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Depression: Major Depression & Unipolar Varieties
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Classic Symptoms of Major Depression

Rashmi Nemade, Ph.D., Natalie Staats Reiss, Ph.D., and Mark Dombeck, Ph.D.

The classic symptoms of Major Depression are described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), the widely accepted standard guidelines for psychiatric diagnosis. Symptoms associated with Major Depression cause clinically significant distress and impairment in social, occupational, or other areas of functioning. A person is diagnosed with MDD when they experience five or more of the following symptoms nearly every day for the same two-week period, and at least one of the symptoms is depressed mood or loss of interest or pleasure:

  • Difficulty sleeping or excessive sleeping
  • Fatigue and lack of energy
  • A dramatic change in appetite resulting in a 5% change in weight (gain or loss) in a month
  • Feelings of worthlessness, self-hate, and guilt
  • Inability to concentrate, think clearly, or make decisions
  • Agitation, restlessness, and irritability
  • Inactivity and withdrawal from typical pleasurable activities
  • Feelings of hopelessness and helplessness
  • Thoughts of death or suicide

Depressive symptoms can vary tremendously from one individual to the next. While one depressed person may experience feelings of sadness, hopelessness, and helplessness, another may feel angry, irritated, and discouraged. Depressive symptoms may also seem like a change in someone's personality. For example, a typically patient person might begin to lose his or her temper about things that normally would not be troubling to him or her. Depressive symptoms can also change across the course of the illness; someone who is initially withdrawn and sad can become highly frustrated and irritable as a result of decreased sleep and the inability to accomplish simple tasks or make decisions.

When Major Depression is severe, people may experience psychotic symptoms, such as hallucinations and delusions. Hallucinations are "phantom" sensations that appear to be real even though they are not caused by real things in the environment. Hallucinations may occur within any sensory realm (including sight, sound, taste, smell and touch), and can be very convincing (as well as disturbing) in their reality. The most common form of hallucination is auditory; involving hearing voices of people who are not actually present.

Delusions are very strongly held false beliefs that cause a person to misinterpret events and relationships. Delusions vary widely in their themes; they may be persecutory (someone is spying on or following you), referential (a t.v. show or song lyrics contain special messages only for you), somatic (thinking that a body part has been altered or injured in some way), religious (false beliefs with religious or spiritual content), erotomanic (thinking that another person, usually someone of higher status, is in love with you), or grandiose (thinking that you have special powers, talents, or that you are a famous person).

When someone is depressed and experiencing psychotic symptoms, the content of hallucinations and delusions is usually consistent with a depressed mood and focuses on themes of guilt, personal inadequacy, or disease. For instance, depressed people might truly believe that they are not able to perform their job or their parenting duties because they are inadequate (a feeling that may be reinforced by voices telling them that they are inadequate) and that everyone is snickering at them behind their back. A depressive episode that involves psychotic symptoms can be particularly problematic because a person can lose the ability to discriminate between real and imagined experiences.