Consumer Information Center Symptoms of Depression and Mania

Symptoms of Depression:

• A persistent sad, anxious or "empty" mood
• Loss of interest or pleasure in ordinary activities, including sex
• Decreased energy, fatigue, feeling "slowed down"
• Sleep problems (insomnia, oversleeping, early-morning waking)
• Eating problems (loss of appetite or weight, weight gain)
• Difficulty concentrating, remembering, or making decisions
• Feelings of hopelessness or pessimism
• Feelings of guilt, worthlessness, or helplessness
• Thoughts of death or suicide; a suicide attempt
• Irritability
• Excessive crying
• Recurring aches and pains that don't respond to treatment

If someone has recently experienced a loss, these feelings may be part of a normal grief reaction. But, if the feelings persist with no lifting mood, the person may need professional treatment.

These symptoms may range from moderate to severe. When mania is moderate, only people close to the affected person may be able to spot the symptoms.

Symptoms of Mania:

• Excessively "high" mood
• Irritability
• Decreased need for sleep
• Increased energy
• Increased talking, moving, and sexual activity
• Racing thoughts
• Disturbed ability to make decisions
• Grandiose notions
• Being easily distracted

Some symptoms of depression also occur in other medical conditions. For example, weight loss, sleep disturbance, and low energy also occur in diabetes and heart disease; apathy, poor concentration, and memory loss are also found in Parkinson's and Alzheimer's diseases; and achiness or fatigue may be present in many other conditions. To determine the proper diagnosis, a physician must conduct a thorough evaluation, keeping in mind that depressed older people are more likely to complain of such physical problems rather than expressing sad, anxious, or hopeless feelings.

Depression Can Co-Occur with Other Illnesses

Depression often co-occurs with medical, psychiatric, and substance abuse disorders, though it is frequently unrecognized and untreated. This can lead to unnecessary suffering since depression is usually treatable, even when it co-occurs with other disorders.

Depression occurs at higher than average rates in heart attack and cancer patients, persons with diabetes, and post-stroke patients. Untreated depression can interfere with the patient's ability to follow the necessary treatment regimen or to participate in a rehabilitation program. It may also increase impairment from the medical disorder and impede its improvment.

Psychiatric Illnesses

Depression also occurs more frequently in persons with other psychiatric disorders, especially anxiety disorders. In such cases, detection of depression can result in more effective treatment and a better outcome for the patient.

Substance Abuse Disorders

Substance abuse disorders (including alcohol and prescription drugs) frequently co-exist with depression. Substance use must be discontinued in order to clarify the diagnosis and maximize the effectiveness of psychiatric interventions. Additional treatment is necessary if the depression remains after the substance use and withdrawal effects have ended.

Individuals or family members with concerns about the co-occurence of depression with another illness should discuss these issues with the physician.

Many factors can contribute to depression. Some people become depressed for a combination of reasons. For others, a single factor appears to trigger depression. Some become depressed for no apparent reason. Regardless of the cause, depression needs to be diagnosed and rated.

Some of the contributing factors that are particularly important among older people are:

Some medicines cause depressive symptoms as side effects. Certain drugs used to treat high blood pressure and arthritis fall in thism category. In addition, different drugs can interact in unforeseen ways when taken together. It is important that each doctor know all the different types and dosages of medicine being taken and discuss them with the patient.

Depression runs in families. Children of depressed parents have a higher risk of being depressed themselves. Some people probably have a biological make-up that makes them particularly vulnerable.

Certain personalities--people with low self-esteem or who are very dependent on others--seem to be vulnerable to depression.

The death of a loved one, divorce, moving to a new place, money problems, or any sort of loss have all been linked to depression. People without relatives or friends to help may have even more difficulty coping with their losses. Sadness and grief are normal responses to loss, but if they linger or are severe, professional help should be sought.

Help for Depression