Depression Defined
Depression is not having a “bad day,” a “bad attitude” or “normal sadness.” It is a pervasive depressed mood or lack of interest/pleasure for more than two weeks, plus one or more of the following symptoms:
- Impaired sleep
- Changes in appetite
- Decreased energy
- Poor concentration
- Guilty ruminations
- Psychomotor changes
- Thoughts of death/suicide

The blue man (depression) affects everybody—cutting across races, across cultures, across national boundaries. Depression affects people. It appears that it is much easier for people to come into a primary care setting and talk about physical symptoms—headache, fatigue, sleep problems, dizziness, chest pain, joint pain, stomach problems, menstrual problems.

It is a little bit more difficult to talk about depressed mood or anhedonia, which is the opposite of hedonism. Hedonism is the pursuit of pleasure; anhedonia is the inability to feel pleasure. That is a hallmark of depression. Hopelessness is associated with suicidality, and so these are the more psychological symptoms: low self-esteem, memory and concentration problems, anxiety, and a preoccupation with negative thoughts.