How depression can show up
Depression looks different in different people. Some feel deeply sad. Others mainly feel irritable, exhausted or numb. Some people notice physical symptoms first and only later realise their mood has changed.
The NHS groups the symptoms into three areas: psychological, physical and social. The lists below are based on NHS information.
Psychological symptoms
These are changes in how you feel and think:
- continuous low mood or sadness
- feeling hopeless and helpless
- low self-esteem
- feeling tearful
- feeling guilt-ridden
- feeling irritable and intolerant of others
- having no motivation or interest in things
- finding it hard to make decisions
- not getting any enjoyment out of life
- feeling anxious or worried
- thoughts of suicide or of harming yourself
Two symptoms are especially central to depression: a low mood that does not lift, and losing interest or pleasure in things you used to enjoy.
Physical symptoms
Depression often affects the body:
- moving or speaking more slowly than usual
- changes in appetite or weight, usually less but sometimes more
- constipation
- unexplained aches and pains
- lack of energy
- low sex drive
- disturbed sleep, such as finding it hard to fall asleep or waking very early in the morning
Physical symptoms can make depression harder to spot, both for you and for others. It is worth mentioning mood changes to your GP even if you have booked the appointment about tiredness or pain.
Social symptoms
Depression can also change how you live and connect with others:
- avoiding contact with friends and taking part in fewer social activities
- neglecting hobbies and interests
- having difficulties in home, work or family life
These changes can feed the depression. Doing less often leads to feeling worse, which leads to doing even less. Treatments such as behavioural activation are designed to break this cycle. Treatment for depression explains how.
How severity is judged
Depression can range from less severe to more severe. Doctors think about:
- how many symptoms you have
- how strong they are and how often you have them
- how long you have had them
- how much they affect your daily life
The NICE guideline on depression in adults (NG222) uses two broad groups:
| NICE term | Includes | What it can look like |
|---|---|---|
| Less severe depression | Subthreshold symptoms and mild depression | Noticeable symptoms, but you can mostly keep going, with extra effort |
| More severe depression | Moderate and severe depression | Symptoms that make work, relationships or self-care very difficult |
A small number of people with severe depression also have symptoms of psychosis, such as hearing voices or holding beliefs that are very unlikely to be true. This is called psychotic depression and needs prompt specialist help.
The PHQ-9 questionnaire
GPs and NHS Talking Therapies services often use short questionnaires to help understand your symptoms. One of the most widely used is the PHQ-9 (Patient Health Questionnaire-9). It asks nine short questions about how often you have recently been bothered by common symptoms of depression, such as low mood, poor sleep or trouble concentrating.
Each answer is scored and the scores are added up. NICE used PHQ-9 scores as one guide to severity: a score under 16 was treated as less severe depression, and 16 or more as more severe depression.
A questionnaire cannot diagnose depression on its own. It is a tool that supports a proper conversation with a clinician, who will also think about your history and circumstances. You may be asked to fill in the PHQ-9 again during treatment, to see whether things are improving.
When to see a GP
The NHS advises seeing a GP if you have symptoms of depression for most of the day, every day, for more than 2 weeks.
It is also worth booking an appointment sooner if:
- you are struggling to cope
- symptoms are affecting your work or relationships
- you are drinking more or using drugs to get through the day
- you have had depression before and recognise the signs returning
In England, you can also refer yourself to NHS Talking Therapies without seeing a GP. Getting diagnosed explains how to prepare for a GP appointment and what questions you may be asked.
When to get help urgently
Get help straight away if:
- you are thinking about ending your life or harming yourself and feel you might act on these thoughts
- you have seriously harmed yourself – call 999 or go to A&E
- someone you know seems very unwell, confused or out of touch with reality
For urgent mental health help, call NHS 111. In England, choose the mental health option. You can also contact Samaritans on 116 123 at any time. The urgent help page covers all four UK nations.
If you are worried about someone else, supporting someone with depression explains how to ask about suicide safely and what to do next.
When a specialist may help
Sometimes symptoms raise questions that are best looked at by a psychiatrist. Examples include:
- periods of unusually high mood, racing thoughts or needing much less sleep, which can point to bipolar disorder
- depression that has not improved after two or more treatments
- depression alongside another condition, such as anxiety, ADHD or problems with alcohol