Signs of Depression

Content advice: this article includes discussion of suicide and self harm.

If someone is at immediate risk, call 000, or your local emergency number if you are outside Australia, or go to the nearest hospital emergency department. Lifeline is on 13 11 14 with text and online chat at lifeline.org.au. Beyond Blue is on 1300 22 4636 with webchat. In WA the Mental Health Emergency Response Line is 1300 555 788 metro, 1800 676 822 Peel, and Rurallink is 1800 552 002 regional. 13YARN is 13 92 76.

Most people picture depression as sadness. In our rooms it far more often arrives as flatness, irritability, exhaustion or a body that hurts for no reason anyone can find.

At the Energetic Institute, Richard and Helena Boyd  have practised in Perth since 2005. This page covers the signs and symptoms across four domains, then the presentations that get missed, which is where most of the delay in treatment happens. Our page on DSM-5 depression covers the formal criteria. On scope: we are psychotherapists, not psychologists, so we do not diagnose.

How Common Is Depression

Depression affects an estimated 332 million people worldwide, around 5.7 per cent of adults, on World Health Organization figures.

In Australia, the ABS found 7.5 per cent of people aged 16 to 85 experienced an affective disorder in a single year, and around one in six will over a lifetime. Men and women both experience depression, though women are affected more often, at 8.6 per cent against 6.5 per cent in a year.

Internationally the picture is tracked by bodies including the National Institute of Mental Health, the Substance Abuse and Mental Health Services Administration, and the National Center for Health Statistics at the Centers for Disease Control and Prevention. Australian figures come from the ABS.

The Two Signs That Have To Be There

Not all symptoms of depression carry equal weight, and this is the part most lists skip.

For a major depressive episode, at least one of two things must be present: persistently low mood, or a loss of interest and pleasure in things that used to matter. Everything else sits around those two. You can have poor sleep, low energy and difficulty concentrating without being depressed, but without one of the cardinal two it is something else.

The other rule is duration. Symptoms must run most of the day, nearly every day, for two weeks or more, and interfere with daily life.

The Four Groups Of Depression Symptoms

The common signs fall into four groups, and people usually notice one group long before the others.

Emotional Signs

The affective signs are the ones everyone expects, and they are broader than sadness.

Persistent low mood, hopelessness about the future, emptiness or numbness, guilt out of proportion to anything, low self esteem, and irritability. Numbness catches people out, because feeling nothing reads as coping rather than as a symptom.

Cognitive Signs

What depression does to thinking is often what stops people working.

Difficulty concentrating, indecisiveness over small choices, memory lapses, and a running negative commentary. Thinking slows and everything takes longer. Many describe reading the same paragraph four times.

Behavioural Signs

These are the specific symptoms other people notice first.

Withdrawing from friends and family, cancelling repeatedly, dropping hobbies, letting self-care slide, and reduced output at work. Some increase alcohol use, and substance abuse both worsens depression and follows from it.

Physical Signs

The body is involved from the start, not as a consequence later.

Fatigue that sleep does not fix, insomnia or excessive sleeping, appetite changes with weight loss or weight gain, physical aches, headaches, stomach problems, and slowed movement or restlessness others can see.

When Depression Arrives As A Physical Problem

This is the most useful thing on this page and it explains a lot of missed cases.

A World Health Organization study across fifteen primary care centres in fourteen countries found that among patients with depression, the proportion reporting only physical symptoms ranged from 45 to 95 per cent by site, averaging 69 per cent. That data is from the early 1990s and has never been repeated at the same scale, so read it as an illustration rather than a fixed rate. More recently, a 2023 study of over four thousand primary care patients found a heavy somatic symptom load in 56 per cent of those with major depression against 1.2 per cent of those without.

The critical detail is what happened next in the original study. Only 11 per cent denied psychological symptoms when asked directly. The pattern is not that depression is invisible, it is that nobody asks. If you have been investigated for fatigue, chronic pain or stomach problems and nothing was found, that is worth raising.

Signs Of Depression In Men

Men often meet the criteria while looking nothing like the picture.

Australian research using a validated male depression scale identified six domains: emotion suppression, alcohol use, drug use, anger and aggression, somatic symptoms and risk taking. Around one in ten men present with these externalising signs only. Anger and irritability substitute for expressed sadness more often than most families realise.

The consequences are not abstract. Australian linked-data research found around three in four men with moderate or greater depressive symptoms did not access a mental health service in the year studied, and men account for roughly three quarters of Australian suicide deaths.

Signs Of Depression In Older Adults

Depression is not a normal part of ageing, and treating it as one is the main reason it goes unrecognised.

Older adults report sadness less often and physical complaints more, and the sleep, memory and concentration changes get attributed to age. Some describe it as their nerves rather than depression. Grief, chronic illness and loss of independence are common triggers.

The overlap with cognitive decline needs care. The old term pseudodementia has been retired, because depression-related cognitive changes often persist, and depression in later life roughly doubles dementia risk. That is a reason for assessment rather than reassurance.

Signs Of Depression In Children And Teenagers

The manual itself makes an allowance here that most parents have never heard.

In children and adolescents, irritable mood can stand in for depressed mood. So a teenager who is snappy, hostile and withdrawn rather than tearful may still meet criteria. In younger children, failure to make expected weight gain counts in place of weight loss.

Watch for a drop in school performance, refusing school, physical complaints with no cause found, and withdrawal from friends. Adolescence involves real mood variability, so the marker is duration and impact rather than intensity.

What About High Functioning Depression?

These terms have real search demand and no clinical standing, so it is worth being straight about them.

High functioning depression and smiling depression are not diagnoses. They appear neither in the Diagnostic and Statistical Manual published by the American Psychiatric Association nor in the international classification of mental disorders. What they describe is real, though.

The closest recognised constructs are persistent depressive disorder, formerly called dysthymic disorder, which is lower grade and runs two years or more, and major depression with atypical features, where mood lifts temporarily in company. Mild major depressive disorder also explicitly allows largely intact functioning. You can hold down a job and be genuinely unwell.

Types Of Depressive Disorder

Depression is a group of conditions rather than one, and which one applies changes the treatment.

Major depressive disorder, often called clinical depression, is the acute and more severe form, with episodes lasting at least two weeks. Persistent depressive disorder is the chronic, lower-grade version. Premenstrual dysphoric disorder and disruptive mood dysregulation disorder are also depressive disorders. Depression with a seasonal pattern follows the time of year, and perinatal depression occurs in pregnancy or the first year after birth.

Bipolar disorder sits in a separate mood disorder group because it involves manic episodes as well as depressive episodes. That distinction matters more than almost any other, since antidepressants given alone in undiagnosed bipolar disorder can destabilise mood.

Warning Signs That Need Action Now

Some signs of depression are not something to monitor.

Talking about death, saying others would be better off, giving away possessions, sudden calm after a long low period, self harm, and any statement about wanting to attempt suicide need a response the same day. Severe depression carries the highest risk, though milder presentations can carry it too.

If you are worried, ask directly whether they are having suicidal thoughts. Asking does not put the idea there, and the research on this is consistent. Then call a crisis lifeline, or 000 if there is immediate danger.

What Can Look Like Depression But Is Not

Several medical conditions produce the same picture, which is why a GP visit comes first.

Thyroid disorders, particularly an underactive thyroid, are the most cited. Anaemia, low vitamin B12 or vitamin D, and sleep apnoea all produce fatigue, low mood and difficulty concentrating. Depression also travels with chronic health conditions and with anxious feelings, including panic disorder: around 39 per cent of people with chronic pain, 35 per cent with diabetes and 21 per cent with heart disease meet criteria.

Certain medications can contribute, with corticosteroids and interferon the clearest examples. One commonly blamed drug is not supported: a review of 285 trials covering more than 53,000 people found no link between beta blockers and depression. Never stop prescribed medications on your own, but do mention the timing to your prescriber.

What Raises The Risk

No single cause explains depression. Several things shift the odds.

Family history matters, and twin studies put the heritability of major depression at around 37 per cent, while genome studies counting common variants land nearer 9 per cent. On either measure most of the variation is not genetic, so having blood relatives with depression raises risk without determining it.

Childhood adversity is one of the strongest environmental factors, with prospective studies putting the odds of adult depression roughly twice as high after physical or sexual abuse. Stressful events, chronic illness, isolation and certain personality traits, particularly a tendency to feel negative emotion strongly, contribute alongside psychological factors and current circumstances.

How Depression Is Diagnosed

Only a GP, psychiatrist or psychologist can diagnose depression, and getting depression diagnosed is more thorough than most people expect.

Your GP, or another mental health professional, will take a history, ask about symptoms, duration and impact, and screen for past manic episodes and family history. A physical exam and targeted lab tests may rule out physical problems, typically a full blood count, thyroid function and sometimes iron, B12 or vitamin D. Australian guidance is clear that testing should follow the clinical picture rather than a routine checklist.

Some people find it easier to start elsewhere, with a counsellor, a helpline, or someone in their faith community such as a spiritual leader. That is a reasonable first step, but it does not replace medical assessment.

What Treatment Looks Like

Depression responds well to treatment, and most episodes end.

For mild to moderate presentations, talk therapy is usually the first line in treating depression, with cognitive behaviour therapy having the largest evidence base. For moderate to severe depression, medication combined with therapy is standard. Antidepressants take several weeks and can make people feel worse before better, which is when many stop.

Lifestyle changes support the rest without replacing it. Exercise has genuine evidence, particularly walking. The aim of mental health treatment is not just to relieve symptoms but to reduce the chance of the next episode, and depression is a mental illness that responds to health care like any other.

How We Work With Depression

Our approach is Integrative Body Mind Psychotherapy, which is relevant to a page about signs.

Depression is a whole-body state. It shows in posture, breathing, energy and how someone occupies a room, and by the time a person can describe it, the body has usually been carrying it for a long time. Working only with thoughts leaves that layer untouched.

We work alongside GPs rather than instead of them, and most people we see are already under medical care. If you have not seen a doctor yet, we will encourage you to.

What This Looks Like In Practice

These are composite examples drawn from our clinical work, with identifying details changed.

A man in his forties had been investigated for two years for fatigue, headaches and gut problems. Every test was normal. Nobody had asked about mood, and when someone finally did, he described eighteen months of flatness he had never thought to mention.

A woman in her seventies was referred for memory concerns. Her family were preparing for dementia. She had lost her husband, stopped going out and stopped eating properly, and her thinking sharpened considerably once she had the depression treated.

A teenager was described by her school as difficult and by her parents as rude. What looked like defiance was ten months of irritable mood, disturbed sleep and hopelessness she had no words for.

Frequently Asked Questions

The questions people ask us most often about this, and our honest answers.

How Long Do Symptoms Have To Last To Count As Depression?

Two weeks is the threshold for a major depressive episode, with symptoms present most of the day nearly every day. Persistent depressive disorder requires two years in adults and one year in children. You do not have to wait out the two weeks to talk to someone.

Can You Have Depression Without Feeling Sad?

Yes, and it is common. Loss of interest and pleasure can carry the diagnosis on its own without low mood, and many people describe numbness or irritability rather than sadness. In men and in adolescents this is a frequent presentation.

What Does Depression Feel Like From The Inside?

Most people describe weight and distance rather than sorrow. Things that mattered stop registering, effort that used to be automatic becomes deliberate, and there is often a sense of watching your life through glass. The flatness is usually more distressing than the sadness.

Should You Seek Treatment If Symptoms Are Mild?

Yes. Milder depression responds faster and with less intervention, and earlier treatment lowers the risk of a longer episode. Waiting until it is undeniable is the most common regret we hear.

Where To Go From Here

The signs of depression are broader than sadness. Two symptoms carry the diagnosis, low mood and loss of interest, and around those sit changes in thinking, behaviour and the body. The presentations that get missed are the physical ones, the irritable ones, and the ones in people who keep functioning.

If you recognise several of these in yourself over recent weeks, the next step is a GP appointment rather than more reading. Bring the specifics: how long, how many days a week, and what has stopped happening in your life. If you recognise them in someone else, ask directly, including about suicide if you are worried.

Depression is treatable and most episodes end. We see people individually and as couples at our Inglewood rooms and online across Western Australia, no referral needed.

Call us on 1300 956 227 , book a session, or read more about our depression counselling.

Need help now: 000 in an emergency. Lifeline 13 11 14. Beyond Blue 1300 22 4636. Suicide Call Back Service 1300 659 467. WA Mental Health Emergency Response Line 1300 555 788. 13YARN 13 92 76. Kids Helpline 1800 55 1800.