Recognizing Depression: Signs, Symptoms, and When to Seek Help

Major Depressive Disorder (MDD), commonly referred to as depression, is a common and serious mental health condition characterized by persistent changes in mood, cognition, and physical functioning. According to the World Health Organization, depression is a leading cause of disability worldwide and affects an estimated 280 million people globally. In Nepal, prevalence studies suggest that depressive disorders affect a significant proportion of the population, though many cases remain undiagnosed due to stigma, limited mental health infrastructure, and the somatic presentation of symptoms that is common in South Asian contexts.

The core symptoms of MDD as defined by the DSM-5 include depressed mood most of the day, nearly every day, and markedly diminished interest or pleasure in all or almost all activities (anhedonia). These must be accompanied by at least five of the following additional symptoms: significant weight change or appetite disturbance, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue or loss of energy, feelings of worthlessness or excessive guilt, diminished ability to think or concentrate, and recurrent thoughts of death or suicidal ideation. At least five symptoms must be present during the same two-week period and represent a change from previous functioning. Importantly, one of the core symptoms — depressed mood or anhedonia — must be present.

Dr. Ruja Shrestha — consultant psychiatrist & cbt therapist at Kathmandu Neurology Clinic & Cognitive Center provides evidence-based evaluation for major depressive disorder.

Depression manifests differently across individuals. Some people experience profound sadness, tearfulness, and hopelessness, while others report feeling empty, numb, or unable to experience emotions at all. Cognitive symptoms can include difficulty making decisions, poor concentration, negative self-perception, and a pessimistic outlook on the future. Physical symptoms are common and often prominent — fatigue, changes in sleep and appetite, reduced motivation, and unexplained aches and pains. In many South Asian cultures, including Nepal, somatic complaints such as headaches, body pain, and digestive problems may be the primary way individuals express psychological distress, which can lead to underrecognition of the underlying depressive condition.

Persistent Depressive Disorder (Dysthymia) involves a chronic depressed mood occurring for most of the day, for more days than not, for at least two years. While symptoms may be less severe than MDD, the chronic nature of dysthymia can be equally impairing and is frequently complicated by episodes of major depression (double depression).

Seasonal Affective Disorder (SAD) is a pattern of depressive episodes that occurs seasonally, typically during autumn and winter months when daylight exposure is reduced. It is less commonly discussed in tropical and subtropical regions but does occur in Nepal, particularly in areas with shorter winter daylight hours.

Postpartum depression occurs after childbirth and involves depressive symptoms that go beyond the transient baby blues experienced by many new mothers. It can significantly impair maternal functioning and bonding with the infant and requires prompt attention.

In older adults, depression may present with prominent cognitive symptoms, sometimes referred to as pseudodementia, and may be mistaken for neurodegenerative disease. Screening for depression is important in elderly populations, particularly those with chronic medical conditions.

Risk factors for depression include a personal or family history of depression, significant life stressors (bereavement, divorce, job loss, financial difficulties), chronic medical conditions, substance use, social isolation, and adverse childhood experiences. The biopsychosocial model recognizes that depression arises from an interaction of genetic vulnerability, neurochemical changes, psychological factors, and social circumstances.

Treatment for depression is well-established. Evidence-based approaches include psychotherapy, pharmacotherapy, or a combination of both. Cognitive Behavioral Therapy and Interpersonal Therapy have the strongest evidence for psychotherapy. Antidepressant medications, particularly SSRIs, are commonly prescribed first-line pharmacotherapy. For treatment-resistant depression, options may include augmentation strategies, electroconvulsive therapy (ECT), and newer neuromodulation techniques. Regular physical activity has also demonstrated antidepressant effects and is recommended as an adjunct to formal treatment.

In Nepal, barriers to depression treatment include stigma, cost, limited access to mental health professionals, and cultural beliefs that may frame depression as a spiritual or character issue rather than a medical condition. Training primary care providers to recognize and manage depression, integrating mental health services into primary care, and community-based mental health programs are strategies that can help bridge the treatment gap.

If you or someone you know is experiencing symptoms of depression, reaching out to a healthcare provider is an important first step. Depression is treatable, and effective interventions can restore functioning and quality of life.

This article is educational and does not replace individual medical advice. If you are experiencing symptoms of depression, please consult a qualified healthcare professional.

**Frequently Asked Questions**

Q: How long does a depressive episode typically last? A: Without treatment, a major depressive episode can last several months or longer. With appropriate treatment, many individuals experience significant improvement within several weeks, though full recovery may take longer. Early intervention is associated with better outcomes.

Q: Is depression the same as feeling sad? A: Sadness is a normal human emotion that everyone experiences. Depression is a medical condition involving persistent changes in mood, cognition, and physical functioning that last at least two weeks and cause significant impairment. Depression may not always involve sadness — some individuals experience emptiness, numbness, or primarily physical symptoms.

Q: Can depression come back after treatment? A: Recurrence is a feature of depression for some individuals. Relapse prevention strategies — including continuation of medication as recommended, maintenance psychotherapy, lifestyle modifications, and early recognition of warning signs — can help reduce the risk of recurrence. Ongoing follow-up with a clinician is advisable for those with a history of recurrent episodes.