Major depressive disorder: Signs and symptoms

A major depressive episode can manifest with a variety of symptoms, but almost all patients display a marked change in mood, a deep feeling of sadness, and a noticeable loss of interest or pleasure in favorite activities. Other symptoms include:

• Persistent sad, anxious or “empty” mood
• Loss of appetite and/or weight loss or conversely overeating and weight gain
• Insomnia, early morning awakening, or oversleeping
• Restlessness or irritability
• Psychomotor agitation or psychomotor retardation
• Feelings of worthlessness, inappropriate guilt, helplessness
• Feelings of hopelessness, pessimism
• Difficulty thinking, concentrating, remembering or making decisions
• Thoughts of death or suicide or attempts at suicide
• Loss of interest or pleasure in hobbies and activities that were once enjoyed
• Withdrawal from social situations, family and friends
• Decreased energy, fatigue, feeling “slowed down” or sluggish
• Persistent physical symptoms that do not respond to treatment, such as headaches, digestive problems, and chronic pain

Not all patients will suffer from every symptom. The severity of symptoms will vary widely among individuals. Symptoms must, however, persist for at least two weeks before being considered a potential sign of depression, with the exception of suicidal thoughts or attempts.[3][1]

Diagnosis of an episode in children is more difficult than in adults and is often left undiagnosed, and thus untreated, because the symptoms in children are often written off as normal childhood moodiness. Diagnosis is also made difficult because children are more likely than adults to show different symptoms depending on the situation.[4]

While some children still function reasonably well, most who are suffering depression will suffer from a noticeable change in their social activities and life, a loss of interest in school and poor academic performance, and possibly drastic changes in appearance. They may also begin abusing drugs and/or alcohol, particularly past the age of 12. Although much more rarely than adults, children with major depression may attempt suicide or have suicidal thoughts even before the age of 12.[4]

Comorbid anxiety

Depression and anxiety frequently co-occur; the National Comorbidity Survey (US) reports that 58 percent of those with major depression also suffer from lifetime anxiety. Even mild anxiety symptoms can have a major impact on the course of a depressive illness, and the commingling of any anxiety symptoms with the primary depression is important to consider. A pilot study by Ellen Frank et al., at the University of Pittsburgh, found that depressed or bipolar patients with lifetime panic symptoms experienced significant delays in their remission.[5] These patients also had higher levels of residual impairment. On a similar note, Robert Sapolsky of Stanford University argues that the relationship between stress, anxiety, and depression could be measured and demonstrated biologically.

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