Each person experiences major depressive disorder (MDD) differently. The severity and length of symptoms vary. Some symptoms, like weight changes or fatigue, may be a sign of another underlying medical issue. But there are some common themes of depression symptoms.1
The most common depression symptoms include:1-5
- Depressed or sad mood
- Loss of interest or pleasure in things you once enjoyed (anhedonia)
- Weight changes
- Sleep issues
- Movement changes
- Extreme tiredness (fatigue)
- Feeling worthless or guilty
- Trouble thinking or concentrating
- Thinking about death or dying
In order to be diagnosed with MDD, a person needs to have at least 5 of the symptoms listed above, with at least 1 being depressed mood or anhedonia. These symptoms must last for at least 2 weeks at a time and occur on most days of the week. You may notice the symptoms in yourself, or a loved one may notice them first.2
Depressed mood
One of the main symptoms is having a depressed mood. This includes feeling hopeless, empty, or sad for most of the day and nearly every day. Signs of a depressed mood may also include crying more often than usual. People with a depressed mood may feel down in the dumps or discouraged. Some people also experience blunted emotions or irritability instead of sadness.3
Loss of interest or pleasure
Losing interest in or excitement for activities you once enjoyed can be a sign of depression. This is called anhedonia. An example of this would be no longer wanting to participate in a hobby you used to love. Loss of interest may also involve not wanting to interact in social settings or with loved ones anymore. Even very positive things still may not lead to happy feelings when a person is depressed.1-3
Weight changes
Changes in appetite or weight are common in people with depression. These changes can be in both directions. A person may have a decrease in appetite and lose weight. They may also have an increased appetite and gain weight. Regardless of what a person experiences, a change of 5 percent or more in body weight may occur when someone has depression.2,3
Sleep issues
Like with weight, sleep changes can go in different directions. Some people may have trouble sleeping nearly every night. This is called insomnia. People with insomnia have trouble falling asleep, staying asleep throughout the night, or both. Other people may sleep too much, which is called hypersomnia.3
Many people with depression report trouble getting out of bed in the morning. They may also feel like they are not well rested even if they sleep through the night.3
Movement changes
Some people with depression experience changes in the way their bodies move. It is possible to have restlessness or move faster than usual. This is called psychomotor agitation. People with psychomotor agitation may have trouble sitting still. They may also perform repetitive motions like pacing, fidgeting, or playing with their hands.2,3
Other people have slowed-down movements. They might also answer questions more slowly than usual or speak with a quieter volume.2,3
Fatigue
Fatigue is often described as an overwhelming sense of tiredness or weariness. It can occur even if a person thinks they are sleeping enough during the night. Some people with fatigue will feel like their arms or legs are heavier than usual. They may also need to take naps during the day.3
Feeling worthless or guilty
It is common for people with depression to experience feelings of worthlessness, or like they do not matter. It is also common to feel guilt. This guilt may be severe. While guilt can be justified when we do something wrong, MDD guilt does not have a clear source. People with depression may feel like minor setbacks are personal failures or feel bad for things that are not their fault.2,3
Trouble thinking or concentrating
Issues with thinking and concentration also are common in people with depression. These are called cognitive changes or neurocognitive dysfunction. Cognitive changes can be subtle signs that a person is dealing with depression. If a person seeks help for these symptoms, their doctor may look for signs of depression before looking for other causes.2-4
Cognitive changes may include trouble with:2-4
- Memory
- Paying attention
- Making decisions
- Planning complex tasks
Thinking about death and dying
In people with depression, thoughts about death can happen often and be severe. Some people may have suicidal ideation, or thoughts that they would be better off dead. Passive suicidal ideation is having these thoughts without a plan. On the other hand, active suicidal ideation involves planning how to hurt oneself. This is a sign of severe depression and can be a mental health emergency.2,3,5
Not everyone with depression has suicidal ideation. But if these thoughts do occur (in yourself or a loved one), seek immediate support and safety. You can call or text the Suicide and Crisis Lifeline at 988 anytime.6
There are other crisis lifeline options, too. Coming up with an emergency plan in advance can be helpful for accessing support quickly.
Subtypes of depression
There are also several subtypes of MDD. These describe additional symptoms or their severity. Examples of MDD subtypes include:2,3,7
- Anxious – Having high levels of anxiety, worry, panic attacks, or distress
- Atypical – Feeling pleasure in response to positive things, weight gain and increased appetite, hypersomnia, heaviness in the body or limbs, and a heightened sensitivity to rejection
- Catatonic – Having catatonia alongside depression. Catatonia is a collection of movement-related symptoms that can greatly impact quality of life. Signs of catatonia include being unable to speak (mutism), freezing in uncomfortable positions, echoing the words or sounds of others, and movements that have no purpose.
- Psychotic – Having signs of psychosis (loss of connection to reality), like hallucinations or delusions
- Mixed features – Having signs of mania alongside depression like a very happy mood, feeling invincible, having a decreased need for sleep, taking risks, or talking very fast or with ideas that do not make sense
Symptoms in kids and older adults
The signs of depression can vary among different groups of people, such as kids and older adults. In kids, behavioral issues at school or changes in eating or sleeping patterns may be the earliest warning signs. These symptoms may be the most noticeable for parents if their child has a hard time describing their emotions.8
In older adults, trouble with thinking or memory can be early signs of MDD. These issues are often misdiagnosed as age-related dementia. Older adults also may report feeling more tired than usual, which also may be chalked up to age. Any change in thinking or behavior in older adults needs a medical evaluation to determine whether it is due to aging, depression, or another medical issue.4,9
