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Signs and symptoms
Two hallmarks of depression — symptoms key to establishing a diagnosis — are:
1. Loss of interest in normal daily activities. You lose interest in or pleasure from activities that you used to enjoy.
2. Depressed mood. You feel sad, helpless or hopeless, and may have crying spells.
In addition, for a doctor or other health professional to diagnose depression, most of the following signs and symptoms also must be present for at least two weeks.
1. Sleep disturbances. Sleeping too much or having problems sleeping can be a sign you're depressed. Waking in the middle of the night or early in the morning and not being able to get back to sleep are typical.
2. Impaired thinking or concentration. You may have trouble concentrating or making decisions and have problems with memory.
3. Changes in weight. An increased or reduced appetite and unexplained weight gain or loss may indicate depression.
Agitation. You may seem restless, agitated, irritable and easily annoyed.
4. Fatigue or slowing of body movements. You feel weariness and lack of energy nearly every day. You may feel as tired in the morning as you did when you went to bed the night before. You may feel like you're doing everything in slow motion, or you may speak in a slow, monotonous tone.
5. Low self-esteem. You feel worthless and have excessive guilt.
Less interest in sex. If you were sexually active before developing depression, you may notice a dramatic decrease in your level of interest in having sexual relations.
6. Thoughts of death. You have a persistent negative view of yourself, your situation and the future. You may have thoughts of death, dying or suicide.
Depression can also cause a wide variety of physical complaints, such as gastrointestinal problems (indigestion, constipation or diarrhea), headache and backache. Many people with depression also have symptoms of anxiety.
Children, teens and older adults may react differently to depression. In these groups, symptoms may take different forms or may be masked by other conditions. Kids may pretend to be sick, worry that a parent is going to die, perform poorly in school, refuse to go to school, or exhibit behavioral problems. Older people may be more willing to discuss the physical manifestations of depression, instead of their emotional difficulties.
Types of depression
The main types of depression include:
Major depression. This type of mood disturbance lasts more than two weeks. Symptoms may include overwhelming feelings of sadness and grief, loss of interest or pleasure in activities you usually enjoy, and feelings of worthlessness or guilt. This type of depression may result in poor sleep, a change in appetite, severe fatigue and difficulty concentrating. Severe depression may increase the risk of suicide.
Dysthymia. Dysthymia is a less severe but more chronic form of depression. Signs and symptoms usually aren't disabling, and periods of dysthymia can alternate with short periods of feeling normal. Having dysthymia places you at an increased risk of major depression.
Adjustment disorders. If a loved one dies, you lose your job or you receive a diagnosis of cancer, it's perfectly normal to feel tense, sad, overwhelmed or angry. Eventually, most people come to terms with the lasting consequences of life stresses, but some don't. This is what's known as an adjustment disorder — when your response to a stressful event or situation causes signs and symptoms of depression. Some people develop an adjustment disorder in response to a single event. In others, it stems from a combination of stressors. Adjustment disorders can be acute (lasting less than six months) or chronic (lasting longer). Doctors classify adjustment disorders based on the primary signs and symptoms of depression or anxiety.
Bipolar disorder. Having recurrent episodes of depression and elation (mania) is characteristic of bipolar disorder. Because this condition involves emotions at both extremes (poles), it's called bipolar disorder or manic-depressive disorder. Mania affects your judgment, causing you to make unwise decisions. Some people have bursts of increased creativity and productivity during the manic phase. The number of episodes at either extreme may not be equal. Some people may have several episodes of depression before having another manic phase, or vice versa.
Seasonal affective disorder. Seasonal affective disorder (SAD) is a pattern of depression related to changes in seasons and a lack of exposure to sunlight. It may cause headaches, irritability and a low energy level.
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