Symptoms

Although it may appear anytime from childhood to old age, depression usually begins during a person’s 20s or 30s.

The illness may come on slowly, then deepen gradually over months or years.

On the other hand, it may erupt suddenly in a few weeks or days.

A person who develops severe depression may appear so confused, frightened, and unbalanced that observers speak of a “nervous breakdown.”

However it begins, depression causes serious changes in a person’s feelings and outlook.

A person with major depression feels sad nearly every day and may cry often.

People, work, and activities that used to bring them pleasure no longer do.

Symptoms of depression can vary by age.

In younger children, depression may include physical complaints, such as stomachaches and headaches, as well as irritability, “moping around,” social withdrawal, and changes in eating habits.

They may feel unenthusiastic about school and other activities.

In adolescents, common symptoms include sad mood, sleep disturbances, and lack of energy.

Elderly people with depression usually complain of physical rather than emotional problems, which sometimes leads doctors to misdiagnose the illness.

Symptoms of depression can also vary by culture.

In some cultures, depressed people may not experience sadness or guilt but may complain of physical problems.

In Mediterranean cultures, for example, depressed people may complain of headaches or nerves.

In Asian cultures they may complain of weakness, fatigue, or imbalance.

If left untreated, an episode of major depression typically lasts eight or nine months.

About 85 percent of people who experience one bout of depression will experience future episodes.

Appetite and Sleep Changes

Depression usually alters a person’s appetite, sometimes increasing it, but usually reducing it.

Sleep habits often change as well.

People with depression may oversleep or, more commonly, sleep for fewer hours.

A depressed person might go to sleep at midnight, sleep restlessly, then wake up at 5 am feeling tired and blue.

For many depressed people, early morning is the saddest time of the day.

Changes in Energy Level

Depression also changes one’s energy level.

Some depressed people may be restless and agitated, engaging in fidgety movements and pacing.

Others may feel sluggish and inactive, experiencing great fatigue, lack of energy, and a feeling of being worn out or carrying a heavy burden.

Depressed people may also have difficulty thinking, poor concentration, and problems with memory.

Poor Self-Esteem

People with depression often experience feelings of worthlessness, helplessness, guilt, and self-blame.

They may interpret a minor failing on their part as a sign of incompetence or interpret minor criticism as condemnation.

Some depressed people complain of being spiritually or morally dead.

The mirror seems to reflect someone ugly and repulsive.

Even a competent and decent person may feel deficient, cruel, stupid, phony, or guilty of having deceived others.

People with major depression may experience such extreme emotional pain that they consider or attempt suicide.

At least 15 percent of seriously depressed people commit suicide, and many more attempt it.

Psychotic Symptoms

In some cases, people with depression may experience psychotic symptoms, such as delusions (false beliefs) and hallucinations (false sensory perceptions).

Psychotic symptoms indicate an especially severe illness.

Compared to other depressed people, those with psychotic symptoms have longer hospital stays, and after leaving, they are more likely to be moody and unhappy.

They are also more likely to commit suicide.