When Sadness Becomes Clinical Depression: Signs to Look For

Most people have felt sad or depressed at times. Feeling depressed can be a normal reaction to loss, life's struggles, or an injured self-esteem.

But when feelings of intense sadness -- including feeling helpless, hopeless, and worthless -- last for many days to weeks and keep you from functioning normally, your depression may be something more than sadness. It may very well be clinical depression -- a treatable medical condition.

How Do I Know If I Have Depression?

According to the DSM-5, a manual used to diagnose mental disorders, depression occurs when you have at least five of the following symptoms for at least two weeks:

• A depressed mood during most of the day, particularly in the morning
• Fatigue or loss of energy almost every day
• Feelings of worthlessness or guilt almost every day
• Impaired concentration, indecisiveness
• Insomnia (an inability to sleep) or hypersomnia (excessive sleeping) almost every day
• Markedly diminished interest or pleasure in almost all activities nearly every day
• Recurring thoughts of death or suicide (not just fearing death)
• A sense of restlessness or being slowed down
• Significant weight loss or weight gain

A key sign of depression is either depressed mood or loss of interest in activities you once enjoyed. For a diagnosis of depression, these signs should be present most of the day either daily or nearly daily for at least two weeks. In addition, the depressive symptoms need to cause clinically significant distress or impairment. They cannot be due to the direct effects of a substance, for example, a drug or medication. Nor can they be the result of a medical condition such as hypothyroidism.

Symptoms of Depression

According to the National Institute of Mental Health, people with depressive illnesses don't all experience the same symptoms. How severe they are, how frequent, and how long they last will vary depending on the individual and his or her particular illness. Here are common symptoms people with depression experience:

• Difficulty concentrating, remembering details, and making decisions
• Fatigue and decreased energy
• Feelings of guilt, worthlessness, and/or helplessness
• Feelings of hopelessness and/or pessimism
• Insomnia, early morning wakefulness, or excessive sleeping
• Irritability, restlessness
• Loss of interest in activities or hobbies once pleasurable, including sex
• Loss of pleasure in life
• Overeating or appetite loss
• Persistent aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment
• Persistent sad, anxious, or "empty" feelings
• Thoughts of suicide or suicide attempts

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While these are common symptoms of depression, they may also occur in patterns. For example, a person may experience depression with mania or hypomania -- a condition called manic depression or bipolar disorder. Or the syndrome of major depression may occur in a seasonal pattern (a condition formerly called seasonal affective disorder).

There are several types of manic depression. People with bipolar II disorder have at least one episode of major depression and at least one hypomanic -- mild elation or high -- episode. People with bipolar I disorder have a history of at least one manic -- extreme elation or high -- episode, with or without past major depressive episodes. A patient with unipolar depression has major depression only and has never had a full hypomanic or manic episode. A new category, though, in the DSM-5 allows for the presence of some symptoms of mania or hypomania during a full depressive episode in someone who technically hasn't met the full criteria for bipolar disorder (called major depressive disorder with mixed features). That suggests the line between unipolar and bipolar disorder can sometimes be blurry.

Is Childhood Depression Common?

Childhood depression is different from the normal "blues" and everyday emotions that occur as a child develops. If your child is sad, this does not necessarily mean he or she has significant depression. It's when the sadness becomes persistent -- day after day -- that depression may be an issue. Or, if your child has disruptive behavior that interferes with normal social activities, interests, schoolwork, or family life, it may indicate that he or she has a depressive illness.

Depression in Teens

It is common for teens to occasionally feel unhappy. However, when the unhappiness lasts for more than two weeks and the teen experiences other symptoms of depression, then he or she may be suffering from adolescent depression. Because as many as one in every 33 children and one in eight adolescents suffer with depression, talk to your doctor and find out if your teen may be depressed. There is effective treatment available to help teens move beyond depression as they grow older.

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How Common Is Depression?

It is estimated that, by the year 2020, major depression will be second only to ischemic heart disease in terms of the leading causes of disability in the world. But people with depression sometimes fail to realize (or accept) that there is a biological cause to their depressed moods. As a result, they may search endlessly for external causes.

In the U.S., about 14.8 million adults suffer from major depression, according to the National Institute of Mental Health. The suicide risk in people with this type of depression is the highest rate for any psychiatric condition. For people between the ages of 10 and 24, suicide is the third leading cause of death. Unfortunately, most people with clinical depression never seek treatment. Left undiagnosed and untreated, depression can worsen, potentially lasting for years and causing untold suffering, and possibly suicide.

What Are the Warning Signs of Suicide?

Depression carries a high risk of suicide. Anybody who expresses suicidal thoughts or intentions should be taken very, very seriously. Do not hesitate to call your local suicide hotline immediately. Call 800-SUICIDE (800-784-2433) or 800-273-TALK (800-273-8255) -- or the deaf hotline at 1-800-4889. Or contact a mental health professional immediately.

Warning signs of suicide include:

• Thoughts or talk of death or suicide
• Thoughts or talk of self-harm or harm to others
• Aggressive behavior or impulsiveness

Previous suicide attempts increase the risk for future suicide attempts and completed suicide. All mention of suicide or violence must be taken seriously. If you intend or have a plan to commit suicide, go to the emergency room for immediate evaluation and treatment.

Are There Different Types of Depression?

There are a number of different types or subtypes of depression including:

• Major depression
• Chronic depression, including dysthymia
• Bipolar depression
• Seasonal depression (SAD or seasonal affective disorder)
• Psychotic depression
• Postpartum depression
• Substance-induced mood disorder (SIMD)

Are There Other Types of Depression?

Other types of depression that can occur include:

• Double depression -- a condition that happens when a person with chronic, low-grade depression (dysthymia) experiences an episode of major depression.
• Secondary depression -- a depression that develops after the development of a medical condition such as hypothyroidism, stroke, Parkinson's disease, or AIDS, or after a psychiatric problem such as schizophrenia, panic disorder, or bulimia.
• Treatment-resistant depression -- a condition that doesn't respond to treatment with antidepressants, and may be longstanding or chronic. For chronic treatment-resistant depression, electroconvulsive therapy (ECT) is sometimes the treatment of choice depending on the nature and severity of symptoms.
• Masked depression -- a depression that is hidden behind physical complaints for which no other medical cause can be found.

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What Illnesses Occur With Depression?

Depression commonly occurs with other illnesses such as anxiety, obsessive compulsive disorder, panic disorder, phobias, and eating disorders. If you or a loved one has symptoms of depression or another mental illness, talk to your doctor. Treatments are available to lift the depression and other mental illnesses.

For more information, see WebMD's article on Depression and Other Mental Illnesses.

Can Depression Have Physical Symptoms?

Because certain brain chemicals or neurotransmitters, specifically serotonin and norepinephrine, influence both mood and pain, it's not uncommon for depressed individuals to have physical symptoms. These symptoms may include joint pain, back pain, gastrointestinal problems, sleep disturbances, and appetite changes. The symptoms may also be accompanied by slowed speech and movements. Many people go from doctor to doctor seeking treatment for their physical symptoms when, in fact, they are clinically depressed.

Where Can I Get Help for Depression?

If you or someone you know is experiencing symptoms of depression, seek care from a health care provider such as your primary care doctor. He or she will evaluate your symptoms and provide treatment or refer you to a mental health professional.

WebMD Medical Reference Reviewed by Joseph Goldberg, MD

Sources

SOURCES:

National Institute of Mental Health: "What is Depression?"

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR, American Psychiatric Pub, 2000.

Fieve, R, MD. Bipolar II, Rodale Books, 2006.

The Journal of the American Medical Association. “Recommendations for Screening Depression in Adults,” Vol. 315, No. 4, January 26, 2016.

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