Editing Major depressive disorder (section)

==Signs and symptoms==
{{See also|Digital media use and mental health#Depression}}
[[File:A woman diagnosed as suffering from melancholia. Colour lith Wellcome L0026686.jpg|thumb|An 1892 [[lithograph]] of a woman diagnosed with [[melancholia]]]]
A person having a [[major depressive episode]] usually exhibits a [[Depression (mood)|low mood]], which pervades all aspects of [[Everyday life|life]], and an inability to experience [[pleasure]] in previously enjoyable activities.<ref name="g379">{{cite book | last1=MacKinnon | first1=Dean F. | last2=Chen | first2=Lisa N. | title=Tasman's Psychiatry | chapter=Depressive Disorders | publisher=Springer International Publishing | publication-place=Cham | date=2024 | isbn=978-3-030-51365-8 | doi=10.1007/978-3-030-51366-5_20 | pages=1823–1880}}</ref> Depressed people may be preoccupied with or [[Rumination (psychology)|ruminate]] over thoughts and feelings of worthlessness, inappropriate [[Guilt (emotion)|guilt]] or [[regret]], helplessness or hopelessness.{{sfn|American_Psychiatric_Association|2013|p=161}}

Other symptoms of depression include poor concentration and [[memory]],<ref>{{Cite journal | vauthors = Everaert J, Vrijsen JN, Martin-Willett R, van de Kraats L, Joormann J |date=2022 |title=A meta-analytic review of the relationship between explicit memory bias and depression: Depression features an explicit memory bias that persists beyond a depressive episode. |journal=Psychological Bulletin |language=en |volume=148 |issue=5–6 |pages=435–463 |doi=10.1037/bul0000367 |s2cid=253306482 |issn=1939-1455|doi-access=free }}</ref> [[Social withdrawal|withdrawal from social situations]] and activities, reduced [[libido|sex drive]], [[irritability]], and [[Suicidal ideation|thoughts of death or suicide]]. [[Insomnia]] is common; in the typical pattern, a person wakes very early and cannot get back to sleep. [[Hypersomnia]], or oversleeping, can also happen,{{sfn|American Psychiatric Association|2013|p=163}} as well as day-night rhythm disturbances, such as [[diurnal mood variation]].<ref>{{cite journal | vauthors = Murray G | title = Diurnal mood variation in depression: a signal of disturbed circadian function? | journal = Journal of Affective Disorders | volume = 102 | issue = 1–3 | pages = 47–53 | date = September 2007 | pmid = 17239958 | doi = 10.1016/j.jad.2006.12.001 }}</ref><!-- cites 3 previous sentences --> Some antidepressants may also cause insomnia due to their [[Stimulant|stimulating effect]].<ref name="v526">{{cite journal |last1=Wichniak |first1=Adam |last2=Wierzbicka |first2=Aleksandra |last3=Walęcka |first3=Małgorzata |last4=Jernajczyk |first4=Wojciech |title=Effects of Antidepressants on Sleep |journal=Current Psychiatry Reports |volume=19 |issue=9 |date=2017 |issn=1523-3812 |pmid=28791566 |pmc=5548844 |doi=10.1007/s11920-017-0816-4 |doi-access=free |url=https://link.springer.com/content/pdf/10.1007%2Fs11920-017-0816-4.pdf |access-date=26 February 2025 |page=63}}</ref> In severe cases, depressed people may have [[psychosis|psychotic]] symptoms. These symptoms include [[delusion]]s or, less commonly, [[hallucination]]s, usually unpleasant.<ref>{{Harvnb |American Psychiatric Association|2000a|p=412}}</ref> People who have had previous episodes with psychotic symptoms are more likely to have them with future episodes.<ref>{{cite journal | vauthors = Nelson JC, Bickford D, Delucchi K, Fiedorowicz JG, Coryell WH | title = Risk of Psychosis in Recurrent Episodes of Psychotic and Nonpsychotic Major Depressive Disorder: A Systematic Review and Meta-Analysis | journal = The American Journal of Psychiatry | volume = 175 | issue = 9 | pages = 897–904 | date = September 2018 | pmid = 29792050 | doi = 10.1176/appi.ajp.2018.17101138 | s2cid = 43951278 | doi-access = free }}</ref>

{{Anchor|physicalSymptoms}}A depressed person may report multiple physical symptoms such as [[fatigue]], [[headache]]s, or [[Human digestive system|digestive]] problems; physical complaints are the most common presenting problem in developing countries, according to the [[World Health Organization]]'s criteria for depression.<ref>{{cite journal |vauthors=Fisher JC, Powers WE, Tuerk DB, Edgerton MT |title=Development of a plastic surgical teaching service in a women's correctional institution |journal=American Journal of Surgery |volume=129 |issue=3 |pages=269–72 |date=March 1975 |pmc=1119689 |doi=10.1136/bmj.322.7284.482 |pmid=11222428}}</ref> [[Appetite]] often [[Anorexia (symptom)|decreases]], resulting in [[weight loss]], although [[Polyphagia|increased appetite]] and [[weight gain]] occasionally occur.<ref name="b502" />

Major depression significantly affects a person's family and [[Social predictors of depression|personal relationships]], [[Employment|work]] or [[school]] life, [[sleep]]ing and [[Dieting|eating habits]], and general health.<ref name=NIMHPub>{{cite book|title=Depression |publisher=[[National Institute of Mental Health]] (NIMH) |url=https://www.nimh.nih.gov/sites/default/files/documents/health/publications/depression/21-mh-8079-depression_0.pdf |archive-url=https://web.archive.org/web/20210828103258/https://www.nimh.nih.gov/sites/default/files/documents/health/publications/depression/21-mh-8079-depression_0.pdf |archive-date=28 August 2021 |url-status=live |access-date=13 October 2021}}</ref> Family and friends may notice [[psychomotor agitation|agitation]] or [[psychomotor retardation|lethargy]].{{sfn|American Psychiatric Association|2013|p=163}} Older depressed people may have [[Cognition#Psychology|cognitive]] symptoms of recent onset, such as [[Forgetting|forgetfulness]],<ref>{{cite journal |vauthors=Delgado PL, Schillerstrom J |title=Cognitive Difficulties Associated With Depression: What Are the Implications for Treatment? |journal=Psychiatric Times |volume=26 |issue=3 |year=2009 |url=http://www.psychiatrictimes.com/display/article/10168/1387631 |url-status=live |archive-url=https://web.archive.org/web/20090722165650/http://www.psychiatrictimes.com/display/article/10168/1387631 |archive-date=22 July 2009}}</ref> and a more noticeable slowing of movements.<ref>{{cite book |title=Consensus Guidelines for Assessment and Management of Depression in the Elderly | vauthors = ((Faculty of Psychiatry of Old Age, NSW Branch, RANZCP)), Kitching D, Raphael B |year=2001 |publisher=NSW Health Department |location=North Sydney, New South Wales |isbn=978-0-7347-3341-2 |page=2 |url=http://www.health.nsw.gov.au/mhdao/publications/Publications/depression-elderly.pdf |url-status=live |archive-url=https://web.archive.org/web/20150401162939/http://www.health.nsw.gov.au/mhdao/publications/Publications/depression-elderly.pdf |archive-date=1 April 2015 }}</ref>

[[Depression in childhood and adolescence|Depressed children]] may often display an irritable rather than a depressed [[Mood (psychology)|mood]];{{sfn|American Psychiatric Association|2013|p=163}} most lose interest in school and show a steep decline in [[Academic achievement|academic performance]].{{sfn|American Psychiatric Association|2013|p=164}} Diagnosis may be delayed or missed when symptoms are interpreted as "normal moodiness".<ref name=APA349>{{Harvnb |American Psychiatric Association|2000a|p=349}}</ref> [[Old age|Elderly people]] may not present with classical depressive symptoms.<ref name="SBU" /> [[Management of depression|Diagnosis and treatment]] is further complicated in that the elderly are often simultaneously treated with a number of other drugs, and often have other concurrent diseases.<ref name="SBU" />