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Below is a recent article written exclusively for our website by Dr. Regan Stanger. Dr. Stanger is a member of the Board of Advisors for the David Dawes Nee II Foundation. She is also a Clinical Psychiatrist specializing in child and adolescent psychiatry and is currently training at the New York Psychoanalytic Institute. Dr. Stanger is in private practice in New York City.

“Really?” is a common surprised response when I inform an adolescent or young adult that he/she is suffering a clinical depression. As a child, adolescent, and adult psychiatrist in private practice, I have the unique perspective of observing how depression presents itself across the decades of life. Not only can the symptoms of depression present somewhat differently at various ages, but a person’s awareness of their illness can also be quite variable. Children almost never self-diagnose depression, whereas older adults often present with a chief complaint of “I’m depressed”. But the young adult hovers somewhere in the middle. The young adults often greet me with complaints of “I’m anxious”, “I’m having a hard time”, or “I don’t feel like myself”. They frequently do not recognize that they are suffering from the medical illness of depression.

Mood disorders often present for the first time in late teen years and early twenties. The reasons for this are plentiful. Not only is there a likely biological component to the emergence of symptoms at this age, but it is an time of tremendous upheaval and transition. There is potential social isolation as the young adult leaves family, friends, and a familiar community. Managing newly found independence can be overwhelming. For the first time, a young adult may be living with a roommate, buying their own food, or planning a daily schedule. Without parental oversight, young adults may begin to experiment with drugs or alcohol. If a young adult enters college or graduate school, they may be faced with profound academic stressors.

Clearly, it is a time in life when people may be more vulnerable to developing a mood disorder. However, the young adult may never have experienced a depression before, and can find the symptoms unfamiliar and bewildering. Most people understand that sadness and suicidal thinking are hallmarks of depression. However, there is a myriad of other symptoms that can indicate depression, many of which people may not be aware of. The societal stigma associated with depression can influence someone to view themselves as anxious, or “just having a hard time”. For these reasons, I wanted to describe in detail the symptoms of depression that are included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). My hope is that this description will further clarify the symptoms of depression, so that people suffering from depression (or their family and friends) can have a better understanding of this illness.

Someone suffering from depression suffers from a low mood most of the day, nearly every day. This is a painful state of mind, often characterized by hopelessness. People may experience frequent tearfulness and feel overwhelmed by their emotions. One patient told me, “I feel so much pain and disappointment that it seems like too much to deal with”. A depressed person will observe happy people around him and feel as though it is impossible for him to ever feel that way. A depressed person may feel like they are a burden to others, especially family members or friends. For this reason, they may be reluctant to share their emotional experiences, further isolating themselves. There may be cyclical shifts in mood throughout the day; this can lead people to believe that they are not truly depressed because they feel a bit better at certain times of the day. One young woman complained of feeling very sensitive, that she would burst into tears at the slightest frustration or disappointment.

With depression, there is a diminished interest in activities. I find that this often occurs because people feel that any task is a monumental effort. The daily routine feels overwhelming. People become socially isolated because all socializing feels like too much of an effort. This is one sign that friends may notice. People become more withdrawn, may spend much of the day in bed, watching TV, or sitting in front of the computer. People complain of feeling stuck, and contemplate fleeing their current situation with hopes that their emotional state will improve. I often hear people with fantasies of quitting their jobs or quitting school. Weekends are difficult; time passes too slowly and people find that they begin to dread the weekends. I often hear the complaint that people are “going through the motions”, without deriving any noticeable pleasure or satisfaction from their lives. Often, people with depression are able to function at a fairly normal level, although they feel miserable. This may lead them to believe that they are not be depressed.

I often hear about changes in appetite and weight. Depressed people often lose weight because they lose their appetite or feel that food no longer tastes good. I also see people gain weight because they are unable to make the effort to purchase or prepare healthy foods. They also use unhealthy foods as a reward for getting through the day.

People with depression may have either insomnia or increased sleep. Insomnia can present with difficulty falling asleep, difficulty staying asleep, or early morning awakening. Insomnia can cause people to feel exhausted during the day. It can also create anxiety, as people worry about how the lack of sleep will affect them the following day. Patients also tell me that sleep feels like their only escape; this can lead to increased sleep throughout the day. People with depression often have trouble getting out of bed because they wake up and immediately feel dread about facing the day. Fatigue is an obvious result of sleep disturbance. Poor sleep (either insomnia or increased sleep) can cause someone to feel incredibly lethargic. This is another symptom that family and friends may notice in someone who is depressed.

Depression can also affect a person’s energy level. Some people develop agitated behaviors: pacing, restlessness, fidgeting. On the other hand, some people seem more slowed and lethargic. Their movements may seem as though they require more effort. One woman told me that it felt like an effort to even raise her arms above her head to get dressed in the morning. Again, these are symptoms that can be observed by others.

Patients may complain that they feel worthless. They expect that the rest of their lives will be pointless. They despair they will ever have academic, romantic, or professional success. I also hear people complaining of feeling guilty. The guilt may be related to experiences in the past or may occur for no tangible reason.

Depression can also impact one’s concentration and ability to make decisions. People complain that their memory seems poor, that they have trouble reading. This can be a significant problem for a young adult in school or starting at a job.

One of the most troubling symptoms of depression is the recurrent thought of death or suicide. People sometimes have thoughts of hoping to go to sleep and not wake up. They may have fantasies of being hit by a car or developing a life threatening illness. The most serious type of suicidal thinking is formulating a plan to harm oneself. If someone expresses this type of wish, they must seek immediate medical attention and should be taken to an emergency room. However, all types of suicidal thinking should be taken very seriously and indicate that someone must seek treatment as soon as possible.

There are other symptoms of depression that are not listed in the DSM-IV but are frequently seen in practice. For example, I often find that anxiety accompanies depression. People find that they are worried and nervous. They often ruminate, which means that they think about worries or negative experiences over and over again. I frequently see people who go over events from their past repeatedly, wondering if they should have done something differently.

I also see people increase their use of alcohol and drugs in an attempt to alleviate the pain of depression. People often use alcohol in particular to alleviate anxiety. This is obviously problematic for many reasons, but one significant issue is that alcohol and drugs can worsen depression and anxiety. This is another symptom that family and friends may notice.

It is imperative that young adults be educated about this illness so that they can recognize the symptoms in themselves or friends. It is also tremendously important to know that depression can be successfully treated with psychotherapy, medication, or both. If you or someone you care about is suffering from the symptoms described above, I strongly encourage that you seek treatment for yourself or for your loved one. I have seen countless patients suffering tremendously from depression who, with treatment, have overcome this terrible illness.