First published May 3, 2020.
Depression is more than a bad week. Health bodies such as the World Health Organization describe a depressive episode as low, empty or irritable mood, or a loss of interest and pleasure, that lasts most of the day, nearly every day, for at least two weeks. Around that core sit other changes: sleep, appetite, energy, concentration, self-worth and how you relate to other people. The ten signs below are common ways it shows up in daily life. Recognising several of them in yourself or someone close to you is a good reason to talk to a doctor, not a diagnosis in itself.
If you are in crisis or thinking about ending your life, contact emergency services now. In the United States you can call or text 988 (the 988 Suicide & Crisis Lifeline); in the UK, Samaritans answer on 116 123.
Why depression is easy to miss
Many people expect depression to look like constant crying. In reality it often hides behind tiredness, irritability, aches or a vague sense that nothing matters. Medical reviews note that physical complaints are a common reason people first see a doctor, and that this can delay recognition of the underlying mood problem.
It is also very common. The WHO estimates that roughly 5 percent of adults worldwide live with depression, and that women are affected about one and a half times as often as men. It can affect anyone, regardless of income, culture or how "strong" they seem. Having it is not a character flaw.
Changes in the body: signs 1 to 3
1. Sleep that goes wrong in either direction
Everyone has restless nights, especially under stress. The pattern to notice is a lasting change: trouble falling asleep, waking in the small hours and lying awake, or waking much earlier than you intended. For other people it goes the opposite way, with long hours in bed and still feeling unrefreshed.
2. Shifts in appetite and weight
The NHS lists appetite and weight changes among the physical symptoms, usually a decrease but sometimes an increase. Some people stop feeling hungry and lose weight without trying; others find themselves reaching for food for comfort and gain weight.
3. Aches, heaviness and low energy
Unexplained aches and pains, constant fatigue and moving or speaking more slowly than usual are all recognised physical symptoms. Ordinary tasks, like showering or answering a message, can feel like they require enormous effort. Because these signs look physical, they are worth mentioning clearly when you see a doctor, so other causes can be checked too.
Changes in thinking and feeling: signs 4 to 6
4. Difficulty concentrating and deciding
Depression can make it hard to focus, follow a conversation or settle on even small choices. Often this mixes with harsh self-criticism: you doubt your judgement, so you put off decisions, and then feel worse for avoiding them.
5. Worry and going over the past
Anxiety and depression frequently occur together. A typical pattern is replaying old mistakes again and again, or worrying about what might go wrong, with feelings of guilt or worthlessness that seem out of proportion to what actually happened.
6. Mood swings, irritability and tearfulness
Low mood is not always quiet. Many people notice they snap at others, cry more easily, or feel fine one hour and flat the next, then feel guilty about it afterwards. Irritability is listed as a core symptom for some people, and it is easy to mistake for simply being "in a bad mood".
Changes in life and relationships: signs 7 to 10
7. Losing interest, including in sex
Loss of pleasure in things you used to enjoy, known as anhedonia, is one of the two central symptoms. Hobbies feel pointless, and low sex drive is common. People sometimes describe feeling numb rather than sad.
8. Drinking more to cope
Alcohol can feel like a quick way to relax or forget for an evening, but the WHO lists harmful alcohol use as a risk factor for depression and advises cutting down or avoiding alcohol and drugs, because both can make it worse. If you notice you need a drink to get through the day, that is worth raising with a doctor.
9. Pulling away from friends
Time with people you love normally lifts your mood. With depression it can feel draining or stressful, so plans get cancelled and invitations ignored. Avoiding friends and neglecting social activities are listed as social symptoms, and the isolation that follows tends to deepen low mood. Good friendship can still help, even if you only manage a short message.
10. Feeling hopeless about the future
Plans, goals and things to look forward to may seem to vanish. Hopelessness and helplessness, the sense that nothing will improve so there is no point trying, are key symptoms. Thoughts of death or suicide can appear here too; if they do, treat them as urgent and contact a crisis line or emergency services.
Common myths about depression
- "It is just sadness." Sadness passes with circumstances. Depression is persistent and affects sleep, energy, thinking and functioning.
- "You need a reason to be depressed." Research points to a mix of genetic, biological, environmental and psychological factors. It can appear when life looks fine from the outside.
- "Asking for help is weakness." Depression is one of the most common health conditions in the world, and effective treatments exist.
- "You must tick every box." Nobody has all ten signs. Diagnosis looks at the overall pattern, how long it has lasted and how much it affects daily life.
What to do if these signs sound familiar
A list like this cannot tell you whether you have depression, and it cannot rule it out either. The NHS suggests seeing a GP if symptoms last most of the day, every day, for more than two weeks. A useful first step is to note when the changes started, which ones you notice most and how they affect work, sleep and relationships, then talk to a doctor or another qualified health professional.
Health organisations say there are effective treatments, and a professional can explain the options that fit your situation. Alongside that, the WHO's general self-care advice includes staying in touch with people you trust, keeping regular sleep and meal times, moving your body, even with a short walk, and continuing activities you used to enjoy where you can.
If you are worried about someone else, a gentle, specific message, such as "I've noticed you seem exhausted lately, how are you really?", often opens the door more easily than advice. Listen, stay in contact and offer practical help with finding support.
Sources: World Health Organization: Depression fact sheet; NHS: Symptoms of depression in adults; NIMH: Depression; Wikipedia: Major depressive disorder.
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