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Learn to Recognize the 12 Signs of Depression

Did you know that depression is predicted to be the leading cause of disease burden by 2030? In fact, it’s already the leading cause in women worldwide. When including depressive-related deaths due to suicide and stroke, depression has the third highest global disease burden. (1)

For people with depression, their negative thoughts overshadow all of their thoughts and actions. Some people have such severe depression that they lack the energy to get help and they may have suicidal thoughts without anyone noticing. Being aware of the signs of depression can help you to determine whether or not you or a loved one needs support and treatment.


What Is Depression? 

Major depressive disorder (MDD) is a syndrome that negatively affects a person’s life. It comprises certain symptom sets that disables the sufferer’s ability to function in daily life. People with depression live in a state of low mood and aversion to activity. In fact, they often feel worthless and unable to function properly. (2)

Interestingly, the word depression comes from the late Latin word “depressare” and the classical Latin word “deprimere,” which literally means to press down. Researchers suggest that the term indicates a feeling of heaviness, of being “pressed down,” or feeling sad, blue or simply down. (3)

Depression includes different phases and people may experience one or several of them in a certain period of time. Some people have signs of depression that last longer, with a mix of severe and less severe phases. Others will develop chronic depression that lasts for years. Some four common phases of depression include:

Depressive episode — a state of low mood and aversion to activity that goes away after a certain amount of time.

Relapse — when signs of depression return within six months after the last depressive episode.

Recurrent depression — when signs of depression return more than six months after the last episode, or even years later.

Chronic depression — when depressive episodes last longer than two years.


Risk Factors for Depression

Depression can arise in various phases of life and under many circumstances. Research shows that depression affects women more than men; in fact, depression is the leading cause of disease-related disability in women. Studies show that the lifetime prevalence of a major depressive disorder in women is 21 percent. In fact, that’s almost twice that in men at 12 percent. National data reveals that sex differences in prevalence first appear around the age of 10 years and persist until midlife, after which they disappear. Therefore, women have the greatest risk for developing depressive disorders after puberty and during their child-bearing years. (4)

Research shows that there are several biological processes that may predispose women to depression. These include genetically determined vulnerability and hormonal fluctuations related to various aspects of reproductive function. For example, the variation in ovarian hormone levels and decreases in estrogen experienced by women have proven to be important factors. Reproductive events such as infertility, miscarriage, oral contraceptives and hormone replacement therapy have been reported to cause depression in women as well. Studies also show that birth control pills cause depression. Women have expressed concern about low sex drive, lack of appetite, helplessness, disinterest and an overall sad disposition while “on the pill.”(5)

Psychosocial events such as role-stress (or job stress), victimization, sex-specific socialization, internalization, coping style and disadvantaged social status have also been considered as contributors to the increased vulnerability of women to depression.

According to research published in the Journal of Psychiatry and Neuroscience, women tend to display more sensitivity to interpersonal relationships, whereas men display more sensitivity to external career and goal-oriented factors. Women also experience specific forms of depression-related illness, including postpartum depression and postmenopausal depression and anxiety. (6)

Signs of clinical depression are also more common in the elderly, unlike bipolar disease, or manic depression, which usually appears in the late teens and early adult years. The definition of late life depression, according to most researchers, is a major depressive disorder that appears for the first time at the age of 60 or later. Researchers suggest that it’s difficult for healthcare providers to accurately diagnose depression in elderly people because signs of depression, such as tiredness, loss of appetite and sleep disorders, are commonly evaluated as part of a medical illness. Elderly people may also have difficulty expressing their emotions. Or they hide complaints when cognitive problems are encountered because they think of these symptoms as a normal process of aging.

According to research published in Aging and Disease, signs of depression seen in the elderly are related to: (7)

  • the advancing of age
  • being a female
  • living alone
  • being divorced
  • having a low education level
  • having a functionality disorder
  • being physically ill
  • having low-level cognitive dysfunction
  • cigarette and alcohol use
  • loss of life purpose
  • multiple medication use
  • economic problems

Depression can also co-occur with other serious medical illnesses, including diabetes, cancer, heart disease and Parkinson’s disease. Also, medications taken for these physical illnesses may cause side effects that contribute to depression. Some other risk factors for depression include a family history of depression, stress, major life changes and trauma. (8)


The Many Causes of Depression

There is no one cause of depression. It’s thought that biological processes, psychological factors, major events in a person’s life and personal circumstances can all play a role. Some examples of the many causes of depression include:

  • genetics
  • stress
  • traumatic experiences
  • unresolved emotional problems
  • certain medications
  • medical conditions (such as cancer, stroke, heart attack or an underactive thyroid)
  • substance abuse
  • lack of sunlight
  • neurotransmitter imbalance
  • hormonal imbalance
  • nutrition deficiencies
  • toxicity from mold and metals
  • diet
  • hypoglycemia

Over the years, researchers have found that more cases of depression are characterized by the accrual of multiple chronic mild stressors. These include work-related stress, homemaking demands and financial trouble, than by major losses such as divorce or the loss of a job. (9) We can dive deeper into some of these common causes of depression in order to better understand how some environments, personal circumstances and decisions, and physical conditions can increase the risk of developing depression.

About half a million Americans, mainly from northern climates, suffer from seasonal affective disorder (or SAD), a form of clinical depression that comes and goes in a seasonal pattern. It is believed that a vitamin D deficiency and a lack of sunlight keeps a part of the brain, the hypothalamus, from working properly, leading to a disruption of circadian rhythms. When our circadian rhythms are out of whack, it can increase our levels of melatonin. These melatonin increases make us feel sleepy and lethargic, and decreases our serotonin levels, affects our mood and appetite. (10)

Our diet can be a major contributor to the development of depression as well. Our bodies are interconnected systems. Everything we put in them, expose them to or do to them affects the whole person, not just one area. The foods that we eat will not only affect our digestion and energy, but also alter the neurochemistry of our brains, specifically the neurotransmitters.

The neurotransmitters dopamine, norepinephrine and serotonin affect mood and behavior. When there is an imbalance, this can lead to signs of depression. In fact, serotonin eases tension and dopamine and norepinephrine raise alertness. The foods commonly consumed in the Western diet have the ability to alter the balance of our neurotransmitters. The high levels of omega-6 and 9 fatty acids in refined and processed foods, for example, have been found to cause dramatic problems in the production of serotonin.

Hypoglycemia (low blood sugar) is a commonly overlooked commonality in depression. Consuming sugar and simple carbohydrates such as white rice, white bread and white flour, causes a rapid and dramatic rise in blood sugar. This then produces an exaggerated insulin response. A 2013 study conducted at the University of Washington Medical School involved over 4,000 patients with diabetes. Researchers found that depressed patients (compared with non-depressed patients) had a significantly higher risk of severe hypoglycemic episodes and a greater number of hypoglycemic episodes. (11)

Alcohol lowers serotonin and norepinephrine levels, it depresses the brain and nervous system and blunts the action of stress hormones. According to a 2011 study published in Addiction, there a link exists between alcohol use disorders and major depression. Researchers found that increasing involvement with alcohol also increases the risk of depression. Potential mechanisms underlying these linkages include neurophysiological and metabolic changes resulting from exposure to alcohol. (12)

Toxic mold exposure is another cause of depression that sometimes isn’t taken seriously enough. Research published in The American Journal of Public Health indicates that there is a link between homes with mold and residents with signs of depression. This data comes from more than 6,000 European adults and it proves that toxic mold causes depression. (13)

12 signs of depression - Dr. Axe


12 Signs of Depression 

It’s perfectly normal to feel sad and lonely at times — this is a common reaction to life’s struggles. However, when feelings of sadness, loneliness and depression become so overwhelming that they keep you from social interactions, physical activity and other normal life events, you may need to seek the help of a counselor or health care provider. Although there are complex and varied features of depression, there are some common signs of depression that can help you to make an accurate diagnosis.

1. Fatigue

People who are depressed often feel exhausted and unable to carry out physical or mental work. In a large study including almost 2,000 depressed patients across six countries, 73 percent of patients agreed that they experienced tiredness. (14)

2. Sleep Disturbance

Insomnia is a frequent symptom of depression. Other signs of depression are disturbances in the ratio of rapid eye movement (REM) sleep to non-REM sleep, decreased slow-wave sleep and impaired sleep continuity. According to research published in Dialogues in Clinical Neuroscience, about three quarters of depressed patients have insomnia symptoms, and hypersomnia (or excessive sleepiness) is present in about 40 percent of young depressed adults and 10 percent of older patients. The symptoms cause huge distress, have a major impact on quality of life and are a strong risk factor for suicide. (15)

3. Cognitive Dysfunction or Difficulty Concentrating

Signs of cognitive dysfunction in depressed patients include disturbances in psychomotor speed, memory, verbal fluency, attention, executive functions (such as planning and problem solving) and processing speed. According to research published in Annual Review of Clinical Psychology, people who show signs of depression also have difficulty disengaging from negative material. They also have deficits in cognitive control when processing negative material. (16)

4. Feelings of Worthlessness or Hopelessness

According to research published in the Journal of Affective Disorders, cognitive models predict that vulnerability to depression is due to a bias to blame oneself for failure in a global way. This results in excessive self-blaming emotions, decreased self-worth, hopelessness and depressed mood. A study involving 132 patients with major depressive disorder found that feelings of inadequacy, depressed mood and hopelessness emerged as the most closely co-occurring and consistent symptoms, affecting more than 90 percent of patients. (17)

5. Irritability or Restlessness

Clinical studies of depressed children and adolescents have shown that the most frequently reported symptom in moderate depression is irritability. Research shows that irritability is more likely in female, young, unemployed people who are lower in functional status and quality of life, and have a history of at least one suicide attempt. Irritability with anger attacks might be present in more than one-third of patients with major depressive disorder, according to research published in Molecular Psychiatry. (18)

6. Loss of Interest in Hobbies or Activities

One of the main signs of depression is reduced work and interest. It’s an essential requirement for the diagnosis of major depressive episode. The scientific term for a reduced ability to experience pleasure is anhedonia. Depressed people no longer value activities and hobbies that once brought them pleasure. People may begin to feel as though they have no purpose. They lose social connections because of their inactivity in the community, at work or within the family. (19)

7. Appetite Changes

According to research published in the Indian Journal of Psychiatry, many of the easily noticeable food patterns that precede depression are the same as those that occur during depression. These may include poor appetite, skipping meals and a dominant desire for sweet foods. There is a growing body of evidence proving that nutritional factors are intertwined with human cognition, behavior and emotions. (20)

Researchers published a study in the American Journal of Psychiatry in which they found that many of the brain regions responsible for appetite and responses to food are implicated in depression. Researchers found that people with depression-related increases in appetite exhibited greater hemodynamic (blood flow) activity to food stimuli, while depressed patients who experience appetite loss exhibited hypoactivation of insular regions of the brain. (21)

8. Persistent Aches or Pains

Physical signs of depression include chronic joint pain, limb pain and back pain. According to research conducted at the University of Texas Southwest Medical School, physical pain and depression have a deeper biological connection than simple cause and effect. The neurotransmitters that influence both pain and mood are serotonin and norepinephrine; dysregulation of these transmitters links to both depression and pain. Researchers suggest that in general, the worse the painful physical symptoms, the more severe the depression. Elevated rates of suicidal thoughts are also found in patients with chronic pain. (22)

9. Digestive Issues

Data indicates that emotional stress and depression might influence the development of gastrointestinal disorders. In a 2015 study, stress and depression were related to functional dyspepsia (or discomfort in the chest and abdomen), irritable bowel syndrome and reflux esophagitis. Depression was also linked to stomach ulcers, and benign tumors and cancer of the colon and stomach. (23)

10. Anxiety

Studies show that 90 percent of depressed patients have co-occurring anxiety symptoms and approximately 50 percent of depressed patients meet the criteria for a comorbid anxiety disorder, meaning they simultaneously experience signs of depression and anxiety, two conditions, at the same time. (24)

11. Sexual Dysfunction

An important and often overlooked sign of depression is sexual dysfunction. Research shows that low libido may contribute to deteriorating interpersonal/marital relationships and further exacerbate depression. Although patients most often report decreased libido, difficulties with arousal, resulting in vaginal dryness in women and erectile dysfunction in men, and absent or delayed orgasm are also prevalent. According to a 2009 review conducted at the University of Toronto, sexual dysfunction is also a frequent adverse effect of treatment with most antidepressants and is one of the predominant reasons for premature drug discontinuation. (25)

12. Thoughts of Suicide

Data published in Annals of General Psychiatry suggests that between 59 and 87 percent of suicide victims suffer from major depression. Suicide has proven to be a multicausal behavior. People who experience anxiety and depression simultaneously are at a greater risk of developing suicidal thoughts. Research also shows that being male, experiencing adverse life situations, social losses such as the death of a loved one, loss of work or income and cognitive decline, physical disease and acute psycho-social stressors are also risk factors. (26)


Natural Treatment of Depression 

Anti-Depression Diet

One of the most important natural remedies for depression is your diet. You want to eat foods that boost your neurological health and cellular function; plus, you need to make sure you’re consuming vital nutrients that support a positive mood.

A 2015 study published in Nutritional Neuroscience aimed to provide a set of practical dietary recommendations for the prevention of depression, based on the best available current evidence. Researchers found that it’s important to increase your consumption of fruits, vegetables, legumes, whole grains, nuts and seeds, consume plenty of omega-3 foods, and limit your intake of processed foods, fast foods, commercial bakery goods and sweets. (27)

It is also important to eat saturated fats found in coconut, raw dairy and grass-fed meats because they support cellular function and neurological health. And in addition to sugary, processed and packaged foods, avoiding caffeine and alcohol can help you to relieve the signs of depression and avoid recurring depressive episodes.

Exercise is also extremely important in fighting depression because it releases endorphins, which are our feel-good chemicals. Aim to exercise three to five times a week for 20 minutes or more.

Supplements for Depression

Fish Oil — The omega-3 fatty acids in fish oil are critical for neurotransmitter function, which is a key component for emotional and physiological brain balance.

Vitamin D — Vitamin D deficiency may cause seasonal affective disorder (SAD), which can manifest depression, especially in people who don’t get regular sunlight.

B-Complex — B vitamins help neurotransmitter function. Researcher have found that people with major depression have low levels of folate and vitamin B12; take oral doses of both vitamins to improve treatment outcomes in depression. (28)

Adaptogen Herbs — Adaptogen herbs like ashwagandha and rhodiola improve the balance of stress hormones and help to relax the nervous system. Rhodiola helps to beat depression by enhancing brain function and lowering cortisol.

St. John’s Wort — St. John’s Wort helps to relieve signs of depression such as anxiety, fatigue, loss of appetite and trouble sleeping. It treats moodiness and seasonal affective disorder.

Psilocybin Mushrooms — Psilocybin mushrooms, or “magic mushrooms,” are used to reduce anxiety and depression among cancer patients and survivors. Psilocybin seems to affect serotonin, the neurotransmitter linked to depression. (29)

Mugwort — Some studies show that mugwort, which is in the same plant family as St. John’s Wort, can treat mild depression and anxiety. (30)

Essential Oils for Depression

Certain essential oils help to elevate mood and bring on feelings of ease and comfort. Because smells travel directly to the brain, they serve as emotional triggers and can promote hormonal balance. The best essential oils for depression include bergamot, lavender, Roman chamomile, ylang ylang and patchouli oil.

Sandalwood essential oil can also be helpful to both sexes because it can increase libido by balancing testosterone levels in men and women. Sandalwood is a natural aphrodisiac, which can be helpful for people with depression who are experiencing sexual dysfunction.

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