Symptoms of Depression

There is no blood test for depression. The diagnosis is based on the reports of sufferers about how they feel and on observations of how they look and behave made by doctors and by people who know them well.

John D. was a forty-five-year-old, self-employed, successful businessman when he suddenly initiated negotiations to sell his company. For months preceding the decision to sell, John had experienced increasing fatigue and decreasing ability to concentrate, which he attributed to the pressures of work. He quit meeting his friends for golf on Sunday afternoons, preferring to sleep in front of the television, but then had problems going to sleep at night. John’s appetite, energy level, and sex drive gradually diminished, while he experienced a growing sense of restlessness, irritability, and futility. John’s wife became concerned when she learned of her husband’s recent purchase of additional life insurance and of his revision of his will. She convinced John to see his family physician for a “good physical.”

The symptoms of depression fall into four categories: mood, cognitive, behavioral, and physical. In other words, depression affects how individuals feel, think, and behave as well as how their bodies work. People with depression may experience symptoms in any or all of the categories, depending on personal characteristics and the severity and type of depression.

Depressed people generally describe their mood as sad, depressed, anxious, or flat. Victims of depression often report additional feelings of emptiness, hopelessness, pessimism, uselessness, worthlessness, helplessness, unreasonable guilt, and profound apathy. Their self-esteem is usually low, and they may feel overwhelmed, restless, or irritable. Loss of interest in activities previously enjoyed is common and is usually accompanied by a diminished ability to feel pleasure, even in sexual activity.
As the illness worsens, the cognitive ability of the brain is affected. Slowed thinking, difficulty with concentration, memory lapses, and problems with decision-making become obvious. Those losses lead to frustration and further aggravate the person’s mounting sense of being overwhelmed. The sufferer longs for escape, and thoughts of death intrude, sometimes taking the form of wishful thinking, as in “I wish God would just take me” or “I wish I could vanish, ” and often involving ideas of suicide.

In its most severe forms, depression causes major abnormalities in the way sufferers see the world around them. They may become psychotic, believing things that are not true or seeing and hearing imaginary people or objects.

Ann H. was forty years old when her husband took her to the family physician after she began crying daily and begging her husband to take good care of their teenage daughters after her death. Despite a normal medical assessment, Ann remained convinced that she was dying of metastatic cancer as had her mother years before. She “felt” the cancer cells destroying her liver and kidneys and pointed to her twenty-pound weight loss in six months as proof of terminal illness. Ann’s appetite was poor, yet she remained constantly, unproductively active throughout the day. At night she lay awake crying about leaving her daughters without a mother, while during the day she worried constantly about becoming an emotional and financial burden on her family in the late stages of her “terminal” illness. Ann decided she must kill herself to protect her family and took a lethal overdose of an antidepressant medication that had been prescribed by her family physician.

Psychosis in depression is not rare. Between 10 and 25 percent of patients hospitalized for serious depression, especially elderly patients, develop psychotic symptoms. Symptoms of psychosis may include delusions (irrational beliefs that cannot be resolved with rational explanations) and hallucinations (seeing, hearing, feeling, tasting, or smelling things or people that are not present).
People with psychoses may develop paranoia, believing that they are being manipulated by known or unknown people or forces, that there is a conspiracy against them, or that they are in danger. No amount of rational explanation changes the delusional belief. Others may be convinced that they have committed an unpardonable sin against loved ones or against their God and deserve severe punishment, even death. Some sufferers become so firmly convinced of their own worthlessness that they begin to view themselves as a burden to their families and choose to kill themselves. Occasionally, severe depression may result in hallucinations in which the depressed person hears or sees things or people that are not present; other types of hallucinations, such as smelling or feeling things that are not present, are less common in severe depression than in some other brain disorders.

The changes occurring with depression understandably result in alterations in behavior. Most individuals with moderate-to-severe depression will experience decreased activity levels and appear withdrawn and less talkative, although some severely depressed individuals show agitation and restless behavior, such as pacing the floor, wringing their hands, and gripping and massaging their foreheads. Given a choice, most begin to avoid people and activities, yet others will be most uncomfortable when alone or not distracted. In general, the severely depressed become less productive, although they may successfully mask the decline in performance if they have been highly productive in the past. In the workplace, depression may result in morale problems, absenteeism, decreased productivity, increased accidents, frequent complaints of fatigue, references to unexplained aches and pains, and alcohol and drug abuse. Severely depressed individuals have been known to work their regular schedule during the day, interact with their coworkers in a routine way, and then go home and kill themselves.

Depression is more than a mental illness. It is a total body illness. People suffering from moderate-to-severe depression experience changes in their body functions. Their energy levels fall, and they fatigue more easily. Insomnia is common and takes many forms; depressed individuals may have difficulty going to sleep or experience early morning awakenings. A subgroup of depressed patients feel an excessive need for sleep. Depressives consistently complain that their sleep is not restful and that they feel just as tired in the morning when they awake as they did when they went to bed the evening before. Some may be troubled by dreams that carry the depressive tone into sleeping hours, causing abrupt awakenings due to distress.

Appetite changes are common. Most depressives experience decreased or total loss of appetite, with associated weight loss resulting in lower energy levels. The same individuals who oversleep when depressed also tend to overeat. They gain weight from a combination of increased caloric intake and decreased activity level, which compounds their problems through increased frustration and lowered self-esteem. Whether the appetite increases or decreases, the end result is a vicious cycle of physical symptoms aggravating the depression.

Physical complaints are common and may or may not have a physical basis. Many seriously depressed people, in fact, first go to their physicians with physical complaints. The depressed mood may not be recognized initially by these patients, especially if they are men. Men, in general, are less apt to look inward when they “feel bad, ” attempting instead to locate the problem in their environment.

Physical symptoms associated with depression can occur in any part of the body and can include pain (headache, backache), gastrointestinal problems (nausea, stomach pain, diarrhea, constipation), neurologic complaints (dizziness, numbness, memory problems), sexual disorders (lack of desire, failure of orgasm), and general complaints of feeling unwell and heavy, as if one’s feet are stuck in mud. The physical complaints of depressed patients cannot be overlooked, because many studies indicate an increased risk of real physical illness in people who have severe forms of depression.

One Response to “Symptoms of Depression”

  1. [...] different and sometimes complicated systems attempt to classify depressions according to their symptoms, severity, causes, and other characteristics. One reason for these rigorous attempts is the need to [...]

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