Depression Symptoms & Signs
Diagnosing depression requires knowledge & understanding of the clinical features of depression, which are listed below. We examine these in detail later in this article.
Signs of depression may include, but are not limited to, what follows. Note that these are not required in order that you are diagnosed with depression; many other factors may also be involved (it is a complex diagnosis):
TYPICAL DEPRESSION SYMPTOMS & SIGNS
Behavioral signs of depression:
- Avoiding eye contact, moving eyes downwards or away, slow eye blinking rate (unless any of these could be considered normal behavior in any individual.
- Slow or increased body movement, again not regarded as the norm.
- Speaking slowly in monotonous voice or unusually rapid talk, or talking gibberish.*
- Prolonged low mood, a sense of hopelessness, feeling heavy, down or desperate, generally accompanied by suicidal ideations. This would be more than a simple reaction to an upsetting event or emotional upheaval, but an acute response that becomes a chronic problem.
- Restlessness, irritability, feeling of being on the edge, or inexplicable tension and stress when external stress loads are not significantly different from normal.
- Anger, sometimes appearing more like the heightened emotions experienced during the manic episode, but it is almost always present in a person with depression; it may, however, be quietly percolating within and not show violently on the outside, at least not initially. This is sometimes directed at the people you love most and can shock you when it comes out.
- Delayed response times. An individual will consume an unusual length of time in formulating a reply to a question, and may seem distracted, or too busy inside their head
- A developed practice of being distant or disengaged, uninvolved with things that usually matter, negligent towards loved ones.
Physical appearance signs:
- Degree of self-neglect can be seen in appearance, for example poor hygiene and personal grooming
- Slouched posture, staring at the ground
- Wearing the same clothes several days in a row, or never changing out of pajamas
Biological symptoms of depression: (also known as somatic, endogenous, melancholic)
- Sudden reduced or increased appetite**
- Rapid and significant weight increase or weight loss, typically over 5% of total body weight.
- Physical pain & exhaustion that is not caused by other physical medical conditions. Common complaints include, heaviness in the limbs, lack of energy, exhaustion, headaches; this pain is commonly unable to be isolated by medical examination and can be a figment of the depressed person’s imagination.
- Muscle tension, frequent use of bathroom, sweating, trembling, being easily startled. Headache and nausea are common complains from those experiencing a depressive episode. Seldom will something as simple as a pain reliever or stomach treatment cure the problem, it is so intrinsically connected to the depression.
- Early morning wakening, typically a few hours before usual waking time, & inability to resume sleep. Also difficulty falling asleep, even when you feel tired. This includes irregular sleep patterns, and oversleeping as well as insomnia
- Recurring variation of mood, also called diurnal. In extreme cases, this may be more correctly diagnosed as bipolar disorder or manic depression.
- Loss of emotions or decreased ability to experience emotions, usually results in anhedonia & decreased libido; the reverse can also be true with vastly increased expression of emotions and excessive crying.
- Inability to experience pleasure from formerly enjoyable activities & hobbies, also known as anhedonia.
- Reduced desire for sexual activity, sex drive, even abnormal abhorrence of the concept of sex.
- In women, menstrual irregularities, including early onset of what appears to be menopause (normal menstrual patterns may resume after depression is managed, especially in women under the age of 50)
- Constipation and/or diarrhea, without obvious cause.
*symptoms like unusually rapid speech, increased movement fall under reversed biological symptoms
**symptoms like unusually increased appetite, oversleeping fall under reversed biological vegetative symptoms, usually associated with atypical depression.
Key to all of these symptoms is that they exist outside of what is normal for you and that they have no clear source. Fr example, if you are suffering from disturbed sleep patterns, but have increased your caffeine intake to 10 cups from 2 cups a day, there’s a reason.
Other depression symptoms:
- Low self-esteem, feelings of being a failure, overly comparing oneself to others, and feelings of great inadequacy dominating what was once a balanced sense of self.
- Thoughts of suicide, fantasies of suicide, talk of suicide; this may manifest in a knee-jerk reaction to suicidal thoughts when a formerly normal reaction would be to find a solution to a problem.
- Impaired cognition, loss of concentration & memory, and the inability to perform simple tasks.
- Impaired judgment, difficulty in making decisions or making plans, inability to understand consequences of their actions (most commonly associated with sociopathic and psychopathic behaviors, but sometimes a part of overall depression), unrealistic, usually exaggerated view of problems, a sense of feeling overwhelmed.
- Excessive, ongoing tension and worry, including anxiety states where everything seems worse than it is, nothing looks like it will have a positive outcome and there is a sense of helplessness, that the victim cannot do a thing about it all.
- Abnormally obsessive thoughts & compulsive behavior.
- Delusions, mainly associated with psychotic depression, include guilt, worries of being struck by a serious decease or thoughts that they are already sick with one. In extreme cases depressed people may deny the existence of body parts, or even the world around them.
SIGNS OF DEPRESSION: GAZE, EYE CONTACT & GESTURES
Studies on gaze, eye contact & depression have no consistent results, though general consensus is that depression (more so endogenous & neurotic) leads to reduced amount of gaze. This is also dependent upon the typical behavior of the individual; shy people often find it difficult to make and maintain eye contact, but that would be regarded as “normal” behavior for them. It is when such activity is abnormal that it becomes suspect pertaining to a diagnosis of depression. For these patients the amount of gaze is likely to increase with advancement in treatment of depression, immediate changes are likely to be noticeable after starting to take medications. People with general depressive disorder are likely to avoid eye contact, mutual gaze or general social contact; conversely, others will hold a gaze too long, and almost seem desperate to maintain any level of inter-human contact. This behavior is likely to increase significantly when the subject of discussion or other type of interaction is personal, rather than neutral. Generally the end & start of utterance are the trigger points. Depressed patients are likely to look away at the end of utterance. Some other key body gestures are likely to occur at these triggering points due to difficulty of speech. Filled pauses in speech or prolonged silence with avoidance of eye contact have shown to be possible signs of depression. This type of behavior is likely to be triggered by the need of discharge from high emotional arousal, lack of social skills or cognitive overload. In diagnosing depression gaze is an insignificant, insufficient factor. As far as person’s ability to heal, gaze can be a good indicator of person’s willingness, ability or capacity to receive social information, unless, as aforementioned, shyness is an inherent character trait. It is not just eye movement that can slow in a depressed individual, all body movement may decrease. This may manifest in slower speech, movement (such as walking or writing), reaction times, and ability to connect thoughts. In short, it appears as lethargy. This usually comes in tandem with a feeling of weight, like the world rests on your shoulders. Every step feels arduous, every breath takes effort, hence the slowness.
SLOW OR UNUSUALLY RAPID SPEECH AS A SIGN OF DEPRESSION
Changes in speech are usually due to a general high arousal, cognitive overload or high emotional arousal, one or more of these can cause speech irregularities. For classical depression slowed or reduced amount of speech, prolonged pauses, frequent hesitation pauses, lax body gestures accompanying speech, prolonged reaction times, monotonous voice, short answers are some of the verbal signs of depression. For the depressed with higher anxiety levels however short latencies, long answers, fast speech rate are common. Negative, pessimistic, cynical, sarcastic, argumentative, excessively vulgar speech is likely to be in dialect of a depressed individual. Humor and sarcasm usually mask anger in a depressed person. Absolute silence, or response involving only a blank stare or shrug of the shoulders, is a serious sign of depression in a person with otherwise normal verbal communication skills; the deeply depressed may find it impossible to articulate or even loathe the sound of their own voice. Data supports that a person’s sex doesn’t seem to affect these symptoms. Silence is also an inherent part of these speech abnormalities. Many people who are enduring a depressive episode cannot find it within themselves to speak, and oddly this often is directed (unwittingly) towards those they love the most. Spouses and children feel rejected as the victim withdraws into silence, sometimes for long periods. What is frustrating for loved ones is that the victim may be able to carry on what seems to be a normal conversation with others, but cannot seem to communicate with those closest to him or her. The best advice for the loved ones is to not take it personally, as hard as that may be.
SLEEP INTERRUPTIONS AS SYMPTOMS OF DEPRESSION: INSOMNIA AND OVERSLEEPING
Insomnia, sleep interruptions or oversleeping are some of the very common complaints from individuals who suffer from depression. Insomnia can be a reason for depression or a symptom of depression or both at the same time; the lack of sleep exacerbates depression, which in turn causes sleep problems. The fear of not being able to sleep creates another avenue of depression and complicates and already tenuous situation. Sleep is essential to human life; in ancient history, a torture that was certain to kill an individual was to deprive him of sleep. Sleep quantity and quality affect a person’s mental & physical well-being, thus long-term sleep interruptions caused by depression can develop new or worsen existing health problems. Depressed people usually feel unrested & tired despite of the time of the day or getting enough sleep, some studies show they usually have deficit in deeper levels of sleep & are irritable & restless in sleep. Chronic initial, middle or terminal insomnia is likely to cause cognitive impairment. Those with early morning waking & inability to fall back to sleep are likely to engage in negative thoughts upon wakening, of which those with diurnal variation of mood are likely to be at high suicide risk. Symptoms of decreased level of sleep with high energy levels my indicate possibility of bipolar disorder (manic depression). Fatigue in the morning with better energy levels later in the day can be a sign of major depression. Those with high anxiety levels are likely to experience decreased levels of sleep; complaints of inability to fall asleep due to endlessly spinning concerns in mind & restless thoughts are likely to come up. Some can only fall asleep with “white noise” such as a fan or TV on in order to drown out their thoughts. Often the effort to fall asleep can result in frustration due to inability of falling asleep. A different type of sleep destruction is staying in bed too long or oversleeping, which again can be a symptom of depression as well as a contributor to depression. Oversleeping is usually a sign of atypical depression. Oversleeping causes disruptive sleep patterns & inability to maintain a regular sleeping routine. This leads to feeling tired, unmotivated, poor vigilance & motor tasks, sleep not seeming restful, being physically out of shape, gaining unnecessary weight and other problems. The Human Performance Institute, aimed at the optimum well-being of athletes, conducted tests in the mid-1990s geared at helping Formula 1 race card drivers combat the inevitability of jet lag as they travel between races as far apart as Europe and Australia. When subjects were placed in a windowless room without any clocks, their circadian rhythms, also knows as “body clocks” immediately began to adhere to a 25-hour day, falling asleep one hour later each day. Depression symptoms often reflect this natural tendency. It’s as though the individual with depression finds some innate comfort at allowing the natural circadian rhythm to overtake the logical one that supports a 24-hour pattern. • Nightmares are another sleep-related indicator of depression. Almost all of us have nightmares from time to time, but they tend to be frequent and repetitive when a period of depression engulfs. Interestingly, they can also become a diversion for the sufferer because interesting books that explain the symbols inherent in dreams are a form of entertainment, and when depression thrives, research into every possible cause becomes a virtual obsession.
EMOTIONAL DISTANCING AND/OR OVER-REACTING WHEN DEPRESSED
Depressed individuals can show extremes of emotion, even if they are not bipolar. In some cases, the distancing or lack of emotions is a practiced action intended to protect oneself from the pain of feeling anything in a depressed state. This sometimes appears in the form of apathy and indifference, and can be marked by a sudden lack of interest in, for example, world events. There’s a war everywhere, murders in each city, famines galore; nothing can be done, so why bother to care. It applies both on a larger scale, like those cited, or close to home in the framework of losing interest in your spouse or your children. By determinedly choosing the path of removal from emotions, the sense of anxiety and hopelessness rests at arm’s length. Sometimes this distancing triggers feelings of guilt, especially if a spouse or children are the recipients of the “cold shoulder” when they do not diverse it. Because the depression can cause a victim to withdraw from the normal routines of life, such as work, household responsibilities and family, a normally committed person will often feel guilt about not honoring his or her duties. This is a normal reaction to being slack, but can manifest in gargantuan proportions compared to the actual level of responsibility being ignored. Conversely, depressed persons may find themselves so emotionally involved, so extremely and acutely sensitive to everything, that they over-react to things that bear little genuine significance in their outcomes. Excessive worry fits into this category, too. Depression can become the root of over-reaction in normally level-headed people, leaving them stressed and anxious about things that would, under normal circumstances, be regarded as “just the small stuff”. Negligible issues can become mammoth in a depressive episode. Worry is essential to this equation, manifesting in chronic anxiety attacks and causing the dichotomy of literally worrying oneself to sickness, something else to worry about (if that makes sense). It hurts to feel things sometimes, and for the person in the depressive episode, all that felt glorious in the manic state is now false and to be avoided. This innate inability to feel anything is a protective device, but the fear of feeling is worse than the feeling itself. It is a destructive phase in the depressive mode. No wall of protection can stay in place forever. For some victims, it offers false comfort and the crash is resultantly deeper when emotions begin to surface again.
PHYSICAL APPEARANCE SUFFERS WHEN DEPRESSION HITS
Some people are naturally careless about their appearance, but most of us take at least some time every day to comb our hair, brush our teeth and put on a set of clean clothes. When a personal suddenly ceases to care about what they look or smell like, then personal neglect as a sign of depression may well be the culprit. It is an early sign and one of the most obvious. Because it connects several aspects of personal care, it shows in various ways. A reduction in personal grooming habits, modes of dress and personal hygiene are typical, as is disregard for weight. Some victims gain substantial weight, in part due to their lack of energy and subsequent activity, and in part due to their changed eating habits. A lack of interest in food can also result in a significant weight loss, and the resultant poor health. This also relates to the matter of personal neglect; those suffering from depression lack the ability to care about themselves. Weight issues associated with a depressive episode are not the same as daily weight-consciousness that demonstrate care of self; they are not about health, fitness and attractiveness, but about the inability to care for and nurture our bodies. The person in a depressed state cannot deal sensibly with such minutiae. Sufferers feel like it just doesn’t matter how they look because they feel so unacceptable within. It is an outward manifestation of the internal depression.
THE INABILITY TO CONTROL YOUR OWN FEELINGS IS A SIGN OF DEPRESSION
This is especially true when no matter what you do, your emotions do not respond, or may even worsen. Because of this, it’s nit just depression that is intrinsic to it, but also exasperation and frustration; those just serve to make the depression worse. The results can be devastating and involve, among many other overwhelming feelings, a sense of abject failure. This is the greatest de-motivator of the depressive person. It effectively stops those in this episode from making an effort toward recovery because they feel that they cannot succeed, regardless of how hard they try. So they don’t. They give up, leaving a feeling of utter hopelessness. This is the end of the road for most people who suffer serious clinical depression, be that part of bipolar disorder or not. Unless hope exists, even in minimal form, there is no reason to carry on. Psychiatrists regard this as the signal to take action that will prevent suicidal actions in a patient. The other emotion that empowers depression and helps it feel larger and more acutely real is anxiety. Once it grips the individual, it’s next-of-kin, despair, settles in and won’t let go. Frustration mounts and the spirits drops even further for those suffering this symptom. Part of the anxiety stems from a feeling that nothing can go right, rather than it actually happening. It’s like an imagined worst-case scenario with no other option. When these emotions seem untenable, it’s time to get help. A diagnosis of depression is almost a piffle; if your emotions are in this state, get immediate help.