Depression affects different
people differently. Some people may present predominantly with physical
symptoms such as backache, headache or stomach complaints that do not respond to treatment.
Others may complain mostly of
disturbed sleep, loss of energy and appetite changes. Not everyone experiences
all the symptoms of a depressive or manic episode. The severity of symptoms may
also be different in different people.
These many different presentations of depression can sometimes make it
difficult to recognise and diagnose a depressive disorder.
sufferer may not seek medical help because they may not realise that they are
suffering from depression (I’m just a bit stressed at work”, “I haven’t been
sleeping well – too hot I suppose”) and that depression is a legitimate medical
The most commonly reported symptoms are:
• A depressed or low mood or feeling of sadness
• Increased irritability
• Increased anxiety or a feeling of nervousness
• Loss of interest or pleasure in activities that were previously enjoyed
• Tearfulness or a feeling of wanting to cry, but a possible inability to do
• Decreased sexual interest or other sexual problems
• Changes in appetite resulting in either weight gain or weight loss when not
• Changes in sleep pattern entail either difficulty falling asleep, frequent
waking during the night or waking up unusually early in
the morning and not being able to return to sleep. Sleep may also be increased
with a desire to be asleep most of the time.
• A feeling of being chronically tired, energy-less, fatigued or unmotivated.
• A slowing down or speeding up of physical activity (including speaking very
softly or slowly). Depression is usually accompanied by slowness –
walking, movement, thought, speech; whereas Mania is accompanied with a
speeding up of action, thought and speech.
• Feeling worthless, useless and helpless
• Feeling inappropriately excessively guilty (and possibly blaming oneself for
being depressed or unable to “snap out of it”)
• Difficulty thinking, concentrating or remembering
• Difficulty making decisions, even over simple matters
• A feeling that life is not worth living and frequently thinking about death
• Becoming increasingly socially withdrawn and feeling reluctant to entertain
or go out visiting
• Not bothering to dress properly/self-neglect
• Multiple physical complaints, e.g. frequent headaches, backaches/stomach
aches or constipation
• Alteration in menstrual cycle
Anxiety symptoms are also often
experienced by people with depression. About 50% will experience anxiety with
depression (co-morbid anxiety).
Symptoms of anxiety include nausea,
dizziness, breathlessness, heart palpitations, feeling worried and fearful,
being tremulous or shaky, feeling sweaty, pins and needles in the hands and
around the mouth or frequently having a runny tummy and passing urine often.
If you have been feeling low or irritable together with several of the above
listed symptoms for at least two weeks, you may wish to complete a
self-evaluation questionnaire to see whether or not you are depressed.
When to call
a health professional
If, after reading the preceding information, you believe that you or a family
member or friend may be suffering from depression, speak to your family
practitioner. He or she may suggest life-style changes, medication or referral
to a mental health professional, i.e. psychologist or psychiatrist, or call the
South African Depression and Anxiety Group (SADAG) on 080 21 22 23 – 7 days a
week from 8am to 8pm.
All thoughts of suicide, threats or attempts should be taken seriously and
professional help sought as soon as possible. People who are planning suicide
often talk about it either directly or indirectly and they may make
arrangements to get their affairs in order, e.g. settling debts, altering or
making a will, getting rid of personal items or letters.
who feel suicidal are often reluctant to seek help and may need a great deal of
encouragement and ongoing support.
Some possible warning signs to take note of:
• Increased anxiety or agitation
• Increased use of drugs or alcohol
Expressing suicidal thoughts or intent
• Slowing down physically
• Extreme feelings of worthlessness or guilt
Those most at risk manifest the following risk factors:
• Male sex, age over 45 years
• A history of alcohol dependence
• An unwillingness to accept help
• Displays of rage, violence or irritation
• Recent loss or separation
• Unemployment or retirement
• Being single, widowed or divorced
• Prior hospitalisation for psychotic illness
What is depression?
Causes of depression
by Zane Wilson, South African Depression and Anxiety Group (SADAG), March 2015.
(Previously reviewed by Dr Stefanie van
Vuuren, Psychiatrist, MB ChB (Stell), M Med (Psig) (Stell), FC (Psych) SA, May