Some symptoms of depression may be more equal than others

Depression is characterised by a lowering of mood. Other symptoms include decreased energy and activity, reduced capacity for enjoyment, reduced appetite, disturbed sleep, poor libido, low self-esteem, and a pessimistic outlook. The symptoms must last longer than a few days – at least two weeks, by the criteria of the International Classification of Diseases. 

Symptoms of Depression

Some depressive symptoms are considered more important than others in diagnosing the condition and are called somatic. They include:

1. Marked loss of interest in previously pleasurable activities
2. Lack of emotional response to activities that generally provoke such response.
3. Waking in the morning 2 hours or more before usual time.
4. Depression is worse in the morning.
5. Marked psychomotor retardation or agitation.
6. Marked appetite loss.
7. Weight loss (5% or more)
8. Marked loss of libido

Diagnosing Depression

Depression is easy to diagnose, easy to miss, and easy to over-diagnose. A missed depression is particularly significant as the condition is highly treatable. On the other hand, a wrongly diagnosed depression means the patient is unlikely to respond to antidepressants. It also means the proper diagnosis is missed.

Many symptoms of depression, such as disturbed sleep and reduced energy levels, are found in other conditions. This crossover of symptoms can make diagnosing depression more challenging. 

Diagnosing Different Symptoms

As a psychiatrist, I try to determine how different symptoms affect my patient. This is important because, even amongst the so-called somatic group of symptoms, there are those that, on their own, may not cause the patient colossal distress, not in the short or medium term. For example, some patients may cope with not having an excellent appetite for some period if it occurs alone, and some people have learned to live with disturbed sleep. 

One symptom stands out for me: the pervasive inability to feel enjoyment, also known as anhedonia. The word pervasive is essential here. Everything, including those the patient used to enjoy, stopped being enjoyable. Like other symptoms of depression, it can occur in different conditions. And no single symptom can diagnose depression. However, having anhedonia, among other depressive symptoms, makes it more likely that you’re dealing with depression. So when assessing a patient for depression, I make sure not to miss the critical question about how their ability to feel enjoyment has changed. 

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