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The key feature of major depression is at least one extended period of very low mood, called a major depressive episode. The mood change usually takes the form of feeling sad. But depressed people may instead feel irritable. Or they may be unable to take any pleasure or interest in their usual activities (a state of mind called anhedonia).

Usually, in major depression, the change is distinct and severe and lasts at least two weeks.

People with major depression often have physical symptoms, too. Their appetite and weight may change, and they may have sleep problems. They may feel tired, with no energy for work or play. They may seem lethargic and sluggish or just the opposite -- unpleasantly agitated and restless. Depression can also affect the ability to concentrate.

These effects on sleep, appetite, and energy level are often called neurovegetative symptoms.

Depressed people may also develop unshakable feelings of worthlessness and guilt, either about specific things they have done or about everything and nothing. Sometimes they can't identify the source of their guilty feelings or the reason for feeling so undeserving.

This self-critical and guilty state of mind can be very painful and sometimes dangerous. It can lead to hopelessness, self-destructive behavior, thoughts of death, and suicide. Although the vast majority of people with major depression do not attempt suicide, this disorder is one of the most important causes of suicide.

Sometimes the thinking of people with major depression becomes so seriously distorted that they lose contact with reality, a condition called psychosis. It may take the form of delusions (false beliefs) or hallucinations (false perceptions).

Many people with major depression are anxious and worry unnecessarily about their physical health. They often have difficulties in relationships with family and friends or have problems at work. Their sex lives may be negatively affected, and they have a high risk of drug abuse and alcoholism.

Although there is no definite limit to the length of an episode of major depression, the average is four to eight months without treatment. Treatment usually shortens the episode, and even if it does not produce a full recovery, it can make the symptoms less severe.

Major depressive episodes may occur once or repeatedly. It is fairly common for depression to return again once you've had an episode.

Have you had more than one episode of depression?



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