Major Depressive Disorder Symptoms and Signs
Major depressive disorder is an episode lasting at least two weeks in which mood stays low or interest and pleasure are lost, along with changes to sleep, appetite, energy, concentration and self-worth.
Also called: Depression, Clinical depression, Major depression, Unipolar depression.
ICD-10 F32, F33 · ICD-11 6A70
A weight that does not lift with rest.
Most people think depression is sadness, only stronger. People who have had it describe something else. They say it feels flat, grey, or empty.
This difference matters. It is why a person can have depression for months and not know what is wrong. It is also why the people around them read it as something else.
Sadness points at something. A thing happened, and the feeling is about that thing. When the thing is sorted out, the feeling fades. Depression often points at nothing. It does not lift when life improves. It can arrive when everything looks fine from outside.
Doctors define it as an episode lasting at least two weeks. Mood stays low, or interest and pleasure are lost. Sleep, appetite, energy, concentration and self-worth change too. Two things make it an illness rather than a bad fortnight. It lasts, and it takes away your ability to function.
BEFORE THE CLINICAL LANGUAGE
What it actually feels like
Most explanations start with "low mood". That is the least useful part of it. People who have been through it describe a flattening instead. The volume goes down on everything at once. Your favourite song still sounds the same. It just does nothing to you now.
This symptom has a name. Doctors call it anhedonia, which means the loss of pleasure. It is worth knowing because it confuses people the most. Good things do not start feeling bad. They start feeling like nothing much, and that is much harder to notice and to describe.
Effort stops turning into results. Getting up costs what a big job used to cost. So does replying to a message. So does having a bath. From outside this looks like laziness. From inside it feels like walking through water.
Depression also lies to you, and this part deserves saying out loud. It produces detailed, confident and completely false accounts of your worth and your future. It does not deliver them as feelings. It delivers them as facts you have finally been clear-headed enough to see.
Think of it this way
Imagine a room where the light still works, but you have stopped seeing colour. Everything is where you left it. You can describe all of it correctly. None of it feels worth getting up for.
IT DOES NOT LOOK THE SAME IN EVERYONE
Four things that are all depression
The diagnosis is a group of symptoms, not one picture. Two people can both have it and look nothing like each other.
Slowed down
This is the version most people picture. Movement and speech slow down. Sleep runs long. Everything takes obvious effort. This one gets recognised, and that is part of why the other three do not.
Wound up
Some people get agitated instead of flattened. They are restless, cannot settle, and snap at people who have done nothing. This is often mistaken for anxiety, or for someone simply becoming difficult. The person it is happening to usually thinks so too.
Functioning
Some people keep working. Deadlines are met and nobody at the office suspects anything. The cost is that nothing is left over. Evenings and weekends quietly empty out. Holding it together does not mean it is mild. It usually shows how much is being spent to hold it together.
Physical
For some people it shows up in the body rather than the mood. Headaches, stomach trouble, back pain, and tiredness that sleep does not fix. This is common enough that some people are tested for other illnesses first. They are not imagining it. The pain is real.
332M — People worldwide
5.7% — Of adults
1.5× — More common in women
⅓ — Receive treatment
When it tends to begin
Peak age of onset: 20.
Median age of onset: 30.
Depression most often starts around age 20. The median age is about 30. It is largely an illness of early adult life. That is also the age when people are least likely to call it an illness. They call it a personal failing instead.
The signs clinicians look for
No single symptom makes the diagnosis. Doctors look for a group of them, present most of the day, nearly every day, for at least two weeks.
- Depressed mood, sad, irritable or empty
- Loss of interest or pleasure in activities
- Poor concentration, or difficulty making decisions
- Excessive guilt, or low self-worth
- Hopelessness about the future
- Disrupted sleep, too little, or too much
- Change in appetite or weight
- Fatigue, or very low energy
- Thoughts of death, self-harm or suicide
An episode is called mild, moderate or severe. Three things decide which: how many symptoms are present, how strong they are, and how much they affect daily life.
This page is education, not diagnosis
Nothing here can tell you whether you have depression. This page does not replace a doctor. If you recognise yourself in it, and it has gone on for a while, that is a reason to talk to someone. It is not a conclusion to reach on your own.
If you are thinking about harming yourself, please reach out now. In an emergency, contact your local emergency number.