Depression symptoms: how do I know if I am depressed?

We all have days when we feel sad, tired or flat. But depression is more than a bad mood. It lasts for weeks, drains the pleasure out of things, and changes our energy, sleep, concentration and how we see ourselves. Depression is not a character weakness or a lack of willpower, and it can be treated.

Symptoms of depression

The two core symptoms of depression are:

• Low mood: feeling sad, empty or hopeless for most of the day
• Loss of interest or pleasure: things you used to enjoy no longer feel like anything

And the accompanying symptoms:

• Changes in sleep: insomnia or sleeping too much
• Changes in appetite or weight
• Tiredness and lack of energy, even for simple tasks
• Feelings of worthlessness or excessive guilt
• Difficulty concentrating and making decisions
• Slowed movement or, on the contrary, restlessness
• Thoughts of death or self-harm

When several of these, including at least one of the two core symptoms, are present on most days for two weeks or more, we may be dealing with depression.

Depression does not always look like sadness

Some people with depression keep going to work, meet their responsibilities and look "fine" from the outside, while feeling empty and exhausted inside. In others, depression shows up more as irritability, physical pain or emotional numbness. The article Hidden, high-functioning depression explains this less familiar form.

Depression and migration

Losing a support network, loneliness, a drop in career or social status after migrating, and being far from family can all set the stage for depression. Many people also see this state as "just part of migrating" and wait years before getting help. Read more: Mental fatigue in Iranian immigrants.

How do I know if I am depressed?

The PHQ-9 questionnaire is one of the most widely used depression screening tools in the world. Its nine questions measure exactly the symptoms listed above. You can take the free PHQ-9 depression test in about two minutes. The result shows how severe the symptoms are; it is not a diagnosis, and your answers are not stored on our servers.

Treatment for depression

• Psychotherapy: approaches such as cognitive behavioural therapy (CBT), behavioural activation and interpersonal therapy have good evidence for depression.
• Medication: for moderate to severe depression, antidepressants prescribed by a doctor or psychiatrist can be effective. Stopping or changing medication should only be done on a doctor's advice.
• A combination of both often gives the best results.

Small steps that help

• One small, doable task a day, even if you do not feel like it; in depression, motivation usually comes after action, not before it.
• A fixed time for going to bed and getting up
• Some daylight and movement, even a short walk
• Contact with one person, even a short message
• Being kind to yourself: depression is not your fault

If you have thoughts of harming yourself

If you are thinking about death or about hurting yourself, please do not stay alone with it and do not wait. If you are in immediate danger, call your local emergency number; otherwise, talk as soon as possible to a doctor, a crisis service or someone you trust. The urgent help page lists crisis numbers for several countries.

When to get help

If symptoms have lasted more than two weeks or everyday tasks have become hard, it is a good time to talk to a professional. At Emotral you can talk with Persian-speaking therapists.

References

• Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606-613.
• American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.; DSM-5-TR).
• National Institute for Health and Care Excellence. (2022). Depression in adults: treatment and management (NICE guideline NG222).
• World Health Organization. (2023). Depressive disorder (depression), fact sheet.