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In ordinary conversation, nearly any mood with some element of sadness may be called "depressed". However, for depression to be termed clinical depression it must reach criteria which are generally accepted by clinicians; it is more than just a temporary state of sadness. Generally, when symptoms last two weeks or more, and are so severe that they interfere with daily living, one can be said to be suffering from clinical depression. Using DSM-IV-TR terminology, someone with a major depressive disorder can, by definition, be said to be suffering from clinical depression. True clinical depression is distinguished from non-organic illnesses that mimic it, such as caffeinism.

symptoms of depression

According to the DSM-IV-TR criteria for diagnosing a major depressive disorder one or both of the following two depression symptoms need to be present:

• Depressed mood, or
• Loss of interest or pleasure.

It is enough to have either of these above depression symptoms in conjunction with four of the following:

• Feelings of overwhelming sadness or fear, or seeming inability to feel emotion.
• Marked decrease of interest in pleasurable activities.
• Changing appetite and marked weight gain or weight loss.
• Disturbed sleep patterns, either insomnia or sleeping more than normal.
• Changes in activity levels, restless or moving significantly slower than normal.
• Fatigue, both mental and physical.
• Feelings of guilt, helplessness, anxiety, and/or fear.
• Lowered self-esteem.
• Decreased ability to concentrate or make decisions.
• Thinking about death or suicide.

Depression in children is not as obvious as it is in adults; depression symptoms children demonstrate include:

• Loss of appetite.
• Sleep problems such as nightmares.
• Problems with behavior or grades at school where none existed before.
• Significant behavioral changes; becoming withdrawn, sulky, aggressive.

In older children and adolescents, an additional indicator may be the use of drugs or alcohol. Moreover, depressed adolescents are at risk for further destructive behaviours, such as eating disorders and self-harm.

One of the most widely used instruments for measuring depression severity is the Beck Depression Inventory, a 21 question multiple choice survey.

It is hard for people who have not experienced clinical depression, either personally or by regular exposure to people suffering it, to understand its emotional impact and severity, interpreting it instead as being similar to "having the blues" or "feeling down". As the list of symptoms above indicates, clinical depression is a syndrome of interlocking symptoms which goes far beyond sad or painful feelings. A variety of biological indicators, including measurement of neurotransmitter levels, have shown that there are significant changes in brain chemistry and an overall reduction in brain activity. One consequence of a lack of understanding of its nature is that depressed individuals are often criticized by themselves and others for not making an effort to help themselves. However, the very nature of depression alters the way people think and react to situations to the point where they may become so pessimistic that they can do little or nothing about their condition. Because of this profound and often overwhelmingly negative outlook, it is imperative that the depressed individual seek professional help. Untreated depression is typically characterized by progressively worsening episodes separated by plateaus of temporary stability or remission. If left untreated it will generally resolve within six months to two years although occasionally depression becomes chronic and lasts for many years or indefinitely. In many cases (but not all) treatment can shorten the period of distress to a matter of weeks. While depressed, the person may damage themselves socially (e.g. the break up of relationships), occupationally (e.g. loss of a job), financially and physically. Treatment of depression can significantly reduce the incidence of this damage, including reducing the risk of suicide which is otherwise a common and tragic outcome. For all of these reasons, treatment of clinical depression is seen by many as very useful and at times life saving.

Some people can experience anhedonia for long periods of time before they discover it is a mental illness. The inability to feel pleasure can advance negativity already present in a depressed person's mental state.