Detecting and Diagnosing Depression: It Can Look Different in Men and Women and in Teenagers, Too

Unlike the usual feelings of sadness that pass relatively quickly, depression is a clinical illness in which negative emotions last for weeks or longer.

It’s one of the most common mental illnesses, affecting an estimated 300 million people or more around the globe, according to the World Health Organization. (1)

Depression is treatable, and it’s important to know the signs and symptoms of the illness so that you can get help as soon as possible.

Signs of Depression in Adults

Depression doesn’t affect all people in exactly the same way, but the illness is associated with particular signs and symptoms. A minimum number of symptoms are needed for a clinical diagnosis of depression, but the combination and number of symptoms each person has can vary. If you have been experiencing some of the following symptoms for most of the day, almost every day, for two weeks or more, you may be struggling with depression:

• Feeling sad or having a depressed mood for most of the day (or an irritable mood in children and adolescents)
• Loss of interest or pleasure in once-enjoyable activities
• Unexplained weight loss or gain
• Insomnia or sleeping too much
• Fatigue or loss of energy
• Restlessness or slowed movements, speech, and thoughts
• Feelings of worthlessness and guilt
• Difficulty thinking, concentrating, or making decisions
• Recurrent thoughts of death or suicide

Additionally, you may experience physiological signs like new, frequent aches, pains, or stomach issues — in some cases, people may experience mental distress physically more than psychologically. Changes in behavior or increased substance use may also be signs of attempts to self-treat underlying mental distress.

Depression in Men

Although men and women can have the same symptoms of depression, there are important differences in how often they report specific symptoms, according to a report published in the journal JAMA Psychiatry. (2)

Men with depression are more likely than women to report the following symptoms of depression:

• Anger
• Aggression
• Drug and alcohol abuse
• Risk-taking behavior

Reflecting cultural norms, men with depression may be more likely to exhibit certain unhealthy coping skills such as workaholism or spending an inordinate amount of time on sports.

Doctors are less likely to diagnose depression in men than in women, even when patients have identical symptoms or have the same scores on assessment measures.

Depression in Women

Depression is more common in women than men. (3) Women with depression are more likely to report the following symptoms: (2,3)

• Stress
• Indecisiveness
• Anxiety
• Complaining
• Sleep problems
• Depressed mood

Teen Depression

Depression has become common in young people between ages 12 and 17, and rates of teen depression are rising fast. According to a study in a November 2016 issue of the journal Pediatrics, (4) the number of adolescents ages 12 to 17 who’d experienced a major depressive event in the previous 12 months jumped from 8.7 percent in 2005 to 11.3 percent in 2014 — a 37 percent increase.

Despite the rise in depression, the researchers did not see an increase in the number of teenagers undergoing mental-health treatment, suggesting that many young people are not receiving the help they need.

Teenagers have many of the same symptoms of depression as adults, but these changes in mood and behavior are sometimes mistaken as a normal part of puberty or adolescence.

Other signs of depression in teenagers can include (4,5)

• Obsession with death, shown in poems and drawings that refer to death
• Criminal behavior, such as shoplifting
• Withdrawal from family and friends
• Sudden sensitivity to criticism
• Drop in grades or school attendance
• Risky behavior, such as unsafe sex and reckless driving
• Drinking alcohol or using illicit drugs
• Irrational or bizarre behavior
• Sudden, dramatic changes in personality or appearance
• Giving away belongings

Complications of Depression

Depression can negatively affect your personal relationships and work life.

It may also raise your risk of developing heart disease or obesity, having a heart attack, or experiencing a sharp decline in mental function in old age.

Experiencing and surviving an episode of major depression puts you at risk for more episodes in the future.

According to a study in the journal Psychological Medicine, more than 13 percent of people who recover from their first episode of major depression go on to have another one within 5 years; 23 percent within 10 years; and 42 percent within 20 years. (6)

More than 90 percent of all people who die by suicide — the tenth leading cause of death in the United States — have a diagnosable psychiatric illness like depression at the time they die, according to the American Foundation for Suicide Prevention. (7)

Depression Tests and Diagnosis

There are a number of online tools and self-tests to determine whether you may be depressed and need to seek help, but only your doctor can diagnose clinical depression.

Before diagnosing major depression — the most common type of depression — your doctor will conduct exams and tests to rule out other problems that could be causing your symptoms, such as thyroid issues, medication side effects, neurological illnesses, autoimmune disease, or nutritional deficiencies.

These efforts may include a physical examination and blood tests, as well as a discussion about your medications, some of which may cause depressive symptoms.

Your doctor will also ask in-depth questions about your mood and feelings, and may ask you to fill out a questionnaire.

Additional reporting by Pamela Kaufman.