Depression signs and symptoms can vary but are important to recognize. Clinical depression is very common but can be difficult to see. Here, what to know to help you recognize this serious problem.

So…you or someone you care about has been out of sorts for a while. You may not be able to put your finger on the problem. Maybe a “play it safe” physical exam turned up nothing of note. Still, you feel in your gut that something isn’t right.

It could be any number of issues. But it’s possible that what you or your loved one is dealing with is depression, even if the feelings or behavior you’re noticing don’t quite fit your idea of what the signs and symptoms of depression are.

“People throw the word ‘depressed’ around a lot in everyday conversation, often to describe feeling sad or down. Sadness can definitely be a symptom of depression. But there are many signs and symptoms that contribute to a clinical diagnosis,” says Alexis Menken, PhD, a Montclair, New Jersey-based clinical psychologist and founder of the Conscious Motherhood Experience.

Missing the Signs and Symptoms of Depression

While it’s estimated that 21 million adults in America¹ had at least one major depressive episode in 2020, the unfortunate reality is that about two-thirds² of those struggling with depression don’t receive treatment. Not just because of the stigma still associated with help-seeking for mental illness. But because many are still unaware of what depression can look and feel like. (Lack of access to healthcare is another issue.)

“Depression can wear many disguises,” says Heidi Heimler, PsyD, a psychologist with New Frontiers Psychiatry in Milwaukee, Wisconsin. How it manifests itself can depend on any number of factors including your physiological makeup, culture, age, gender, and mental health history.

Symptoms of depression may also emerge gradually, even subtly, and may therefore not be obvious. “A person with a limp or a hacking cough will likely get concerned or may be urged to see their doctor. But a person who grows more sullen or quiet, who doesn’t show up for social functions or misses days of work, is more likely to fly under the radar,” says Heimler.

What are the Signs and Symptoms of Depression?

To make a diagnosis of clinical depression, health care providers generally follow guidelines laid out in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Your doctor may also order lab work and conduct a thorough physical exam to rule out other conditions like thyroid disease, low blood pressure, anemia, and vitamin D deficiency, which can have similar symptoms.

According to the DSM-5³, a patient meets the criteria for major clinical depression if they exhibit at least five out of a list of nine common symptoms on a daily basis for a minimum of two weeks. These symptoms may be a departure from what is usual. And a patient may be experiencing one of two symptoms in particular: sadness/depressed mood and loss of enjoyment of things they once found pleasurable (also sometimes called anhedonia). However, even these two symptoms can manifest in less obvious ways depending on the individual.

Keep in mind that the DSM gives health care providers flexibility when it comes to making their diagnosis. “Sometimes a patient may repress feelings of sadness and instead come off as irritable or disengaged. It’s up to therapists to explore those feelings and make the determination of whether their patient is dealing with depression, something else like anxiety or PTSD, or a combination of issues,” says Brent Metcalf, LCSW, a provider at Tri-Star Counseling in Johnson City, Tennessee.

Emotional Symptoms

Following are some emotional symptoms often associated with major depressive disorder, some of which are included as DSM-5 criteria, but also others that can still be common related signs of the condition:

• Persistent feelings of sadness and hopelessness. You feel down most of the day, almost every day, and have little or no optimism about life improving.

• Loss of interest in activities you have usually enjoyed. You start to avoid or dread many of the pursuits that made life pleasurable, from hanging out with friends to having sex to exercising to eating. You may lose motivation, even to get up out of bed each morning.

• Irritability and frustration. Your fuse is short. Everything seems to rub you the wrong way. “For some, it may be easier to lash out at others instead of sitting with what they are feeling. Often, though, under that anger is a lot of sadness. Think back to the bullies in school,” says Menken.

• Anxiety. Almost half⁴ of those diagnosed with depression also struggle with intense and persistent anxiety (which can be diagnosed as a disorder unto itself). You may worry incessantly, fixate on certain issues, feel nervous, restless, and even have panic attacks.

• Trouble with concentration and other cognitive functions. You just can’t seem to organize your thoughts and take action. Tasks are piling up, you can’t make decisions, the house is a mess, and you’re forgetting details and commitments more than usual.

• Feelings of guilt and worthlessness. You question your value as a human being. You blame yourself or feel overwhelming guilt about any number of things, from the burden you think you are to your spouse to your perceived failure to fulfill the dreams your parents held out for you.

• Suicidal thoughts and ideations. You may or may not have a plan to carry out an attempt (see below for more on this topic). If you or someone you know needs help now, contact the Samaritans 116 123

Physical Symptoms

Depression often goes undiagnosed because a significant percentage⁵ of depressed patients are aware of only physical symptoms (which can get genuinely exacerbated by mental distress: the mind and body are often linked). Also, people (particularly some in certain cultures and/or who feel uncomfortable discussing their mental health) can tend to express emotional upset as physical or bodily issues and seek help from primary care or other non-mental health providers first.

And far too often, these health care providers who are consulted fail to delve beneath the surface.⁶

Here are some common physical symptoms of depression:

Unexplained aches and pains. Achy joints and muscles. Headaches. Back pain. You notice that things just hurt more these days. One possible reason: How we experience pain is regulated by serotonin and norepinephrine, two neurotransmitters that also regulate mood.⁷ In a sense, pain and mood share a pathway in the brain. And when one is affected, the other may be, as well.

Digestive issues. Often called the second brain, the gut is where we process a lot of our emotions and is also rich in serotonin receptors. That’s why when we’re worried or scared, we can literally feel “sick to our stomach.” When you’re depressed, the impact can be ongoing, plaguing you with gastrointestinal miseries like indigestion, nausea, cramps, constipation, and diarrhea.

Changes in sleep patterns. You may be up all night. Or fall asleep, only to wake up in the wee hours, your mind buzzing with worry about anything and everything. “On the other hand, you may find that sleep is the only thing you can do, the only way you can get relief. So you may sleep excessively,” says Heimler.

Fatigue and consistent low energy. Even if you do sleep at night, you are exhausted all the time. Your limbs feel like lead. You can barely—or just plain can’t– muster the energy to care for yourself or your family.

Appetite or weight changes. You don’t have much or any interest in eating and may be losing weight. “Or you may find that you’re really hungry, eating without hunger, without pleasure, or joy,” Heimler says.

Signs of Depression in Teens, Young Adults, and Children

Young people have many of the same symptoms of depression that adults do, including persistent sadness, anxiety, low energy, unexplained aches and pains like headaches and stomach aches, and changes in appetite.

That said, younger children often are not yet capable of expressing their feelings. So, they may be more likely to show or complain about physical symptoms. Behaviorally, kids may also be more prone to tantrums and crying, crankiness, and may act out in school, at home, and in public.

Teens may behave erratically, crying, lashing out, and angering with little or no trigger. They may stop going out with friends, make frequent visits to the school nurse with vague complaints, tank in their classes, or constantly seek reassurance from parents and loved ones. It’s also not uncommon for depressed teens to self-medicate with drugs or alcohol and engage in self-harm, such as cutting and burning or getting excessive piercings or tattoos.

Signs of Depression in Women

Depression can look different in women. Most research confirms that depression is about twice as common⁸ in women than in men. Fluctuations in estrogen levels throughout the reproductive cycle likely play a role, as do genetics. So do socioeconomic factors, such as women’s increased risk of living in poverty and experiencing emotional and sexual abuse.⁹

Women, in general, tend to be more in touch with their emotions than men and may be more inclined to seek help. Men on the other hand (thanks to social stereotypes about what it “means to be a man”) may consider mental illness and help-seeking as signs of weakness. Uncomfortable with and embarrassed about feelings of sadness and despair, they may withdraw from others and mask their symptoms. They can also be less talkative about their emotions.

“People often just think men are angry because they’re men and full of testosterone or have a temper. Really, this can be a symptom of depression,” says Metcalf. To cope, men may avoid family and friends by spending much of their time at work or playing sports; drink too much or develop a drug habit; exhibit risky behaviors, like aggressive driving; or become violent, controlling, or abusive.

Symptoms of Depression in Older People

Depression is often missed¹⁰ in elderly people because symptoms–such as social withdrawal, memory loss, and cognitive impairment–are chalked up to aging or attributed to age-related illnesses, like Alzheimer’s, Parkinson’s, or vascular disease. Sometimes these conditions may also co-occur or exacerbate one another. Complaints about physical aches and pains are common in elderly depression. Older people may also begin to neglect their personal hygiene, fixate on death, and seem to lose their will to live.

Men 85 and older have the highest suicide rate of any group in the U.S., according to the Substance Abuse and Mental Health Services Administration (SAMHSA).

What To Do if You Think You Have Symptoms of Depression

If you suspect you’re depressed, you might first want to reach out to your primary care provider. They can screen you for depression and rule out any physical issues that might be causing your symptoms. Make sure you share with your doctor exactly what you’re feeling and tell them outright that you believe you may be depressed. Otherwise, they may miss the diagnosis, which is common.¹¹

If your primary care provider suspects depression, they can refer you to a therapist, and, if needed, a psychiatrist who can prescribe medication. If access to mental health specialists is limited (a problem that’s been exacerbated by the pandemic) your primary care provider can prescribe medication for depression. However, the best outcomes for major clinical depression are generally associated with a combination of talk therapy and medication.¹²

“Some people absolutely do not want their primary care provider to know anything about their mental health. If that’s the case with you or if you don’t have a primary care provider, you can reach out to a therapist directly,” says Metcalf. And, of course, if you or someone you care about might be in danger of harming themselves, go to an ER or call the police for a welfare check. You can also contact the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).

Suicidal Thoughts And Ideations

People with depression (and those with substance abuse issues) are at increased risk of suicide and suicidal ideation. What is suicidal ideation? Simply put, suicidal ideation involves thoughts about taking your own life. Some people in distress wish they could stop living but they don’t actually have an organized plan to make that happen. Others put together an actual plan to end their life. Both are forms of suicidal ideation.

Suicide is the 10th leading cause of death in the United States and the second leading cause of death for young people (ages 10 to 34). Although women attempt suicide more often than men, men are three to four times more successful, according to data from the National Institute of Mental Health (NIMH).

Suicide risk factors include a previous suicide attempt, depression, social isolation, struggling financially, having impulsive behavior, job loss or problems with crime, issues around substance use, legal problems, and having a serious illness.

Pay close attention to subtle behavior changes as they can be warning signs that someone is contemplating suicide. Be on the lookout for these indications:

• Talking about death and suicide

• Seeking access or researching the topic

• Threatening to kill oneself

• Withdrawing from family and friends

• Expressing hopelessness by telling friends or family members they’d be “better off without me.”

• Drinking more alcohol or using more drugs

• Giving away possessions

• Saying goodbye

Mood changes—from dark to light—can also be a major red flag. It seems counterintuitive but once a person makes the decision (or formulates a plan) to end their life, they may feel relieved. Don’t be fooled into thinking they are doing better, especially if other risk factors are present or you’d noticed the behaviors mentioned above.

One common misconception is that asking a person if they are thinking about suicide gives them the idea to do it. This is not the case. Many people struggling with depression don’t feel comfortable talking about it and may be grateful for your concern. Having the courage to ask what’s going on could quite literally save a life.