Clinical depression (also called major depressive disorder, severe depression disorder or unipolar depression) is characterized by a pervasive low mood, loss of interest in usual activities and diminished ability to experience pleasure. The term “depression” is used to describe a temporary depressed mood when one “feels blue,” however clinical depression is a serious and often disabling condition that can significantly affect a person’s work, family life, performance in school, sleeping and eating habits, general health and ability to enjoy life.
The course of clinical depression varies widely. It can be a once in a lifetime event or recurrences many times. It can appear gradually or suddenly, and can last for a few months or be a life-long disorder. Depression is a major risk factor for suicide; also, people with depression suffer from higher mortality from other causes.
Clinical depression can present with a variety of symptoms, but almost all display a marked change in mood, a deep feeling of sadness, and a loss of interest or pleasure in favorite activities. Other symptoms include:
- Persistent sad, anxious or “empty” mood
- Loss of appetite and/or weight loss or conversely overeating and weight gain
- Insomnia, early morning awakening, or oversleeping
- Restlessness or irritability
- Psychomotor agitation or psychomotor retardation
- Feelings of worthlessness, inappropriate guilt, helplessness
- Feelings of hopelessness, pessimism
- Difficulty thinking, concentrating, remembering or making decisions
- Thoughts of death or suicide or attempts at suicide
- Loss of interest or pleasure in hobbies and activities that were once enjoyed
- Withdrawal from social situations, family and friends
- Decreased energy, fatigue, feeling “slowed down” or sluggish
- Persistent physical symptoms that do not respond to treatment, such as headaches, digestive problems, and chronic pain
- Decreased feeling in motor-speed (time seems to slow down)
Not all patients have every symptom. The severity of symptoms varies widely among individuals. Symptoms must persist for at least two weeks before being considered a potential sign of depression, except for suicidal thoughts or attempts at suicide. Diagnosis of clinical depression in children is more difficult than in adults and is often left undiagnosed, thus untreated. Symptoms in children are often ignored as normal childhood moodiness. Diagnosis is also difficult because children are more likely than adults to show different symptoms depending on the situation. While some children still function reasonably well, most who suffer from depression will suffer from a noticeable change in their social activities and life, a loss of interest in school and poor academic performance, and dramatic changes in appearance. They may also abuse drugs and/or alcohol, particularly past the age of 12. Although much rarer than in adults, children with major depression may attempt suicide or have suicidal thoughts even before the age of 12. Parents should speak openly about depression and ask pointed questions about mood, even if there is no overt sign of depression. Many parents have experienced the suicide of a child who had no obvious signs of depression.