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Depressive Disorder - Symptoms
Last reviewed: 04.07.2025
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Depression is characterized not only by a depressed mood, but also leads to cognitive, psychomotor and other disorders (for example, poor concentration, fatigue, loss of sexual desire, menstrual irregularities).
Other psychiatric symptoms or disorders (such as anxiety or panic attacks) often coexist with depression, sometimes making diagnosis and treatment difficult. Patients with all forms of depression are likely to abuse alcohol and other psychoactive substances to self-medicate sleep problems or anxiety symptoms; however, depression is less likely to be a cause of alcoholism and psychoactive substance abuse than is commonly believed. Patients with depression also smoke heavily and neglect their own health, which increases their risk of developing and progressing other diseases (such as chronic obstructive pulmonary disease). Depression can reduce immune defenses. Depression increases the risk of myocardial infarction and stroke by releasing cytokines and factors that increase blood clotting.
Major depression (unipolar disorder)
Periods (episodes) that include 5 or more mental or somatic symptoms and last 2 weeks or more may be defined as major depression. The essential symptoms are a depressed mood to the point of despair and hopelessness (often called depressive mood) or a loss of interest or pleasure in daily activities (anhedonia). Other mental symptoms include feelings of worthlessness or guilt, recurrent thoughts of death or suicide, decreased ability to concentrate, and sometimes agitation. Somatic symptoms include changes in weight and appetite, loss of energy, fatigue, psychomotor retardation or agitation, and sleep disturbances (insomnia, hypersomnia, early morning awakenings). The patient may appear unhappy, with tears in the eyes, furrowed brows, drooping corners of the mouth, hunched posture, poor eye contact, lack of facial expression, slow body movements, and speech changes (e.g., quiet voice, monosyllabic responses). This appearance is also characteristic of Parkinson's disease. Some patients experience such a profound depression that they are unable to cry; they say they are unable to experience normal emotions, and it seems to them that the world around them has become colorless and lifeless. The patient's nutrition may be significantly impaired, requiring immediate intervention. Some depressed patients neglect personal hygiene or even their children, loved ones, and pets.
Major depression is often divided into subgroups. The psychotic subgroup is characterized by delusions, convictions of unforgivable sins or crimes, hidden, incurable, or shameful illnesses, or ideas of persecution. Patients may have auditory or visual hallucinations (eg, voices of accusation and condemnation). The catatonic subgroup is characterized by severe psychomotor retardation or excessive aimless activity, withdrawal, and, in some patients, grimacing and repetition of others' speech (echolalia) or movements (echopraxia). The melancholic subgroup is characterized by loss of pleasure in virtually all activities, inability to respond to positive stimuli, unchanging emotional expressions, excessive or inappropriate feelings of guilt, early morning awakenings, marked psychomotor retardation or agitation, and marked loss of appetite or weight. The atypical subgroup is characterized by an improvement in mood in response to positive stimuli and increased sensitivity, which manifests itself in a pronounced depressive reaction to criticism or rejection, a feeling of painful helplessness or anergy, weight gain or increased appetite, hypersomnia.
Dysthymia
Mild or subthreshold depressive symptoms are considered dysthymia. Symptoms typically begin insidiously during adolescence and persist for years or decades without becoming severe (>2 years duration required for diagnosis); dysthymia may be periodically complicated by episodes of major depression. Patients with this disorder are typically gloomy, pessimistic, joyless, passive, apathetic, introverted, overly critical of themselves and others, and complaining.
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Depression not elsewhere classified
Clusters of symptoms that do not meet criteria for other depressive disorders are considered depression not elsewhere classified. For example, mild depressive disorder may include some symptoms of major depression lasting 2 weeks or more, but fewer than the 5 required for a diagnosis of major depression. Brief depressive disorder includes the symptoms required for a diagnosis of major depression, but lasts only 2 days to 2 weeks. Premenstrual dysphoric disorder includes depressed mood, anxiety, and decreased interest in activities, but only during specific periods of the menstrual cycle, beginning with the luteal phase and ending a few days after the onset of menses.
Mixed anxiety and depression
Although this condition, also called anxious depression, is not considered a variant of depression in the DSM-IV, it is characterized by mild symptoms of both anxiety and depression. The course is usually chronic and intermittent. Since depressive disorder is more severe, patients with mixed anxiety-depressive disorder should be treated for depression. Obsessions, panic, social phobia in combination with hypersomnic depression are indicative of bipolar II disorder.