cause to a sleep problem. For example, someone could have sleep apnea or a pain issue and have trouble sleeping. It is important to rule out a physical cause for the sleep problem.
Just because a person has trouble sleeping does not mean they are depressed. Still, when a person feels depressed it can be common for them to want to stay in bed most of the day. People may also get days mixed up with nights and end up sleeping less and less.
If a person feels depressed he/she needs to identify the sleep problem (insomnia/hypersomnia) and work on getting more rest. Sleep, especially good REM (Rapid Eye Movement) sleep helps depression.
5. “Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).”
This depressive symptom, while less known, does happen to some people who have depression. A person may have what appears to be uncontrollable movement (a shaking) in the extremities. They may also become more lethargic in their movements. A person may believe this is random and/or attribute such movements to anxiety, but it sometimes is a sign of depression.
Be careful here. Shaking leg syndrome, Parkinson’s disease, drug addiction/withdrawal, and a host of other maladies could be the reason for shaking or lethargic legs and arms. Once again, a physician should be consulted to rule out other possibilities.
6. “Fatigue or loss of energy nearly every day.”
A person who is depressed is often tired. This can result from insomnia but a depressed person can feel fatigue even when their sleep is adequate. Often this person will want to take naps during the day and complain of being tired all the time. The fatigue is not usually a result of hard work or a long day but often is a constant companion throughout the day.
Interestingly, this symptom often goes together with isolation. A person is tired and needs to sleep, needs more time in bed to catch up on sleep, feels so tired … This person just never feels rested.
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).”
A depressed person often has self-esteem issues. It may be low self-esteem taught by a negative experience from the past, or with a parent or family member. Low self-esteem can also be connected to the current negative situation the person is in. Often, when there is guilt, it will be excessive, may not be accurate, and it will feel like nothing can be done about it. (This is a favorite trick of the enemy.)
A person may be talented, gifted, and a hard worker but most of the time still feels like a failure and believes he/she is unworthy. Often there appears to them no way to escape these feelings of inadequacy and failure. This feeling often spills over into relationships and can make it difficult for them to love others. They often do not feel very lovable.
People who have low self-esteem often believe nothing can be done to help. Just a word here about being “delusional.” People who are depressed are not always delusional. Severe depression can have an added element of delusions (belief in something that does not line up with reality), but this is not always or even often the case.
Most depressed people’s thoughts remain in reality unless it is about what they believe about themselves and/or their feelings of guilt (which often get exaggerated). If there are full delusions (something they believe that no one else believes), it is often a sign of something more serious and should be addressed by a professional.
8. “Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).”
This symptom is often a change from the norm. A person who normally thinks clearly and is decisive has muddled thinking or can’t make up one’s mind. Lack of concentration may worsen as a person gets more depressed. Partners may become exasperated because they can never get the person to make decisions.
The depressed person may ask the partner or close friend to make all the decisions, both small and large ones. This lack of concentration may not be a constant state, but when depressed, it may happen most days. This symptom may or may not be identifiable by the person who is depressed. It may or may not bother them.
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.”
All depressed people do not have suicidal ideation. A person can feel like a failure and even feel hopeless without wanting to harm themselves. A depressed person may have thoughts of death but never have a plan or go through with a plan. Some people, when depressed, think of suicide everyday but never go any farther. This fact can be difficult for them to admit. Suicidal ideation is a common symptom of (MDD) and may affect many people from all backgrounds.
A vital point to understand about suicide is that a person with suicidal ideation may need to admit that these thoughts come into his/her head. This person may need to talk about it. Even passive comments like, “I would be better off dead or the world would be better off without me,” should not be ignored. The person should be allowed to talk about it without being shamed.
When someone admits to suicidal thoughts, consider the following: First, don’t let someone swear you to secrecy about their self-harm thoughts. Tell the person you will do whatever keeps them safe even if it makes them angry. Second, ask the person if they have a plan and knows how to follow through with the thoughts.
Whether they share more details or not, at this point even professional counselors call for help from other crisis professionals. Third, if no other help is available, call the police or a crisis agency in your area. Don’t try to fix it or carry it all by yourself. Get help when needed. It could save someone’s life.
Getting Help for Depression
These are the nine symptoms of Major Depressive Disorder (MDD). How many appear to fit the situation you or a loved is currently in? Remember, you don’t need to diagnose depression, but if 5 or more of these symptoms appear relevant, it may be time to get some professional help.
Even if you only notice two or three of these symptoms, it would be wise to get an evaluation from someone who understands mental health problems. Many people go undiagnosed, which is a pity when we live in a day where there is medication and therapy that can help.
Don’t wait another minute. I have experienced depression myself. God sent people, some professionals, to walk with me through the dark days. I have figured out that God was looking out for me and understood and loved me even when I was depressed. It changed my life! I now have the privilege to work with people who have depression and would be pleased to see you in my office. Make that call today!
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