Test Your Knowledge

The signs and symptoms of major depression may vary greatly among patients. Generally, there are nine primary symptoms of depression, which include:

• Sad or depressed mood. Patients may experience profound sadness, anxiety, anger, irritability or apathy (lack of emotion). They may be pessimistic or discouraged and may experience crying spells or excessive emotional sensitivity.
  
  
• Anhedonia. Reduction or loss of interest in activities the patient formerly found pleasurable, such as eating, sex, work, friends, hobbies and entertainment.
  
  
• Significant change in appetite or weight. The patient may experience reduced or increased appetite or significant weight loss or gain.
  
  
• Changes in sleep patterns. The patient may sleep too much (hypersomnia) or not enough (insomnia). The patient will often awaken early in the morning and have difficulty falling back asleep.
  
  
• Physical or verbal activity. Patients may be agitated and anxious. They may wring their hands, pace or not be able to sit still. Conversely, patients may have sluggish movements or speech. There may be a pause before answering questions or starting actions. Patients may speak quietly or not be able to be heard. They may not speak except in response to a direct question or may not talk at all.
  
  
• Fatigue and decreased energy level.
  
  
• Self-worth. The patient may have feelings of worthlessness, self-reproach or excessive or inappropriate guilt.
  
  
• Concentration. The patient may exhibit a diminished ability to think or concentrate.
  
  
• Death thoughts. Patients may have recurrent thoughts of death and death wishes. They may think about committing suicide (suicidal ideation) or engage in suicidal actions. Patients may even attempt or complete suicide.

People who have major depression may not initially seek treatment for their mood, but may instead see their primary physician to treat what they believe is a physical disorder. Fatigue, headache and stomach pains that do not respond to medication are often reported. Irritability rather than profound sadness is also common. Older adults may appear confused.

Major depression is common in children and adolescents. However, young people may not be willing to express their emotions to an adult, or may not know how to do so. In addition, it may be difficult to differentiate symptoms of depression from some accepted adolescent behaviors. Because of this, it is important to watch for signs that a child or adolescent may be depressed. These signs include:

• Missing or refusing to go to school
  
  
• Poor performance in school
  
  
• Complaints of boredom
  
  
• Changes in eating and sleeping habits
  
  
• Withdrawal from friends and activities that used to be enjoyed
  
  
• Problems with authority
  
  
• Overreaction to criticism
  
  
• Frequent physical complaints (e.g., headaches, stomachaches)
  
  
• Pattern of dark images or themes or excessive aggression toward the self or others in drawings, painting, poetry and other forms of expression