Depression symptoms: Recognizing common and lesser-known symptoms

Depression is one of the most common mental health disorders in the United States. In 2020, 18.4% of people over the age of 18 reported having received a diagnosis of depression at some point.

While we tend to associate depression with feeling sad and withdrawn, there are also other, less-recognized signs of depression. These include physical pain, poor hygiene, and a variety of behavioral changes

What is depression?

Depression is a mental health disorder that affects a person's mood and feelings of self-worth. Symptoms of depression can range from mild to severe. The most severe type of depression is called major depression.

A combination of genetic, biological, environmental, and psychological factors are believed to play a role in depression.

What are classic depression symptoms?

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), there are nine classic symptoms of depression:

• depressed mood
• markedly diminished interest or pleasure in most or all activities
• poor appetite, weight loss, or weight gain
• insomnia or hypersomnia
• slowing down of mental or physical activities (for example, sluggishness or diminished hand-eye coordination)
• fatigue or loss of energy
• feelings of worthlessness or excessive or inappropriate guilt
• diminished ability to think or concentrate ("brain fog"), or indecisiveness
• recurrent thoughts of death; thinking about, planning, or attempting suicide.

Mental health professionals will give someone a diagnosis of major depression if they experience five or more of these symptoms over a period of two weeks or longer. The five symptoms must include depressed mood or a lack of pleasure in usual activities.

What are less-recognized symptoms?

While they may not be required for an official diagnosis of depression, there are other symptoms that are often experienced by individuals who are depressed. Being able to recognize these signs and symptoms may prompt you or a loved one to seek help.

Substance use

Substance use disorders have complex causes, but they are closely linked to depression. Often, using alcohol, drugs, or both, is a form of self-medicating depression. People with substance use disorders may not recognize that they are depressed.

Physical pain

There has been research showing an association between depression and an increase in inflammation and decrease in immune function. This may contribute to a person with depression experiencing various types of physical discomfort such as headaches or stomachaches.

Neglecting personal hygiene

Low mood, sluggishness, and fatigue can make it difficult for someone with depression to muster the energy to tend to personal hygiene practices such as showering, brushing teeth, doing laundry, or brushing hair.

Sexual issues

Loss of libido is a common but lesser-known symptom of depression. It can cause erectile dysfunction in men and vaginal dryness in women, along with problems achieving orgasm.

What behavioral changes may be associated with depression?

Depression can also cause changes in mood or behavior that go beyond crying and sadness. These include:

• increased anger or irritability
• feeling restless or on edge
• becoming withdrawn, negative, or detached
• increased engagement in high-risk activities
• greater impulsivity
• isolating from family and friends.

When to seek help

If you or someone you love is experiencing symptoms of depression, consider contacting your primary care physician or a mental health professional.

If you feel overwhelmed by negative thoughts or feelings, or are having thoughts of self-harm or suicide, seek immediate help by calling 911, going to your nearest emergency department, or contacting one of the following emergency hotlines:

• National Suicide and Crisis Lifeline: Call or text 988
• National Suicide Prevention Lifeline: 1-800-273-TALK (8255)
• Crisis Text Line: Text HOME to 741-741