Depression is often subtle. Before a patient seeks medical help and receives a definitive diagnosis, their symptoms may masquerade as any number of other conditions, ranging from a poor attitude or alcohol abuse to a sleep disorder or an eating disorder. Behavior that may seem off-kilter may actually signal a larger problem.

Part of the difficulty in recognizing depression is that it may manifest in so many different ways. Men who are depressed, for example, may throw themselves into their work or become aggressive, irritable, or even abusive. Others may simply become lethargic, anxious, restless, or listless. Women sometimes cry uncontrollably, complain of persistent aches, experience difficulty sleeping, or lose interest in things they used to enjoy. Any of these behaviors may be evident in men or women who experience depression.

Some people eat more than usual and gain excess weight. Others lose their appetite and begin to lose weight. Some simply appear to lose focus. They become unable to concentrate or pay attention and have difficulty remembering things. Many people with depression lose interest in sex. Others feel guilty, hopeless, or express feelings of worthlessness. 

Children may become sullen, pretend to be sick, or resist going to school. Sometimes, depressed children fixate on worries that a parent may die. Any of these behavior changes may hint at underlying depression. Symptoms of depression vary from person to person, but may include:

  • agitation, restlessness and irritability
  • feeling sad or “empty”
  • notable changes in appetite, accompanied by unwanted weight gain or weight loss
  • feelings of hopelessness or helplessness
  • feelings of worthlessness, self-hate, and inappropriate guilt
  • problems concentrating
  • feeling tired all the time or lacking energy
  • becoming withdrawn or isolated
  • loss of interest or pleasure in activities that were once enjoyed
  • thoughts or talk of death or suicide, or attempts to commit suicide
  • insomnia (trouble sleeping) or sleeping too much
  • aches, pains, or cramps that don’t go away, even after treatment

As a concerned friend, family member, or loved one, you may wonder when you should intervene and how to go about it. Experts recommend consulting a medical professional when any of these symptoms last longer than a few weeks. Sadness in the wake of a life event such as grief after the loss of a loved one, stress over a divorce, or even the loss of a job, are all normal responses. But sadness and depression are not the same thing. Eventually, sadness abates and healthy people move on. But depression lingers, and mood deepens.

If a person talks about or threatens to commit suicide, it’s extremely important to take the threat seriously. Although it may seem like a bid for attention, the danger that a patient may follow through is very real. In such instances, it’s crucial that you seek immediate help. Call 9-1-1, your family doctor, or the National Suicide Prevention Lifeline (1-800-273-8255).

If someone you know exhibits any of the signs of depression, it may be time for you to intervene. Insist that the person seek medical attention and help them follow through. Once the person receives treatment, help them follow the health professional’s advice. About 60 percent of patients will feel better after being prescribed an antidepressant. Those who don’t respond to the first drug prescribed may be switched to another drug which may work better. In most cases, it will be necessary for the patient to take medication for at least six to nine months, if not longer.

What to Say and Do—and What Not To

As a concerned friend or loved one, your actions may be crucial to helping the patient get help and avoid hurting themselves.

Do: Take all talk or threats of suicide seriously.

Don’t: Criticize, nag, or ignore the depressed person or insist that they “just snap out of it.”

Do: Be gentle, but persistent, encouraging them to seek medical help. Remind them that depression is a legitimate illness that’s serious, but treatable. It can be overcome, things can improve.

Don’t: Assign blame, become angry, or react to negative talk with equally negative talk. The afflicted individual is not themselves. 

Do: Talk encouragingly and gently with the depressed person. Help them remember to eat, sleep, or dress for the day. Offer to assist with basic hygiene tasks.

Do: Firmly but gently insist that they see a doctor and help them follow up with the doctor’s advice. Keep an eye on the patient, especially for the first month or two of drug therapy, as thoughts of suicide may temporarily increase during this period.

If the patient is a child, adolescent, or young adult, the temporarily increased risk of suicide is even greater during the initial phase of drug therapy. Monitor the patient closely and continue to offer support and encouragement.