Knowing the signs

Depression is an illness that involves not only the mind or brain but the whole body, affecting the way a person eats, sleeps, feels about him or herself, and thinks about things.

It is not a passing, normal, state of mind and it is neither a sign of personal weakness nor a condition that one can “snap out of”. It is not up to the affected person to decide to 'pull themselves together' and get better.

Depression is far beyond distress or normal suffering: it is an illness involving signs and symptoms that will last for weeks, months, or years without recognition of the condition or appropriate treatment.

Common signs and symptoms of depression are:

  • a persistently sad, anxious, or empty mood;
  • loss of interest in activities that were once interesting or enjoyable, including sex;
  • unusual fatigue, low energy level, a feeling of being slowed down;
  • loss of appetite (with weight loss) or overeating (with weight gain);
  • sleep disturbance and insomnia, early-morning awakening or oversleeping;
  • loss of emotional expression (flat affect);
  • feelings of hopelessness, pessimism, guilt, worthlessness, or helplessness;
  • social withdrawal;
  • trouble concentrating, remembering, or making decisions;
  • unusual restlessness or irritability;
  • persistent physical problems such as headaches, digestive disorders, or chronic;
  • pain that do not respond to treatment;
  • thoughts of death, suicide, suicide attempts or self-harm.

Depression is often accompanied by anxiety and is always associated with significant problems in the family, with friends, in work or school because of the effect that depression has on the person.

Some symptoms are age-specific and may be more common in children (behaviour issues), youth (agitation and irritability), or among older people (withdrawal, apathy and delusional ideas). Also, because depressive disorders are not just psychological disorders but involve biological process, physical symptoms are very common.

Typical physical symptoms associated with depression are:

  • Inner discomfort and tension;
  • Reduced appetite and weight loss;
  • Loss of sexual interest;
  • Headaches;
  • Dizziness;
  • Back pain;
  • Breathing problems;
  • Heart problems;
  • Gastrointestinal complaints;
  • Abdominal pain;

These physical symptoms are often noticed first, but might not immediately be recognised as being linked to depression. Furthermore, existing problems - e.g. back pain – can be experienced more severely during a depressive phase.

Due to prominent physical symptoms, it is often hard for a general practitioner to recognise and diagnose an underlying depression even if, as in two thirds of cases, the main complaint is a somatic symptom. Sometimes it is helpful to get a second opinion. You should encourage your friend or family member to talk about this with their doctor.

Anxiety symptoms are also very common in depression and many are also physical in nature, such as chest tightness, shortness of breath, nausea and dizziness.

Take a look and complete the screening test for depression on behalf of your family/friend on this website in the box 'Recognising Depression' on the left side of the page.