ORGANUM
A depressed mood and a loss of interest or pleasure are the key symptoms of depression; patients may feel blue, hopeless, in the dumps, or worthless. For the patient, a depressed mood often has a distinctive quality which can be differentiated, personally, from the normal emotion of grief or sadness.
It will often be described as an emotion of 'agonising emotional pain'. Alternatively, it may be described as a physical illness in which exhaustion and unmotivated are prominent.
Other patients may describe feeling 'little', unable to cry, and find it difficult to experience any pleasure (anhedonia).
The classic presentation of a depressed patient is a person with a stooped posture, decreased movement, and a downward averted gaze. In practice, there is a considerable range of behaviours ranging from persons with no observable signs of depression, to the catatonically depressed patient. Among observable signs of depression, generalised psychomotor retardation is most often described, in which patients show little spontaneous movement. At times it may be so severe as to be challenging to differentiate from catatonia. Psychomotor agitation my occur, including such behaviours as hand wringing and hair pulling. Many depressed patients have a decreased rate and volume of speech; they respond to questions with single words and exhibit delayed response to questions.
When present, observable symptoms are helpful in the diagnosis, although the lack of symptoms does not imply that a patient has no disorder. it is not abnormal, for example, to encounter patients who can maintain a measure of social appropriateness, even smiling and laughing when with others despite the internal feeling of depression.
The most typical somatic symptom of depressed are known as the neurovegetative symptoms, which include.a variety of physical symptoms. Almost all depressed patients (97%) complain about reduced energy - difficult finishing tasks, impaired at school/work, and lowered motivation. 80% of patients complain of trouble sleeping; especially early morning awakenings known as terminal insomnia and multiple awakenings at night (during which they ruminate about their problems). Many patients have decreased appetite and weight loss, but others experience increased appetite and weight gain and sleep longer than usual. These are sometimes referred to as reversed neurovegetative symptoms or atypical features.