The hallmark of depression is a persistent sad or “empty” mood, sometimes experienced as tension or anxiety. Life lacks pleasure. People with mild depressions may go through the motions of eating, sex, work, or play, but the activities seem hollow; people with more severe depressions withdraw from these activities, feeling too tired, tense, or bitter to participate. There is often a nagging fatigue, a sense of being unable to focus, a feeling of being unproductive. There is usually difficulty concentrating, remembering, and making decisions. Guilt and excessive self blame may take the form of negative, accusatory thinking—you can’t do anything right. Might as well give up. No one loves you. The negative mood distorts reality to create a negative world. People often turn to alcohol or other drugs for relief, but it just adds another problem.
There are often a host of physical symptoms with depression, and sleep disturbances are key. People may have difficulty falling asleep, or may awaken early without feeling refreshed. Appetite may increase or decrease. There may be difficulty in sexual functioning. There may be nagging aches and pains that don’t respond to medical treatment.
Suicidal thoughts and impulses are often present, and suicide may be a real risk. Some people are repeatedly tormented by these impulses, which they experience as frightening and painful, while others have them appear as if out of the blue, detached from emotions. The impulse to spin the wheel and drive suddenly into oncoming traffic is horribly common, though no one ever talks about it.
From all these symptoms, it might seem that a depressed person is easy to recognize. It is often easy, when the person recognizes it himself. When it’s a distinct change from a more normal state of mind, the depression is experienced as something foreign to the self, something to be overcome. But very often, depression has gradually become part of the self: the person has felt this way for as long as he or she can remember, and can’t imagine anything else.