Depression: Symptoms, Complaints, Signs

The following are the symptoms of a depressive episode:

Main symptoms

  • Depressed, depressed mood
  • Loss of interest and joylessness
  • Lack of drive, increased fatigability (often even after small efforts) and activity limitation

Additional symptoms (according to ICD-10 (see chapter F32 there):

  • Decreased concentration and attention
  • Decreased self-esteem and self-confidence
  • Feelings of guilt and feelings of worthlessness
  • Negative and pessimistic outlook on the future
  • Suicidal thoughts/actions
  • Insomnia (sleep disturbances)
  • Inappetence (decreased appetite)

Classification of the severity of depression

  • Mild depression: (2 main symptoms + 2 additional symptoms) + symptoms ≥ 2 weeks.
  • Moderate depression: (2 main symptoms + 3-4 additional symptoms) + symptoms ≥ 2 weeks.
  • Severe depression: (3 main symptoms + ≥ 4 additional symptoms) + symptoms ≥ 2 weeks.

Subtyping: somatic syndrome and psychotic symptoms

In ICD-10, mild or moderate depressive episodes can also be classified as having a somatic syndrome in addition to the main and additional symptoms. Typical features of the somatic syndrome are:

  • Loss of interest or pleasure in normally pleasurable activities.
  • Lack of ability to respond emotionally to a friendly environment or joyful events
  • Early morning awakening, two or more hours before the usual time
  • Morning low
  • The objective finding of psychomotor inhibition or agitation.
  • Marked anorexia (loss of appetite)
  • Weight loss, often more than 5% of body weight in the past month.
  • Significant loss of libido

Depression with somatic syndrome corresponds to the form according to the depressive disorder formerly called “endogenous” or “autonomic”. In the ICD-10, the syndrome called “somatic” is also synonymously called “melancholic”, “vital”, “biological” or “endogenomorphic”. Typical psychotic symptoms include:

  • Delusions
  • Hallucinations
  • Depressive stupor (rigidity of the body). Delusions and hallucinations

Note: In delusions, reality is misinterpreted, while in hallucinations, things are perceived that do not exist. Subdivision of a depressive episode

  • Monophasic
  • Relapsing/chronic
  • In the context of a bipolar course

Complaints that may be indicative of a depressive disorder (modified from)

  • General physical fatigue, lassitude
  • Appetite disturbances, gastric pressure, weight loss, constipation (constipation), diarrhea (diarrhea).
  • Insomnia (sleep disorders: difficulty falling asleep and staying asleep).
  • Feeling of pressure in the throat and chest, globus sensation (lump feeling: foreign body feeling in the throat or throat complains, which regardless of food intake).
  • Functional disorders:
    • Heart and circulation – e.g. tachycardia (heartbeat too fast: > 100 beats per minute), arrhythmia, syncope (momentary loss of consciousness).
    • Respiration – e.g. dyspnea (shortness of breath).
    • Stomach and intestines
  • Diffuse headache
  • Dizziness, flickering before the eyes, visual disturbances.
  • Muscle tension, diffuse nerve pain (neuralgiform pain).
  • Loss of libido, sistieren menstruation (menstruation), impotence, sexual dysfunction.
  • Cognition disorders (memory disorders)

The following are the symptoms of depression, divided into psychological and somatic complaints:

Psychological complaints

  • Listlessness and dejection, sadness – hopeless mood, often worst in the morning.
  • Increased fatigability
  • Agitation (inner restlessness) and emptiness
  • Aggression
  • Anxiety or irritability
  • Lack of joie de vivre (joylessness) – declining interest and withdrawal from the social environment.
  • Excessive sickliness
  • Lack of concentration
  • General slowing of mental activity
  • Indecisiveness and difficulty thinking clearly
  • Loss of interest – disinterest in clothing and appearance.
  • Decreased self-esteem
  • Feelings of guilt, self-accusations
  • Hypochondria
  • Loss of libido in men and women
  • Constant preoccupation with pessimistic thoughts
  • Disturbed color perception – everything appears gray
  • Feeling of hopelessness
  • Thoughts of suicide

Somatic complaints

  • Sleep disturbances – early waking (= sleep through) and problems with falling back asleep.
  • Anorexia (loss of appetite) and weight loss – but in some patients overeating is observed, which quickly leads to obesity
  • Constipation (constipation)
  • Unexplained pain or aching discomfort in any part of the body
  • Headache
  • Physical complaints

Symptoms can develop over weeks and months or in days or hours.

Gender differences (gender medicine)

  • Symptom patterns:
    • Male: irritability, aggressiveness, and antisocial behavior, as well as increased to excessive alcohol and nicotine use (substance abuse); increased suicidality (suicidal tendencies).
    • Woman: restlessness, depressed mood and lamentation.

Depression in old age

In old age, there are certain peculiarities in terms of symptoms. Old-age depression is characterized by the same symptoms as depression in younger people. However, comorbidities (concomitant diseases) such as diabetes mellitus, apoplexy (stroke), Parkinson’s disease, or psychiatric disorders such as anxiety disorders or dementia complicate the diagnosis of depression in old age. In general, it can be said that in old age, especially in the presence of a need for care, existing physical complaints increase the risk of depression. In contrast to young people, however, older people often do not dare to admit their worsened mood or even to evaluate it as a symptom of illness. Older people, however, are more willing to talk about their anxiety. In addition, older depressives complain more about physical complaints. The following physical complaints are most frequently mentioned:

  • Rapid fatigue
  • Lack of strength
  • Shortness of breath
  • Palpitations
  • Dizziness
  • Headache
  • Pain