Depression creeps into one’s life often unnoticed until the point where the demands of everyday life become too much. It is difficult to evaluate your own condition: is this sadness, is it normal, has feeling down become a way of life? Some people have it harder than you, are you just being weak? Is it worth the effort, maybe it will just go away with time? But how much time is too much time? There is a way to navigate the world of emotions and there are certain criteria by which depression is diagnosed. See below detailed explanations of the symptoms, expected durations and types of progression as per international guidelines. Please do not use this information as a substitute for professional help and treatment.

Symptoms

Emotional changes
In the early stages of depression, people usually notice the diminishing feeling of pleasure in life. It is often preceded by a great feeling of sadness and sorrow. Sense of humour also diminishes – people understand a joke, but do not find it funny. Gradually mood lowers even more until it settles into a steady feeling comparable to grief while the content of personal thoughts matches the mood. Memories about the past are confided to failure and wrong decisions. Future is perceived as hopeless and threatening. Patients with depression share that they usually have uncontrollable crying outbursts, while others feel like crying but can’t. People also report a deep feeling of losing life’s purpose as well as contemplating suicide. The feeling of attachment to family and friends is reduced, religious people might experience loss of faith.

Cognitive changes

This includes the feeling of dislike towards a person’s own self and overestimation of everyday problems. The loss of self – confidence could be seen especially well when people are asked to compare themselves to others. Often people with depression feel that others are talking behind their backs and making disrespectful remarks towards them. Religious patients might think they are sinful and unworthy. Due to lack of confidence or impaired thought processes, one might find it difficult to make decisions. In severe depression cases, there is a self-perception of guilt and worthlessness. They are usually accompanied by serious suicidal thoughts and nihilistic ideas: lack of feelings, claiming they are already dead and the world doesn’t exist.

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Changes in motivation

Low energy levels, tiredness, apathy, inability to concentrate are all secondary symptoms to lower mood levels and are very common among depressive conditions, especially those following an infectious disease. People suffering from depression usually avoid taking responsibility and difficult tasks because their job seems boring or they are not confident they can handle the tasks. Because of this lack of initiative, depressed people are often perceived as needing constant help and support, unable to handle simple tasks in everyday life.

Neurovegetative symptoms

They include change in appetite, weight loss/gain, sleep, sexual arousal, energy levels and posture. The depressive state can change the way a person talks, walks or sits. In light depression forms, excessive appetite and weight gain are as common as weight loss and loss of appetite. However, the latter symptoms are more common in more severe depression forms. Sexual interest and functions diminish. People have trouble falling asleep and the sleep itself is not restorative. Mornings are reported to be the most difficult accompanied by severe mood swings.

Please see below the list of depression symptoms (as per DSM-V – used by the American Psychological Association):

1. Depressed mood by self-report or observation made by others
2. Loss of interest or pleasure
3. Fatigue/loss of energy
4. Worthlessness/excessive or inappropriate guilt
5. Recurrent thoughts of death, suicidal thoughts or actual suicide attempts
6. Diminished ability to think/concentrate or indecisiveness
7. Psychomotor agitation or retardation
8. Insomnia/hypersomnia
9. Significant appetite and/or weight loss

(Read part 2 next week: Severity and course of depression).

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