Depression can present with many symptoms. As a rule men tend to get angry to cover their grief and sadness, whereas women tend to get sad and tearful to cover their anger. Anxiety overlaps significantly with depression, and has bodily and mental elements.
In all the lists below remember that few people will have every one of these symptoms, but most will have some symptoms from each group. The more symptoms you have the more likely it is you have a full blown depression, as opposed to a bad day, stress etc.
Anxiety symptoms may include palpitation, racing heart beat, excessive breathing (faster and deeper) tingling, chest pains (nondescript, stabbing, tingling) pins and needles, numb areas of body, butterflies in stomach. Constipation in some. Diarrhoea in others. Sweating profusely. Brain thinking too quickly, never achieving anything, and generating 'mind monsters' rather than coherent thoughts. It's a dreadful state we're in and anxiety makes it far worse. All these symptoms reflect excessive activation of the sympathetic nervous system. Beta blockers, exercise, yoga, calming down, prayer, reflection can all help reduce these symptoms.
Angry symptoms of depression include: Irritability, friction with friends and family, rows at work, being grumpy, snapping at people, increasing sarcasm or bitterness, abruptness 'What now?- rather than 'How are you?, what can I do for you?' Men often retreat into their 'caves'.
Grief symptoms include: Sadness, tearfulness, low mood, down, social withdrawal, narrowing network. As this gets more severe thoughts of worthlessness, and of suicide can occur. Statements such as 'I'm worthless, a waste of space, and I don't want to burden people any more' are common here. Many people are not actively suicidal but may feel 'If I woke up dead it wouldn't be so bad.' GPs and psychiatrists are trained to assess suicide risk. If they get a hint that you are severely depressed they will, gently but firmly, ask about thoughts of self harm. We know this can be intrusive but it's a vital safety check for both doctor and patient. A simple rule is that most people who commit suicide just do it, whereas those who talk about it are usually wanting help to avoid it.
Mental symptoms include: Poor concentration, poor memory, increasing forgetfulness, Anhedonia- an inability to enjoy life fully (E.g I offer you a fabulous holiday and you shrug your shoulders and go 'So what?'). Jobs go unfinished, standards of cleanliness and presentation fall.
Bodily symptoms: Anergia - your get up and go has got up and gone. Tiredness. Malaise. Aches and pains shift from minor to major. Constipation. Diarrhoea. Your immune system works less well so minor infections hang around longer. When your mind is depressed your body is too. Loss of libido - no interest in sex. Worsening severity or frequency of migraine or other headaches.
Time course:One bad day may give you some of the above symptoms but this is not depression. The symptoms have to be persistent through time. (at least 4 weeks, though in practice most people have depressive symptoms for 3-12 months before eventually they or their family decides that 'something must be done.' The diagnosis is often made by the family noticing there is something wrong with patient. In a severe depression the symptoms become persistent, pervasive and permanent. It can seem as if there is nothing that can be done, by anyone, or anything. In extremes this progresses to 'depersonalisation' where yoou feel detatched from yourself.
Peter Davies, 24/07/2008