Signs of Depressive Illness

Last Updated: Dec. 1, 2003

In major depression, sometimes referred to as unipolar or clinical depression, people have some or all of the symptoms listed below for at least two weeks but frequently for several months or longer. Episodes of the illness can occur once, twice, or several times in a lifetime.

In dysthymia, the same symptoms are present though milder, and last at least two years. People with dysthymia are frequently lacking in zest and enthusiasm for life, living a joyless and fatigued existence that seems almost a natural outgrowth of their personalities. They also can experience major depressive episodes.

Manic-depression, or bipolar disorder, is not nearly as common as other forms of depressive illness and involves disruptive cycles of depressive symptoms that alternate with mania. During manic episodes, people may become overly active, talkative, euphoric, irritable, spend money irresponsibly, and get involved in sexual misadventures. In some people, a milder form of mania, called hypomania, alternates with depressive episodes. Unlike other mood disorders, women and men are equally vulnerable to bipolar disorder; however, women with bipolar disorder tend to have more episodes of depression and fewer episodes of mania or hypomania.

A thorough diagnostic evaluation is needed if three or more of the following symptoms persist for more than two weeks (one week in the case of mania), or if they interfere with work or family life. An evaluation involves a complete physical checkup and information gathering on family health history. Not everyone with depression experiences each of these symptoms. The severity of the symptoms also varies from person to person, but depression is a highly treatable illness.

Depression symptoms:

• Persistent sad, anxious, or “empty” mood
• Loss of interest or pleasure in activities, including sex
• Restlessness, irritability, or excessive crying
• Feelings of guilt, worthlessness, helplessness, hopelessness, pessimism
• Sleeping too much or too little, early-morning awakening
• Appetite and/or weight loss or overeating and weight gain
• Decreased energy, fatigue, feeling “slowed down”
• Thoughts of death or suicide, or suicide attempts
• Difficulty concentrating, remembering, or making decisions
• Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain

Mania symptoms:

• Abnormally elevated mood
• Irritability
• Decreased need for sleep
• Grandiose notions
• Increased talking
• Racing thoughts
• Increased activity, including sexual activity
• Markedly increased energy
• Poor judgment that leads to risk-taking behavior
• Inappropriate social behavior

Causes of Depression

Genetic factors: There is a risk for developing depression when there is a family history of the illness, indicating that a biological vulnerability may be inherited. The risk is somewhat higher for those with bipolar disorder. However, not everybody with a family history develops the illness. In addition, major depression can occur in people who have had no family members with the illness. This suggests that additional factors, possibly biochemistry, environmental stressors, and other psychosocial factors, are involved in the onset of depression.

Biochemical factors: Evidence indicates that brain biochemistry is a significant factor in depressive disorders. It is known, for example, that individuals with major depressive illness typically have dysregulation of certain brain chemicals, called neurotransmitters. Additionally, sleep patterns, which are biochemically influenced, are typically different in people with depressive disorders. Depression can be induced or alleviated with certain medications, and some hormones have mood-altering properties. What is not yet known is whether the “biochemical disturbances” of depression are of genetic origin, or are secondary to stress, trauma, physical illness, or some other environmental condition.

Environmental and other stressors: Significant loss, a difficult relationship, financial problems, or a major change in life pattern have all been cited as contributors to depressive illness. Sometimes the onset of depression is associated with acute or chronic physical illness. In addition, some form of substance abuse disorder occurs in about one-third of people with any type of depressive disorder.

Other psychological and social factors: Persons with certain characteristics – pessimistic thinking, low self-esteem, a sense of having little control over life events, and a tendency to worry excessively – are more likely to develop depression. These attributes may heighten the effect of stressful events or interfere with taking action to cope with them or with getting well.

Upbringing or sex role expectations may contribute to the development of these traits. It appears that negative thinking patterns typically develop in childhood or adolescence. Some experts have suggested that the traditional upbringing of girls might foster these traits and may be a factor in women’s higher rate of depression.

Source: National Institute of Mental Health

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