signs of depression

the two core signs, and the rest

The diagnosis rests on two things, and without at least one of them it isn’t made:

• low mood for most of the day, nearly every day;
• loss of interest and pleasure in things you used to enjoy. That one has a name of its own — anhedonia — and it isn't exclusive to depression: what else hides behind can't feel emotions.

It has to hold for at least two weeks and get in the way of ordinary life. A bad day, or a hard week after a loss, doesn’t count here.

The other signs of depression travel alongside, usually several at once:

• sleep has come apart — you can’t drop off, or you wake at four, or you sleep twelve hours and wake up tired;
• appetite has gone, or eating has become the only comfort left;
• everything runs slower: thought, speech, movement;
• there is no energy from the moment you wake, before anything has started;
• concentrating fails, and decisions become an ordeal;
• guilt and a sense of being worthless, often with no cause attached;
• thoughts that it would be easier not to be alive.

That last one is worth stopping at right now, whatever the rest of the list says. Helplines wherever you are: findahelpline.com. You don’t have to be sure it counts as serious to call.

To check yourself against the scale clinicians use, there is the depression test — nine questions, about two minutes. It doesn’t diagnose, though it does show how heavy the past two weeks were, which gives you a number to bring to a doctor.

what it isn’t

Tiredness. Rest fixes it. Depression doesn’t lift that way: people come back from a holiday the same or worse.

Burnout. It is tied to work and usually eases when the circumstances change. Depression colours everything at once, including what work never touched. More in burnout, and there is a burnout test too.

Grief. After a loss, low mood is normal, and it comes in waves: it lifts, it returns. In depression the background is level and heavy, and self-worth drops with it — in grief a person longs for the one who’s gone; in depression they turn on themselves.

Thyroid trouble, anaemia, iron and B12 deficiency. They produce exactly the same picture: no energy, nothing matters, fog. With the thyroid it’s usually the underactive kind — hypothyroidism. Which is why the doctor will often start with blood tests.

what the evidence says treats it

Psychotherapy. The largest meta-analysis of cognitive behavioural therapy — four hundred and nine trials, fifty-two thousand patients — puts the effect, against those who didn’t get it, at g = 0.79. That is a lot. Other therapies do about as well: the gap between them is small and vanishes in most checks.

Medication. Over a short horizon, antidepressants and therapy are comparable; at six to twelve months therapy came out ahead, though on few trials. Combining them beats medication alone and doesn’t beat therapy alone. Medication takes weeks to start working, and stopping it abruptly is a conversation to have with a doctor first.

Movement. The caveat comes first here: the authors rated their own confidence as low — one study out of all of them met the low-risk-of-bias criteria. With that in mind: a network of 218 studies, fourteen thousand participants at clinical depression level, walking and running g = −0.62, yoga −0.55, strength training −0.49, and the harder the work the larger the effect. Movement is worth having whatever the exact numbers turn out to be; that doesn’t make it a substitute for treatment.

what we can do, and what we can’t

Breathing does not treat depression.

Breathwork does show an effect on depressive symptoms, and it is weaker than both therapy and movement, and it was measured mostly through self-report in samples where clinical depression wasn’t universal. Lining that up beside four hundred trials of therapy would be a con.

What breathing genuinely helps with here:

• the anxiety that travels with it. Most people have both, and for anxiety breathing has a tested effect — modest but real: constant anxiety;
• not sleeping. A long exhale helps you get in, and depression breaks sleep almost every time: can’t sleep;
• getting through this evening. Five minutes of an even rhythm won’t change a diagnosis, and the hour before bed will pass more easily.

Too little to recover on; enough that you aren’t empty-handed while you wait.

how to get out of depression on your own

The honest answer is short: help. Depression is treatable, and treated well; waiting costs more than starting.

But the question of doing it alone has a real answer, and a better one than people expect. The same CBT meta-analysis counted unguided programmes separately — no therapist, worked through from a book or an app. They work: g = 0.45. Less than with a therapist, and considerably more than nothing.

What is worth doing while a specialist is out of reach:

Start from the action, not the mood. In depression the wanting arrives after the doing; before it there is none. “I’ll do it when I feel like it” doesn’t work here, because feeling like it won’t arrive on its own.

Cut tasks down past the point of embarrassment. Instead of “tidy up”: “take one cup off the table”. The point is breaking the loop of “tried — couldn’t — worse now”.

Walk. Twenty minutes on foot, no gym and no plan. The caveat from the movement section still applies — but this one is free and has no side effects.

Keep the wake-up time. The same alarm, weekends included. Broken sleep deepens depression.

Tell one person. Isolation is how depression keeps itself going. One person is enough.

when not to wait

• thoughts that it would be better not to be alive — and any thought of hurting yourself;
• it has held for more than two weeks and hasn’t shifted;
• ordinary things have stopped working: your job, eating, washing;
• a sense that it is hopeless and always will be;
• alcohol has become the way you reach the evening.

A GP is a reasonable first stop — thyroid and deficiencies get ruled out there. After that, a psychiatrist or a psychotherapist.

short answers