Most people mistake two different concepts associated with a negative mood. We tend to think that it is the same feeling depressed than being depressed. It is not the same thing. The former is a natural emotion we all go through. Nobody can say a depressed mood has never knocked his or her doors because even if we deal differently with sadness, it is part of our human experience. However, clinical depression is a pathologic state of mind characterized by negative feelings but deeply rooted in the chemistry of the human mind.
Clinical depression is very different from feeling depressed or down because it involves not only a temporary thought or emotion, but also continuous signs and symptoms both in the train of thought, the levels of energy, and the body itself. Thus, clinical depression goes beyond the boundaries of a simple emotion, and it is when this negative emotion becomes pathologic and unbearable. So, read this article if you suspect you or someone you love has a clinical condition of depression and do not hesitate to see a professional if everything seems to point out to that direction.
The most important signs and symptoms of clinical depression are as follows:
1. Pessimistic thoughts and sad emotions
Even if clinical depression is not the same as sadness, it is often an important part of the diagnosis. We should give importance to sad emotions as a part of experiencing depression, but make clear they are not always completely clear, or they are but patients do not know where does this feeling come from. Sadness is included in the criteria to diagnose depression, but there are many others, and even though it is common, diagnosing depression might be independent of this symptom.
However, patients who do feel sad experience this emotion for a very prolonged period. It is not necessarily related to a given thought, loss, or situation they are living with their families or friends. In most cases, they can’t make out a clear reason why they are feeling like this, and most of them think they are just being pessimistic and delay their diagnosis. However, this level of sadness in depressed patients reach the point of affecting their lives and that of their loved ones.
Depressed patients are usually very susceptible to see and blame themselves for their own mistakes. They usually have a pessimistic sight of the world and live in constant frustration by the way everything turns out to be and how their lives tend to go. They are often unsatisfied and disappointed and feel worthless of a good life, good experience or good friends.
2. No interest in exciting things
This is one of the most important symptoms in depression, and it is even more important than sadness itself because it is a change everybody can see, both the patient and his family. These patients stop feeling interested in things they enjoyed or liked before starting their depressive symptoms. They do not have any specific hobbies, they are not interested in sharing passions with other people, and do not feel any surge of excitement when they are doing their favorite activities or practicing their favorite sports.
In this regard, it is important to say that having a lack of interest over things that we usually enjoy is a common symptom in people who are overcoming a duel. However, it is limited to a short time and these intense emotions that overshadow excitement slowly fade away with time. That does not happen in depressed patients, and this prolonged absence of interest soon starts to deteriorate their social behavior.
3. Social withdrawal
In a way, the lack of interest in these patients lead them to social withdrawal and voluntary seclusion. They feel sad, worthless, and they don’t have any interest in sharing their thoughts, passions or hobbies. Thus, they turn progressively away from their friends and their family, even more, when they are hardly criticized. They may become rude and careless when dealing with others, and in some cases, they become aggressive towards family members and people trying to help them or get closer to them.
That is how depressive patients progressively impair their own social contact reducing it to the minimum and doing less and less extracurricular activities and extra hours at work because they can’t withstand being close to others. Their isolation is often filled with passive activities such as staying behind a screen for a long time or spending excessive time in bed.
4. Fatigue
Depression is associated with a low level of energy, in a clinical entity called chronic fatigue. In some cases, patients would experience fatigue without any seemingly major negative feelings, and if they fulfil the rest of the criteria, they might be diagnosed as a depressed patient. Chronic fatigue usually results from an alteration in the chemistry of the brain. Patients have insufficient sleep as we will address further, they struggle to fall asleep, and at the same time, their organism is always on metabolic stress due to depressive feelings, trying to stabilize brain chemistry levels.
Thus, it is common that depressed patients feel drowsy most of the time, and fall asleep in the middle of the day, struggling to concentrate and making efforts to think when it is required. This only adds up to the fact that they feel worthless and do not want to go out anymore.
Depressed patients often experience chronic fatigue, but if you have low energy levels, there are many other things to consider before thinking about depression as a diagnosis. Thus, if you are experiencing this terrible symptom and want to know the real cause, talk to your doctor about it and follow his instructions to be correctly diagnosed.
5. Unplanned weight loss or weight gain
Eating is one of the activities that trigger more pleasure in the organism, especially certain foods. That is why many depressed patients try to cope with their feelings by eating disproportionately. This emotional eating often leads to weight gain, and it is not necessarily because they eat large portions of food in each meal. Some patients are very anxious and eat small bites of food throughout the day, adding up to a very large volume of food at the end of the day.
The opposite is also true, and some patients with depression would instead refuse to eat, showing a complete apathy to foods they used to enjoy. Thus, they lose weight without making plans and become malnourished and susceptible to infectious disease and other health problems.
6. Disruption of the sleeping pattern
Another symptom we should not take lightly is a difficulty to sleep and a disruption of the normal sleeping pattern. These patients often have severe sleeping problems consisting of both difficulties to fall asleep and to achieve a meaningful sleep. They wake up continuously in the middle of the night and in most cases they are unable to reach REM, and profound stages of sleep required to wake up rested and feeling energetic for the day to come.
Anxiety is often an important part of depression, and patients usually feel the silence of the night as a welcoming moment to think. Even if they do not want, they can’t stop thinking about their worries, past experiences, their mistakes throughout the day, and any other disturbing thought that intrusively comes to mind. Insomnia is a common cause of low energy levels, and it further aggravates many other symptoms in depressed patients, including their cognitive skills and overall mood.
7. Difficulty to make decisions and think clearly
Depressed patients have impaired brain chemistry, which reflects in their way of thinking and how fast they are able to respond to various stimuli. They have a very slow cognitive processing, which means they think and process information very slowly and need too much time to make decisions and think straight. They need to make real efforts to concentrate, and their thoughts are often vague.
Sluggish thinking may also reflect in their movements, and they start doing things in slow motion, which may be even worse if they already started medication because some of them would make them feel better in almost every other symptom described in this list, but slow down their movements further in the process.
These patients are not confident enough in their own capacities, and this often leads them to be indecisive and difficult to make choices. When they do, it is also difficult to maintain their decisions and not change their course of action. Their impaired decision-making becomes more and more prominent as the disease progresses, and this impairs their social, academic and working performance.
8. Reduced performance at school or work
Patients with depression often have a progressive deterioration in their social performance as we have mentioned previously. But as they turn away from society, they are often tired, and thinking and deciding become more difficult. All of this slowly impairs their performance in their academic and working goals. They may think they have the same academic goals, but their motivation levels have dropped dramatically. They may be working somewhere they like doing something they used to enjoy, but they are not interested anymore, and it reflects in their work.
These patients slowly become unresponsive and irresponsible in their day-to-day activities. They avoid all social contact with their co-workers and stop doing any extracurricular activities because they are often unsatisfied. This leads in time to many different problems in the school or at work, especially if they are becoming aggressive as a part of their abnormal behavior.
Depressed patients are often anxious patients as well, and both work and school trigger that anxiety and make them feel even worse. As depression progresses, grades start declining, and they may not care if they are fired from their job or do very little to avoid that.
9. Substance abuse
This is one of the most common consequences of depression, especially in men. Substance abuse is associated with clinical depression, and it is usually around alcohol, but may also include illegal drugs and some prescription drugs these patients find illegally. They use these substances, and often food as well, as a means to cope with depression and momentarily feel better. This one is not included in the diagnostic criteria, but substance abuse is responsible for making the symptoms of depression even worse.
Patients with depression and substance abuse are more susceptible to feeling worthless and sad when they are off the effects of alcohol and drugs. They are usually more aggressive and impulsive, and their social, academic, and working skills become even more impaired. Thus, it is important to address this issue before it becomes an additional problem for the patient and his family.
10. Recurrent thoughts of suicide
This symptom is very serious and should be considered carefully in people with diagnosed depression and those who do not fulfil the criteria. So, if you or any of your loved ones have recurrent thought of suicide, it would be a good idea to talk to a professional about them and figure out what is going on, whether or not it is dangerous and what to do. Suicidal thoughts are not as common in depression as many people may think, but when they start appearing it is probably because it is a major depression sustained for a very long time. Thus, it is important to diagnose these patients without any further delay and start their medical treatment right away.
The progression of suicidal thoughts in depression is very slow. It starts as a vague and occasional thought. However, it is recurrent and comes back after some time with or without any trigger. As depression deepens further, these patients may start having more serious thoughts about suicide and self-harm, making plans, writing goodbye letters, and even making attempts to kill themselves.
Self-harm behaviors such as cutting themselves should be a warning sign in depressed patients. We should take this seriously because not doing so has been the reason why some of these patients have taken their own lives without a proper diagnosis or treatment to avoid these consequences.
As you can see, it is very important to differentiate clinical depression from feeling sad. Different from a simple emotion, depression is a major health problem that involves many different body systems and affects not only the psychological but also the physical health of patients. That does not mean you should neglect your feelings as a secondary problem if you don’t see any physical symptom associated to it. If you suspect you are suffering from depression, try to find professional help right away and do not delay your diagnosis.
References
Kanter, J. W., Busch, A. M., Weeks, C. E., & Landes, S. J. (2008). The nature of clinical depression: Symptoms, syndromes, and behavior analysis. The Behavior Analyst, 31(1), 1-21.
Hollon, S. D., Kendall, P. C., & Lumry, A. (1986). Specificity of depressotypic cognitions in clinical depression. Journal of Abnormal Psychology, 95(1), 52.
King, C. A., Ghaziuddin, N., McGOVERN, L. A. U. R. I. E., Brand, E., Hill, E., & Naylor, M. (1996). Predictors of comorbid alcohol and substance abuse in depressed adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 35(6), 743-751.
Beck, A. T., Steer, R. A., Beck, J. S., & Newman, C. F. (1993). Hopelessness, depression, suicidal ideation, and clinical diagnosis of depression. Suicide and Life‐Threatening Behavior, 23(2), 139-145.