Feeling down or sad is something everyone experiences. Sometimes, these difficult feelings go away on their own, but other times they get worse, turning into depression. Depression can be debilitating and painful, but it’s also treatable. That’s why it’s important to recognize the signs of depression so you can get help or help someone you love.
To tell the difference between temporary sadness and clinical depression, there are three factors to consider, says UNC Health psychiatrist Nate Sowa, MD, PhD: the symptoms, how long they last and how much they affect daily life.
Know the Symptoms of Clinical Depression
Many of the symptoms of clinical depression can occur outside of depression. That’s why psychiatrists look for some of the following symptoms to occur simultaneously to determine whether someone might be experiencing major depressive disorder, Dr. Sowa says.
- Having a low mood, feeling sad, empty or hopeless.
- Changes in sleep habits, such as sleeping more or less than usual.
- Changes in appetite, such as eating more or less than usual.
- Losing interest in things that once made you happy (exercise or hobbies, for example).
- Lack of energy; feeling tired to the point that small tasks seem challenging.
- Trouble concentrating or difficulty remembering things.
- Changes in how you move or speak, either doing so more slowly or becoming restless and fidgety.
- Feeling guilt, dredging up things from the past or blaming yourself unnecessarily.
- Lack of self-esteem, feeling like people would be better off without you and thoughts of suicide.
If you have thoughts of suicide, please seek help right away by calling or texting 988 for the Suicide & Crisis Lifeline, or 911. If you are experiencing some of these symptoms but do not feel immediately at risk, talk to your doctor. He or she can give you a screening to help assess whether treatment is needed.
“Primary care physicians can provide help or point patients in the right direction,” Dr. Sowa says. “Even feeling down can have an impact on different areas of your life, like taking your prescribed medications, getting exercise and eating healthy.”
Note the Duration of Symptoms of Depression
If a patient is experiencing at least five of the above symptoms, Dr. Sowa says the next thing he considers is how long the person has been feeling that way. A clinical diagnosis of depression requires someone to be experiencing symptoms for at least two weeks. That said, depression often builds up over a longer period of time.
“For most people these things develop slowly,” Dr. Sowa says. “They feel themselves falling into depression, as if they are falling into a deep hole. It doesn’t hit them like they’ve suddenly fallen off a cliff. Some patients describe it as feeling themselves rolling down a hill, and then eventually they’re at the bottom.”
For those who have experienced depression before, this fall may be identifiable. If you can detect that the process is starting early enough, you can adopt some practices that will help slow, or even fully prevent, a depressive episode, such as getting in touch with a therapist or focusing on reducing stress and getting adequate sleep. Dr. Sowa recommends physical exercise; do something that you already enjoy, or start small with a daily walk.
“The benefits of exercise are clearly documented and can reduce stress levels and symptoms of depression,” Dr. Sowa says. “Even better—exercise outside. Being in nature helps reduce cortisol, which plays a role in your body’s hormonal response to depression and anxiety.”
Check Your Ability to Function as Usual
The biggest gauge of clinical depression is how your life is being impacted. If you cannot function as usual on a daily basis, it’s a big indication of a major depressive episode. Some people with depression don’t want to work, interact with others or get out of bed. Sometimes this change may be more obvious to the people around you than to yourself.
“When I meet a patient for the first time and we have a conversation about what’s going on, I ask if that person’s friends, family and co-workers have noticed a change in them,” Dr. Sowa says.
Because depression often takes time to develop, the changes may not seem as drastic to you, or you may try to rationalize them away. It’s important to listen to your loved ones about depression symptoms they may see in you.
Because we are living in such stressful times, more people are reporting symptoms of depression. The coronavirus disease 2019 (COVID-19) pandemic and other crises in the news, including systemic racial injustice and natural disasters, can make it harder to maintain mental health. Whether you think you have clinical depression or not, it’s a good idea to speak to your doctor about how you’re feeling, Dr. Sowa says.
Talk to your doctor about your mood and any mental health concerns you have. Need a doctor? Find one near you.