Depression symptoms: signs in mood, body and thinking, and how they vary

Depression is more than a bad day. The World Health Organization (WHO) describes it as a depressed mood (feeling sad, irritable or empty) or a loss of pleasure or interest that lasts most of the day, nearly every day, for at least two weeks, together with other symptoms such as poor concentration, excessive guilt, hopelessness about the future, changes in sleep and appetite, or feeling very tired (WHO, 2026). The diagnostic criteria (five or more of the nine DSM-5 symptoms) are summarised in burnout versus depression.

This guide looks at how those symptoms actually show up. The same diagnosis can look quite different from one person to the next: a study that counted the symptom combinations of 3,703 US outpatients found 1,030 different ones, and even the most common was shared by only 1.8% (Fried & Nesse, 2015). Whether or not the descriptions below match your experience, they are not enough to decide on their own; a diagnosis is made in an interview with a professional.

Two symptoms sit at the core of depression: a depressed mood, and a marked loss of interest or pleasure in activities you usually enjoy. At least one of them must be present for a diagnosis. The International Classification of Diseases (ICD-11) notes that loss of interest can include reduced sexual desire (WHO, 2024).

A depressed mood is not always felt as sadness. According to ICD-11, in some people it is experienced mainly as irritability, or as an absence of feeling, a sense of “emptiness”, and this can be considered to meet the depressed mood requirement if it is a marked change from how the person usually is (WHO, 2024). Irritability and anger are also common in depression: among 536 people who joined a study during a depressive episode at five US academic medical centres between 1978 and 1981, 54.5% showed overt irritability or anger (Judd et al., 2013).

Hopelessness about the future is another important sign. DSM-5 added hopelessness to its description of depressed mood (Uher et al., 2014), and ICD-11 lists it as a symptom in its own right (WHO, 2024).

Depression shows up in the body too. Some people have trouble falling asleep, wake often or wake too early; others sleep far too much. In clinical samples, about three in four depressed patients have insomnia symptoms, and oversleeping affects about 40% of patients under 30 and 10% of those in their 50s (Nutt et al., 2008).

Appetite can fall or rise, with weight loss or gain. Fatigue is common: ICD-11 describes marked tiredness after only minimal effort. Others may also notice slowed speech and movement, or the opposite, restless agitation (WHO, 2024).

Many people first see a doctor about physical complaints that are hard to explain, such as headaches, constipation, weakness or back pain. In a WHO study at 15 primary care centres in 14 countries, of the 1,146 patients who met the criteria for major depression, 69% presented with physical symptoms only (45% to 95% depending on the centre), but when asked directly, only 11% denied psychological symptoms of depression. The data were collected in 1991 and 1992 (Simon et al., 1999). If physical complaints persist and tests find no cause, it is worth looking at mood as well. Conversely, some conditions, such as thyroid disorders, and some medicines can cause symptoms like those of depression, so a medical check-up helps rule them out (NIMH, 2024).

Changes in thinking are part of depression too: trouble concentrating, difficulty making even small decisions, feeling worthless or excessively guilty, and recurring thoughts of death (WHO, 2024). A meta-analysis of studies that used the same computerised cognitive test battery (CANTAB) found moderate deficits in executive function, memory and attention in people with depression compared with controls (d = −0.34 to −0.65); after remission, moderate deficits in executive function and attention remained (d = −0.52 to −0.61), while the memory difference was no longer statistically significant (Rock et al., 2014).

Some symptoms linger. In a study that followed 267 initially depressed primary care patients for three years, cognitive problems, lack of energy and sleep problems were present 85% to 94% of the time during depressive episodes and still 39% to 44% of the time during periods of remission (Conradi et al., 2011). It is not unusual for concentration or energy to come back more slowly than mood.

Concentration problems also weigh heavily on daily life. In an analysis of 3,703 US outpatients, sad mood and concentration problems had the strongest links to impairment overall and were among the most disabling symptoms in all five areas studied: work, managing the home, social activities, private activities and close relationships (Fried & Nesse, 2014).

In some cultures, changes in mood are more readily expressed through bodily symptoms (WHO, 2024), and Korean studies have reported that depressed mood is less openly expressed. A study comparing 1,592 Korean and 3,744 American outpatients diagnosed by the same criteria found that, at the same overall severity, Korean patients scored lower on depressed mood and guilt and higher on hypochondriasis (worry about health) and suicidality; the authors suggest this may delay diagnosis (Jeon et al., 2014). Comparing community surveys of 5,349 Koreans and 7,423 Americans aged 18 to 54, another study found that Koreans with depression more often reported low energy and difficulty concentrating, and less often depressed mood and thoughts of death (Chang et al., 2008). Both studies are more than ten years old and looked at different groups (outpatients and community residents), and their findings on suicide-related symptoms point in different directions. Hwabyung, a Korean cultural concept of long-suppressed anger that shows in the body as chest tightness or a feeling of heat, overlaps with depression in some ways and differs in others; it is covered in a separate guide.

ICD-11 notes that the lifetime prevalence of depressive disorders is about twice as high in women as in men (WHO, 2024). A meta-analysis of nationally representative samples from more than 90 countries found an odds ratio of 1.95 for major depression in women compared with men, with the gap appearing around age 12 and peaking at 13 to 15 (Salk et al., 2017). It is often said that depression in men shows as anger. A meta-analysis of sex differences (32 studies, 108,260 participants) found only small differences: depressed men more often reported alcohol or drug misuse (g = 0.26) and risk-taking or poor impulse control (g = 0.58), while depressed women more often reported depressed mood, appetite or weight changes and sleep problems (Cavanagh et al., 2017). Irritability and anger are common in depression: in the study above they were present in more than half of the patients, men and women together (Judd et al., 2013). Depression that starts after childbirth is covered separately in postpartum depression, and controlling what you eat out of worry about weight or shape in eating disorders. Low mood that comes back before every period is covered in PMS and PMDD.

In young people, depression can show as irritability rather than sadness, and the diagnostic criteria allow for this in children and adolescents (NIMH, 2024). But in a US study that followed 1,420 young people, among those who met the criteria for depression between the ages of 9 and 16, 58.7% had depressed mood only, 35.6% had both depressed and irritable mood, and only 5.7% had irritable mood alone (Stringaris et al., 2013). ICD-11 also notes that irritability in itself does not indicate a depressive episode. According to ICD-11, oversleeping and overeating are more common in adolescents than in adults (WHO, 2024).

Depression in later life differs only in part. A meta-analysis of 11 studies found that older depressed adults showed more agitation, health worries and general and digestive physical symptoms, and less guilt and loss of sexual interest, than younger ones (Hegeman et al., 2012). Memory problems can be prominent, so they need to be told apart from dementia (WHO, 2024). How everyday forgetfulness differs from signs of dementia is covered in the forgetfulness guide. In Korea’s 2021 National Mental Health Survey, the 12-month prevalence of depressive disorders was highest among people aged 70 to 79, at 3.1% (National Center for Mental Health, 2023).

Feeling low after something hard happens is a natural reaction. ICD-11 says that a depressed mood after severe adverse events, such as divorce or job loss, is common, and that a depressive episode is distinguished from it by the severity, range and duration of symptoms. It adds that if the criteria are met, a depressive episode is still present even if an event seems to have triggered it (WHO, 2024).

Grief after the death of someone close can also resemble depression. The American Psychiatric Association points to two differences. In grief, painful feelings come in waves, often mixed with positive memories of the person who died; in depression, mood and thoughts are almost constantly negative. In grief, self-esteem is usually preserved; in depression, corrosive feelings of worthlessness and self-loathing are common (APA, 2013). Most bereaved people feel intense sadness, but only a minority meet the criteria for major depression (Zisook & Shear, 2009).

So even after a death, feelings of worthlessness, thoughts of suicide that are different from wanting to join the person who died, and a general decline in functioning call for a look at depression as well (APA, 2013). ICD-11 likewise says that constant depressive symptoms for a month or more after the loss, with no periods of positive mood, suggest a depressive episode on top of grief (WHO, 2024). If thoughts of death, including wanting to be with the person who died, keep coming or feel hard to bear, do not carry them alone; the crisis lines are in the questions at the end.

Korea’s 2021 National Mental Health Survey interviewed 5,511 adults aged 18 to 79 face to face with a diagnostic interview (CIDI). The lifetime prevalence of major depressive disorder was 7.7% (5.7% of men, 9.8% of women), and the 12-month prevalence of depressive disorders was 1.7% (1.1% of men, 2.4% of women) (Ministry of Health and Welfare, 2021). Worldwide, WHO estimates that 5.2% of adults have depression and that about 322 million people live with it (WHO, 2026). WHO’s figure is a modelled estimate from the Global Burden of Disease study, while Korea’s comes from diagnostic interviews, so the two cannot be compared directly. How Korean adults score on the PHQ-9 questionnaire is covered in our guide average PHQ-9 score.

Most do not get help. In the same survey, among people who had a depressive disorder in the past year, 28.2% had used mental health services that year, which means roughly seven in ten had not seen a professional. The survey took place during the COVID-19 pandemic, though, and this figure rests on a small number of people, so read it as a rough guide (Ministry of Health and Welfare, 2021; National Center for Mental Health, 2023). WHO notes that even in high-income countries only about one in three people with depression receive treatment (WHO, 2026).

Treatment works. A network meta-analysis of 522 randomised trials of short-term treatment for major depression in adults (116,477 participants) found that all 21 antidepressants studied were more effective than placebo, with mostly modest effect sizes (Cipriani et al., 2018). An analysis of 331 trials of psychotherapy for adult depression (34,285 patients) found that all the main psychotherapies, including cognitive behavioural and interpersonal therapy, worked better than usual care or a waitlist, with few differences between them (Cuijpers et al., 2021). Even people with only a few symptoms may benefit from treatment (NIMH, 2024).

The mind.io depression check-in (PHQ-9) turns the nine symptoms of the diagnostic criteria into nine items: for each, you rate from 0 to 3 how often it bothered you over the last two weeks, for a total from 0 to 27 (Kroenke et al., 2001). A total of 0 to 4 reads as “Minimal depression symptoms”, 5 to 9 as “Mild depression symptoms”, 10 to 14 as “Moderate depression symptoms”, 15 to 19 as “Moderately severe depression symptoms” and 20 to 27 as “Severe depression symptoms”.

In the original validation study, a mental health professional interviewed 580 US primary care patients by telephone, and against those interviews a score of 10 or more picked out major depression with 88% sensitivity and 88% specificity (Kroenke et al., 2001). That is why mind.io suggests talking with a professional when the total is 10 or more, or when item 9 (thoughts of death or of hurting yourself) is answered anything other than “Not at all”. Whatever your score, if you have thoughts of harming yourself, do not carry them alone: call or text 988 now in the US or Canada, call Samaritans on 116 123 in the UK or Ireland, or find a line at findahelpline.com elsewhere. A self-check is not a diagnosis; a diagnosis also rules out physical causes, normal bereavement and any history of mania (Kroenke et al., 2001). Even with a low score, if the changes described here have lasted two weeks or more and make daily life hard, talk to someone.

Q. What are the early signs of depression? A. There is no fixed set of early signs that everyone gets. Combinations of symptoms vary a lot from person to person (Fried & Nesse, 2015), and many people first see a doctor about physical complaints rather than mood (Simon et al., 1999). If such changes last two weeks or more, nearly every day, and get in the way of daily life, it is time to talk to someone. If it feels hard sooner than that, it is fine to reach out at any time.

Q. How is feeling down different from depression? A. Low mood after something hard is a common, natural reaction. Depression differs in that symptoms are more severe and more numerous, present nearly every day for at least two weeks, and clearly interfere with daily life (WHO, 2024).

Q. Can it be depression if I only have physical symptoms? A. It can. In the WHO primary care study, 11% of depressed patients denied psychological symptoms of depression even when asked directly (Simon et al., 1999). Some conditions, such as thyroid disorders, and some medicines cause similar symptoms, though, so get a medical check-up as well (NIMH, 2024).

Q. Can depression be treated? A. Yes, there are treatments with proven benefits. Antidepressants and the main psychotherapies have both shown benefits in randomised trials (Cipriani et al., 2018; Cuijpers et al., 2021). WHO recommends psychological treatment first, which can be combined with antidepressants in moderate and severe depression (WHO, 2026).

Q. I am having thoughts of ending my life. A. Please do not carry them alone. Reach out to a crisis line right away: call or text 988 in the US and Canada, call Samaritans on 116 123 in the UK and Ireland, or find a line at findahelpline.com elsewhere. If you are in immediate danger, contact your local emergency services.

References: World Health Organization (2026), Depressive disorder (depression) [Fact sheet], https://www.who.int/news-room/fact-sheets/detail/depression; World Health Organization (2024), Clinical descriptions and diagnostic requirements for ICD-11 mental, behavioural and neurodevelopmental disorders (CDDR), https://www.who.int/publications/i/item/9789240077263; National Institute of Mental Health (2024), Depression (NIH Publication No. 24-MH-8079), https://www.nimh.nih.gov/health/publications/depression; American Psychiatric Association (2013), Major depressive disorder and the “bereavement exclusion” [DSM-5 fact sheet], https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM-5-Depression-Bereavement-Exclusion.pdf; Uher, R., Payne, J. L., Pavlova, B., & Perlis, R. H. (2014), Major depressive disorder in DSM-5: Implications for clinical practice and research of changes from DSM-IV, Depression and Anxiety 31(6), 459-471, https://doi.org/10.1002/da.22217; Fried, E. I., & Nesse, R. M. (2015), Depression is not a consistent syndrome: An investigation of unique symptom patterns in the STAR*D study, Journal of Affective Disorders 172, 96-102, https://doi.org/10.1016/j.jad.2014.10.010; Fried, E. I., & Nesse, R. M. (2014), The impact of individual depressive symptoms on impairment of psychosocial functioning, PLoS ONE 9(2), e90311, https://doi.org/10.1371/journal.pone.0090311; Judd, L. L., Schettler, P. J., Coryell, W., Akiskal, H. S., & Fiedorowicz, J. G. (2013), Overt irritability/anger in unipolar major depressive episodes: Past and current characteristics and implications for long-term course, JAMA Psychiatry 70(11), 1171-1180, https://doi.org/10.1001/jamapsychiatry.2013.1957; Nutt, D., Wilson, S., & Paterson, L. (2008), Sleep disorders as core symptoms of depression, Dialogues in Clinical Neuroscience 10(3), 329-336, https://doi.org/10.31887/DCNS.2008.10.3/dnutt; Simon, G. E., VonKorff, M., Piccinelli, M., Fullerton, C., & Ormel, J. (1999), An international study of the relation between somatic symptoms and depression, The New England Journal of Medicine 341(18), 1329-1335, https://doi.org/10.1056/NEJM199910283411801; Rock, P. L., Roiser, J. P., Riedel, W. J., & Blackwell, A. D. (2014), Cognitive impairment in depression: A systematic review and meta-analysis, Psychological Medicine 44(10), 2029-2040, https://doi.org/10.1017/S0033291713002535; Conradi, H. J., Ormel, J., & de Jonge, P. (2011), Presence of individual (residual) symptoms during depressive episodes and periods of remission: A 3-year prospective study, Psychological Medicine 41(6), 1165-1174, https://doi.org/10.1017/S0033291710001911; Jeon, H. J., Walker, R. S., Inamori, A., Hong, J. P., Cho, M. J., Baer, L., Clain, A., Fava, M., & Mischoulon, D. (2014), Differences in depressive symptoms between Korean and American outpatients with major depressive disorder, International Clinical Psychopharmacology 29(3), 150-156, https://doi.org/10.1097/YIC.0000000000000019; Chang, S. M., Hahm, B. J., Lee, J. Y., Shin, M. S., Jeon, H. J., Hong, J. P., Lee, H. B., Lee, D. W., & Cho, M. J. (2008), Cross-national difference in the prevalence of depression caused by the diagnostic threshold, Journal of Affective Disorders 106(1-2), 159-167, https://doi.org/10.1016/j.jad.2007.07.023; Salk, R. H., Hyde, J. S., & Abramson, L. Y. (2017), Gender differences in depression in representative national samples: Meta-analyses of diagnoses and symptoms, Psychological Bulletin 143(8), 783-822, https://doi.org/10.1037/bul0000102; Cavanagh, A., Wilson, C. J., Kavanagh, D. J., & Caputi, P. (2017), Differences in the expression of symptoms in men versus women with depression: A systematic review and meta-analysis, Harvard Review of Psychiatry 25(1), 29-38, https://doi.org/10.1097/HRP.0000000000000128; Stringaris, A., Maughan, B., Copeland, W. S., Costello, E. J., & Angold, A. (2013), Irritable mood as a symptom of depression in youth: Prevalence, developmental, and clinical correlates in the Great Smoky Mountains Study, Journal of the American Academy of Child and Adolescent Psychiatry 52(8), 831-840, https://doi.org/10.1016/j.jaac.2013.05.017; Hegeman, J. M., Kok, R. M., van der Mast, R. C., & Giltay, E. J. (2012), Phenomenology of depression in older compared with younger adults: Meta-analysis, The British Journal of Psychiatry 200(4), 275-281, https://doi.org/10.1192/bjp.bp.111.095950; Zisook, S., & Shear, K. (2009), Grief and bereavement: What psychiatrists need to know, World Psychiatry 8(2), 67-74, https://doi.org/10.1002/j.2051-5545.2009.tb00217.x; Ministry of Health and Welfare (2021), Results of the 2021 National Mental Health Survey [press release, in Korean], https://www.mohw.go.kr/board.es?mid=a10503010100&bid=0027&act=view&list_no=369088; National Center for Mental Health (2023), 2021 National Mental Health Survey (adults): Statistics [in Korean], https://mhs.ncmh.go.kr/menu.es?mid=a10501040000 and https://mhs.ncmh.go.kr/menu.es?mid=a10501070000; Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001), The PHQ-9: Validity of a brief depression severity measure, Journal of General Internal Medicine 16(9), 606-613, https://doi.org/10.1046/j.1525-1497.2001.016009606.x; Cipriani, A., Furukawa, T. A., Salanti, G., Chaimani, A., Atkinson, L. Z., Ogawa, Y., et al. (2018), Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: A systematic review and network meta-analysis, The Lancet 391(10128), 1357-1366, https://doi.org/10.1016/S0140-6736(17)32802-7; Cuijpers, P., Quero, S., Noma, H., Ciharova, M., Miguel, C., Karyotaki, E., Cipriani, A., Cristea, I. A., & Furukawa, T. A. (2021), Psychotherapies for depression: A network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types, World Psychiatry 20(2), 283-293, https://doi.org/10.1002/wps.20860.