Major depressive disorder

Signs and Symptoms

The foremost symptoms of depression are loss of interest, loss of energy, and an inability to experience pleasure. Sadness associated with depression is often described as inescapable and more painful than normal sadness, which the person may or may not be able to remember having. Depression can be so overwhelming that a person cannot recognize the symptoms. Many symptoms are revealed only when treatment begins.

Symptoms of depression include the following:

-Loss of Energy:

More than 90% of depressed people experience overwhelming loss of energy. This can cause a person to stay home and avoid social interaction, and prevent a person from starting or finishing projects, maintaining previous interests, or exercising. The effects of diminished energy compound the effects of depression, when work, school, and family obligations are compromised. Also, lack of activity results in loss of muscle tone, muscle mass, and, eventually, bone mass. In turn, these effects lead to degeneration in physique, strength, and physical well-being.

-Feelings of Worthlessness:

Feelings of worthlessness are common during episodes of depression. Depressed people often feel they are not good at anything and not important to anyone. It becomes impossible for them to accept compliments, or to recognize their achievements. Low self-esteem not only intensifies a low mood, it also compounds a negative view of the world. The apathy that results can obscure a person’s recognition and treatment of depression. Depressed people may get so used to having low self-esteem that they feel ineffectual (like they have no impact on the world). Self-loathing and extensive, unwarranted guilt often result from feelings of worthlessness.

-Sleep Disruption:

Approximately 80% of depressed people suffer from insomnia and may be unable to fall asleep (sleep onset insomnia). This can lead to a loss of energy, excessive daytime sleepiness, and fatigue. Polysomnogrpahic tests have shown less REM sleep in depressed people, which means less time in deep sleep and less dreaming. Sleep disorders are twice as likely to cause depression as vice versa. People with insomnia are 4 times as likely to suffer from depression as people who sleep normally and people with psychiatric disorders are twice as likely to experience insomnia. Insomnia is also a symptom of other psychiatric disorders, such as schizophrenia.

Conversely, some depressed people sleep a lot during the day, and longer than normal at night. Feelings of isolation may cause people with depression to sleep too much.

-Weight Loss and Weight Gain:

When depressed people lose the energy it takes to accomplish basic tasks, important needs such as eating are compromised. Many depressed people lose their appetite, which results in erratic eating habits and missed meals. Subsequent weight loss may result in nutritional deficiency and mental and physical sluggishness. A high percentage of people, especially women, who suffer from eating disorders, such as anorexia, bulimia, and binge eating, are diagnosed with depressive disorder. Some people with depression have an increased appetite and gain weight. These people are usually the same who oversleep.

-Loss of Libido:

Depression manifestations such as weight gain, sleeping too much, and a loss of interest in sex are known as vegetative states. Feelings of worthlessness and self-loathing, combined with a disinterest in pleasure, cause a loss of intimacy and a decline in sexual activity. Depressed people (especially those undiagnosed) are typically unable to talk about the cause for their reduced sexual drive with their partners. When partners do not understand that depression is causing an absence of intimacy, counseling and sex therapy is often sought without a proper diagnosis of mood disorder. Loss of libido is also a common side effect of antidepressant medications.

-Psychomotor Agitation and Psychomotor Retardation:

Psychomotor agitation and retardation occur in depression, producing states of over activity and under activity respectively. Agitation and retardation can lead to impaired cognition, judgment, reason, and decision making, which often further isolates depressed people and prolongs symptoms. Psychomotor agitation can also lead to generalized restlessness.

Motor agitation is rarer than motor retardation and is often occurs in the elderly. Over activity in this sense does not mean mania. The agitated state in major depressive disorder should not be confused with the manic episode that occurs in bipolar disorder, when mood is temporarily elevated by a transient sense of hope and elation.

Psychomotor activities are the physical gestures that result from mental processes and are a product of the psyche. Many psychomotor behaviors associated with mental disorder affect impulses, cravings, instincts, and wishes. The spectrum of agitated behavior includes the following:

-Incoherent conversation

-Expansive gesturing

-Pacing and hair twirling

Psychomotor retardation manifests as a slowing of coordination, speech, and impaired articulation. In this state, a person appears sluggish and seems hesitant or confused in speech and intention.

-Suicidal Ideation:

 Depression can be a fatal disease. Recurrent thoughts of death, especially suicide, plague about 60% of depressed people, and 15% commit suicide. Women attempt suicide more often than men, but men succeed nearly twice as often.

Other Symptoms

In addition to the main criteria for diagnosis, several other symptoms are common to depression. These include:

-Withdrawal (i.e., from family, friends, work, school)

-Quitting activities previously enjoyed (e.g., sports, hobbies)

-Violence (especially in depressed adolescents and the elderly)

-Inability to cry despite the urge

-Generalized negative views

-Memory loss (i.e., plans, short-term)

-Slumped posture, especially when at rest

-Lack of facial expression

-Repeated loss of concentration, often with trancelike staring

-Substance dependency (e.g., alcoholism, illicit drug use)

-Disregard for appearance and personal hygiene

-Compulsion that affects most normal activities

-Recurrent need to get away, leave town, or talk of this need.